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Bulimia nervosa

Published by Bupa's health information team, June 2008.

This factsheet is for people who have bulimia nervosa, or who would like information about it.

Bulimia nervosa, often abbreviated to bulimia, is an eating disorder where you have an intense dread of putting on weight. Bulimia is most common in teenage girls and young women, although anyone can develop the illness at any age.

About bulimia nervosa

If you have bulimia you have cycles of eating too much in a short period of time - often in secret. This is called binge-eating or bingeing. Bingeing often involves rapid eating of high calorie foods, often thought of as treats (eg chocolate and cakes). This is followed by a feeling of shame due to overeating.

If you have bulimia you then find ways of ridding yourself of the food or of the calories you have consumed. This is called purging. This may be by vomiting, taking laxatives or diuretics (water tablets), excessive exercise, periods of fasting or a combination of these.

About four in 100 women have bulimia at some point in their lives. Bulimia most often develops in women in their late teens to early twenties. For every ten women with bulimia, about one man has the condition.

If you have bulimia you often remain within the normal weight range for your height. The other main eating disorder is anorexia nervosa, which is characterised by excessive weight loss. Some people with bulimia have had, or go on to develop, anorexia.

Symptoms

Bulimia is often not noticed until associated health problems have developed. However, if you have bulimia you may:

  • not eat with others or disappear to the toilet after meals to vomit the food you have eaten
  • have a binge-purge cycle at least twice a week for three months or more
  • have an intense dread of gaining weight
  • have frequent weight changes
  • be preoccupied with thoughts of food or cravings
  • secretly hoard away food
  • self-harm
  • be obsessed with exercise
  • have a distorted body image
  • become secretive and unwilling to socialise
  • find it hard to concentrate
  • feel depressed

Complications

Over time, bulimia can lead to various health problems. These can include:

  • tooth decay, discoloured teeth, gum disease and bad breath caused by stomach acid in the mouth from regular vomiting - also patches of rough skin on the knuckles or fingers if they are used to make you vomit
  • a puffy face over the jaw from swollen salivary glands (glands in the mouth which produce saliva to keep the mouth moist)
  • a sore throat
  • irregular periods or periods stop altogether
  • severe dehydration, which can cause weakness, fainting or kidney damage
  • inflammation of the stomach and oesophagus (the tube leading from the mouth to the stomach), caused by the acid in vomit
  • low blood pressure and palpitations (irregular heart beat)
  • constipation or diarrhoea and tummy pain
  • swollen hands and feet
  • dry skin and hair loss
  • difficulty sleeping and tiredness
  • damage to the bowel muscles caused by use of laxatives
  • damage to the heart

It's important that people with bulimia receive appropriate treatment. If untreated, there is a chance that they may die from related health problems, although this is rare.

Causes

The cause of bulimia isn't fully understood at present. It may develop due to a combination of emotional, physical and social reasons. The precise reasons for developing bulimia are probably different for each person.

Certain personality features are commonly associated with eating disorders, these include:

  • low self-esteem, where how you think about your body shape affects your self-worth
  • a loss of interest in other people
  • trying to be perfect
  • mood problems, especially depression
  • mental health problems such as obsessive compulsive disorder (where you can't stop thinking about or doing certain actions)

If you have these personality features, an eating disorder may give you a sense of control and achievement.

There are certain factors that make it more likely that you will develop bulimia.

  • Eating disorders are more common in white people in western societies and are rare in developing countries.
  • Some people believe that media images of thinness may influence the start of eating disorders.
  • If you have type 1 diabetes, you are more likely to develop bulimia.
  • If you have previously had anorexia, you have an increased risk of developing bulimia.
  • If you have tried to lose weight by dieting a number of times, you have an increased risk of developing bulimia.
  • A family history of eating disorders increases the risk of developing bulimia. This could be due to genetic factors or copying behaviour from other family members.
  • A specific emotionally upsetting event, such as divorce or abusive family relationships may cause bulimia to develop. Binge-eating may be a way to block out unhappy feelings.

