Bulimia nervosa

Written by Katherine Nicholls
Katherine Nicholls
Nutritionist Resource Content Team

Last updated 23rd November 2022 | Next update due 22nd November 2025

Bulimia nervosa is an eating disorder characterised by a repetitive cycle of binge eating and purging. Here we’ll look at how bulimia can affect you and how a nutrition professional can help.

What is bulimia?

Bulimia is a mental health condition and a type of eating disorder. Those with bulimia will binge eat and then purge (or ‘get rid’) of the food eaten. Bingeing is the part of the cycle when someone eats a lot of food in one sitting and may feel out of control while eating.

After a binge, those with bulimia will often feel guilty about what they’ve done and will purge to try to counteract the eating. Purging is the part of the cycle when someone will attempt to avoid weight gain by ridding the digestive system of the consumed food. The most common methods used to get rid of digested food include:

  • forcedly vomiting
  • excessively exercising
  • taking laxatives and diuretics

People with bulimia tend to feel anxious about their weight and body image. It is widely understood that bulimia, like other eating disorders, stems from underlying emotional distress such as low self-esteem, low confidence, depression, stress and anxiety.  

Getting support early, both mentally and physically, can really improve chances of recovery.

Nutritionists who can help with bulimia

Signs and symptoms of bulimia

People with bulimia may fear gaining weight, and often have a distorted perception of what their bodies really look like. They may feel a need to control their bodies, and bulimia can feel like a way to do this.

If you are worried someone may have bulimia, here are some signs you might notice:

  • they are secretive about what they eat (or lie about what they eat)
  • they often visit the toilet after mealtimes
  • they talk about being unhappy with their weight/body
  • they are over-exercising
  • they are storing and/or hiding food
  • they are buying laxatives or other similar medication they don’t need

If you recognise these signs in someone, it can help to speak to them about it and to see if they would consider getting help. 

If you are worried you have bulimia yourself, you may recognise these symptoms:

  • eating a large quantity of food in a short amount of time
  • feeling the need to ‘get rid’ of the food eaten
  • making yourself sick after eating
  • exercising to ‘make up’ for what you’ve eaten
  • using laxatives or diuretics to get food out of your system
  • talking to yourself negatively and having low self-esteem
  • feeling anxious around food and eating in front of others

If you recognise these symptoms, getting help early can help you break the binge-purge cycle and rebuild your relationship with food and yourself. Visiting your GP is a great first step, so they can diagnose you and put a treatment plan together. 

What causes bulimia?

Eating disorders are complex mental illnesses, and there is rarely one reason why someone develops bulimia. It is often a combination of causes and factors, which may include the following:

  • Low self-esteem – Sometimes eating disorders can be caused by feelings of inadequacy. Some people feel that if they lose weight, they will be accepted and liked by others. For them, losing weight is a way of gaining self-worth.
  • Depression – People who feel sad or unhappy on a regular basis may find that binge eating distracts or momentarily comforts them. Straight after eating the feelings can return, often accompanied by additional guilt. This precedes the purging stage of the cycle.
  • Stress – Bulimia can be triggered by stressful or traumatic life events such as an abusive childhood, rape, witnessing a crime or losing a loved one. Trauma can often make us feel like we’re out of control of our lives. This feeling of helplessness can lead to other emotional states, such as anxiety or stress. Those with bulimia may find that binge eating provides temporary emotional comfort during times of stress.
  • Anger – People who have problems expressing intense emotions, such as anger, might channel them through compulsive habits like binge-eating and purging.

Whatever it was that triggered your eating disorder, know that help is available and you don’t have to live your life like this. 

I felt I had to keep it together, somehow, so I started using bulimia as a coping mechanism.

- Read Helena’s story

Bulimia treatment

There are a number of different treatments available to help those with bulimia. Everyone is different, so your doctor will work with you to identify what the best approach would be for you. Often psychological treatment is the first port of call.

Psychological treatment can include:

  • Cognitive behavioural therapy for bulimia (CB-BN) - This therapy explores the relationships between patterns of thinking and patterns of behaviour. It aims to examine emotions in detail in order to devise new ways of tackling difficult situations without resorting to bingeing/purging.
  • Interpersonal therapy (IPT) - This form of therapy aims to tackle problems relating to personal relationships with the idea of reducing the need to comfort eat. Patients are more likely to be referred to this form of treatment if they have recently suffered the loss of loved ones or experienced a big change in their lives.

Alongside psychological support, you may need help with your physical recovery. Bulimia can have damaging effects on your body, so doctors may need to help you get healthy again. Part of this may also involve nutrition support, helping you form a more positive relationship with food and changing your eating habits. 

How can a nutritionist help with bulimia?

A nutrition professional can offer a branch of support during recovery. They can teach you about the nutritional benefits of certain foods and help you create an eating plan that supports recovery and encourages healthy habits. Exploring new foods, trying new recipes and spending time preparing meals can also help you develop a positive relationship with food.

A nutrition professional can also help you tune into your body more, helping you recognise your hunger cues and what will satisfy them, which can help you avoid binges. Any nutrition support around eating disorders should not focus on weight, but instead on helping you get healthy and improving your relationship with food. 

Further reading

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