Bulimia is an eating disorder involving eating a large amount of food in a short time, followed by doing things to make up for the binge, such as vomiting, excessive exercise or misusing laxatives.
- Bulimia can affect people of any gender and at any age. It is most likely to develop during your late teens or early twenties, and it is more common among women.
- Binge eating involves eating a large amount of food in a short space of time, often feeling as though you are out of control, and also feeling shame and guilt.
- Behaviours to make up for the effects of binge eating can include vomiting, fasting, excessive exercise, misusing laxatives, diuretics and prescription medication, or illegal drug use.
- Bulimia can affect the long-term health of your teeth, digestive system, hormones, fertility, heart and kidney function.
- People with bulimia over-value the importance of their body weight or shape in determining their self-worth.
- If you get treatment from an eating disorder specialist, you have a very good chance of getting better, even if you have had this condition for a long time.
What causes bulimia?
Many factors contribute to developing bulimia, including genetic (inherited from your parents), environmental, psychological and cultural influences. Many people report that their bulimia began after dieting or restricting the amount and/or type of food they were eating. Other causes can include growth spurts, illness and intense athletic training.
Those at risk include people who:
- are dissatisfied with their body image
- have experienced stigma or bullying about their body weight
- have dieted and pushed their body weight below where it naturally sits
- restrict their food intake
- have a close relative with a history of an eating disorder
- have unhelpful skills for coping with negative thoughts and emotions
- are depressed, have issues with self-esteem and identity or are a perfectionist
- have experienced a trauma including childhood sexual abuse or neglect
- have had (or have) drug and alcohol problems.
A personal crisis can be the trigger for someone to start using bulimia as a way of coping with their feelings.
What are the symptoms of bulimia?
The main symptoms of bulimia are:
- binge eating (eating large amounts of food over a short period of time, which is different from overeating)
- compensatory behaviours – eg, vomiting, excessive exercise, laxative misuse, food restriction to get rid of the food or control your weight
- feeling your eating is out of control
- low self-esteem and excessive concern about body image, weight and shape
- focusing on or being secretive about food and eating.
You may be concerned about a friend or family members eating habits but it can be hard to tell whether they have bulimia. Some clues might be:
- a focus on their weight and body shape
- anxiety about certain foods or food groups
- limiting how much food they eat
- spending a lot of time in the bathroom after meals
- their weight going up and down
- saying things that show they have low self-esteem.
How is bulimia diagnosed?
Your doctor will ask questions to help find out whether you might have bulimia. They will check out how binge eating and the related behaviours have affected your physical health, which may include blood tests. They will help you find an eating disorders specialist, who can confirm the diagnosis and offer you treatment.
What is the treatment for bulimia?
The best treatment for bulimia is therapy with someone experienced in eating disorders who you like and trust. They can affirm your feelings, help you explore the causes of your bulimia and support you to get back to normal eating behaviours. Cognitive behaviour therapy (CBT) is the leading treatment for bulimia. It may also be helpful to seek support from a registered dietitian who is experienced in the treatment of bulimia.
Self-help for bulimia
- Get help early, as this makes recovery much easier.
- Educate yourself through self-help books and online forums.
- Tell your family and friends – they can help.
- Avoid dieting and trying to lose weight.
Where can I find support?
Talk to your doctor, who if you need it, can refer you to the eating disorders service in your area, or they can help you get therapy from an eating disorders specialist. You can also contact the Eating Disorders Association (EDANZ) to find out about local self-help groups on 0800 2 EDANZ, 09 5222679 or firstname.lastname@example.org.
Eating Disorders Association of New Zealand For information, resources and support
Bulimia nervosa Mental Health Foundation, NZ
Bulimia nervosa – fact sheet National Eating Disorder Collaboration
Overcoming disordered eating Centre for Clinical Interventions, Australia
Reach out and recover Interactive website
FEAST Families Empowered and Supporting Treatment of Eating Disorders
- Hay P, Chinn D, Forbes D, Madden S, Newton R, Surgenor, L, Touyz S, Ward W. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian and New Zealand Journal of Psychiatry 2014, 48(11) 1-62.
- Mehler P, Rylander M. Bulimia Nervosa – medical complications. Journal of Eating Disorders 2015 April 3; 3 (12).
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4;319(7223):1467-8.
|Dr Eve Hermansson-Webb works as a senior clinical psychologist and the coordinator of the adult treatment team at Tupu Ora Eating Disorder Service within the Auckland DHB. She co-facilitates a treatment group for bulimia nervosa, and has a specialist interest in treating negative body image and promoting Health At Every Size.|
|Sylvia Pyatt works as a specialist dietitian at the Tupu Ora Eating Disorder Service within the Auckland DHB. She works with both adults and adolescents. She co-facilitates a treatment group for bulimia nervosa. Sylvia has a special interest in a non-diet approach to nutrition.|