What is Bulimia Nervosa?

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Bulimia Nervosa is characterised by recurrent episodes of binge eating and subsequent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications; fasting, or excessive exercise.

  • Weight loss or unusual fluctuations in weight;
  • Alternating restricted and binge pattern of eating; Large amounts of food disappearing from cupboards;
  • Use of bathroom immediately after meals;
  • Preoccupation with food.
  • Largely similar to Anorexia Nervosa
  • Low mood; Low energy;
  • Decreased concentration;
  • Decreased ability to perform to potential in work and life environment;
  • Loss of confidence;
  • Loss of enjoyment of activities;
  • Menstrual cycle disturbance and potential infertility; Increasing social isolation and avoidance of friends.

Physical effects include:

  • Increased risk of osteoporosis;
  • Repeated vomiting can lead to a number of complications. Oesophagitis which is an inflammation of the oesophagus may occur and causes symptoms of heartburn and chest pains. If the vomiting is severe, persistent tears can develop in the wall of the oesophagus leading to bleeding which may be life threatening. Severe vomiting can also result in electrolyte imbalances such as low potassium levels. Electrolyte imbalances can lead to cardiac problems such as abnormal heart rhythms;
  • Calluses may occur on the back of the hands from rubbing on the teeth to induce vomiting;
  • Inflammation of the pancreas leading to abdominal pain may occur The salivary glands can become enlarged and painful;
  • Acid from the stomach may wear away the enamel of the teeth leading to tooth decay and gum disease.

The overall prognosis for someone with Bulimia is better than for Anorexia Nervosa. Approximately one third of people with Bulimia will remain continuously ill. Relapses are extremely common and occur in approximately 60% of people with Bulimia. Depression very frequently co-occurs.

Bulimia Nervosa is more common than Anorexia Nervosa. About 30% of people with Bulimia will have had Anorexia Nervosa. Frequently, people with Bulimia describe a long history of dietary problems. The peak age of onset tends to be later than for Anorexia Nervosa, occurring in late adolescence and early twenties.

As with Anorexia Nervosa, the causes of Bulimia are multi-factorial and similar to those mentioned above.

  • Biological
    Genetic studies have revealed that there is a genetic contribution to Bulimia Nervosa. Chemical transmitters in the brain such as serotonin and dopamine have also been studied and have been found to be lower than the levels found in people without Bulimia.
  • Psychological
    People with Bulimia have been found to show high rates of Depression and alcohol misuse. They also commonly describe feelings of impulsivity and low self-esteem. Occasionally, there is a history of sexual abuse.
  • Familial
    Families of people with Bulimia have been noticed to demonstrate high levels of other mental health difficulties, particularly Depression.

The effects of bulimia are less apparent than the effects of anorexia. A person with bulimia can maintain a normal weight for their height and they may outwardly give the impression of coping well with life’s challenges. They may put off seeking help and support because they are frightened of the reaction they might get if they disclose what they are doing. Shame and the fear of rejection become powerful barriers to change. Being able to come out of isolation may take time. Recovery can only begin when a person is ready to change. Change can be made easier for a person if those around them inform themselves about bulimia and about how they can offer support and show understanding.

As with Anorexia Nervosa, the treatment of Bulimia involves many different therapeutic approaches. Most people with Bulimia can be treated as outpatients. Helping the person to understand the importance of healthy eating with a regular diet is a cornerstone of treatment.

  1. Cognitive Behavioural Therapy can be very helpful in enabling the person to challenge distorted beliefs about food and diet. Overvalued ideas about body shape and weight can be replaced with more realistic and helpful thinking. The person can be helped to understand more about the emotional cues that trigger bingeing and restricting patterns of eating. This awareness can facilitate changes in the person’s relationship to food by generating alternative, healthier responses to situations that would previously have triggered a binge or purge.
  2. Interpersonal Therapy (IPT) may be very helpful in older adolescents where there are often difficulties with relationships.
  3. Medication: Antidepressants such as Fluoxetine can be helpful in the short term both for comorbid depression and reducing binges.

The HSE has a National Clinical programme for Eating Disorders (NCP-ED) in collaboration with the College of Psychiatrists of Ireland and BodyWhys, the national support group for people with eating disorders.

For information on the HSE’s Eating Disorder Self Help app and a link to download, click here.

For more information on the clinical programme, click here.