Diagnosis

Getting help is very important. Admitting you have a problem is the first, yet hardest, step. If you take that step, you can find the support and treatment you need to stop bulimia taking over your life.

Your GP is the first point of contact for help. He or she will ask about your life and eating habits and will examine you to check for any physical problems resulting from bulimia.

He or she may refer you to a psychiatrist or psychologist who is trained in the treatment of eating disorders.

Treatment

Bulimia can be helped much more easily if the problem is identified and treated early. However, for treatment to be successful, you must be ready to get better.

Self-help

Bulimia can sometimes be treated with a self-help manual and occasional guidance from a therapist. This treatment allows you to develop skills that will help you manage your bulimia.

Keeping a diary of eating habits and learning about healthy eating and sensible weight control may be helpful.

Support groups may also be helpful. It's often comforting to talk to other people who have been through the same thing, and who can offer understanding and acceptance without blame or guilt.

Medicines

Your GP may prescribe medicines to treat depression, such as fluoxetine (eg Prozac), in the short term. Antidepressants have been shown to reduce bingeing and purging. However, there is no clear evidence that they can treat eating disorders long-term.

Other treatments

A type of talking therapy, or psychotherapy, called cognitive behavioural therapy (CBT) is frequently used. CBT allows you to talk through the issues that upset you and that may lie at the heart of your eating disorder. CBT can help you to learn healthier ways of thinking about food and rebuild your self-esteem.

Interpersonal therapy (IPT) is another talking therapy which allows you to discuss your relationships with other people. Rebuilding these relationships may stop you turning to food for emotional support.

Hospital treatment

Most people who have bulimia can be successfully treated without being admitted to hospital. But if the person has serious health problems that puts their life at risk, or if they are at risk of suicide or self-harm, they may need to be admitted to hospital.

Help and support

It can be upsetting to witness loved ones putting their health at risk and it's natural to want to help. But unwanted pressure or criticism from others usually makes matters worse.

Try to let the person make his or her own choices and let the person know that love and support are always there. Once the person has recognised the problem, offer to help with practical matters such as finding medical help and support groups. Support groups also provide advice and information for families and friends of people with eating disorders.

Recovering from bulimia

You can recover from bulimia, but it can be a long and difficult process. You may need to have psychotherapy for months or years, and you can have relapses in times of stress. You may find bulimia difficult to overcome, but with determination, patience and support it can be done.

Further information

Related topics

Sources

  • Eating disorders. NHS Library for Health. Clinical Knowledge Summaries. www.cks.library.nhs.uk, accessed 4 January 2008
  • Perkins SJ, Murphy R, Schmidt U, Williams C. Self-help and guided self-help for eating disorders. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No: CD004191.pub2
  • Eating disorders. The Royal College of Psychiatrists. www.rcpsych.ac.uk, accessed 4 January 2008
  • Eating disorders - core interventions in the treatment and management of anorexia nervosa, bulimia nervosa and related eating disorders. National Collaborating Centre for Mental Health, 2004. Clinical Guideline 9. www.nice.org.uk
  • What is bulimia nervosa? Beating Eating Disorders. www.b-eat.co.uk, accessed 4 January 2008
  • World Health Organisation (WHO). The ICD-10 Classification of Mental and Behavioural Disorders - Diagnostic criteria for research. Switzerland: WHO, 1993
  • Simon C, Everitt H, Birtwistle J, Stevenson B. Oxford Handbook of General Practice. Oxford, 2002
  • Eating disorders in the UK: policies for service development and training. Report from the Eating Disorders Special Interest Group of The Royal College of Psychiatrists. October 2000, Council Report CR87. www.rcpsych.ac.uk
  • Collier J, Longmore M, Scally P. Oxford Handbook of Clinical Specialities. 6th edition. Oxford, 2003

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr W H Simpson, MBBS, General Practitioner, and by Bupa doctors. It has also been reviewed by Beating Eating Disorders (beat). The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: June 2008

 

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