Bulimia Nervosa

In 2018, statistics revealed that 7.8% of the global population is affected by an eating disorder with the median age being 18 years for Bulimia Nervosa (BN) (SingleCare). While prevalent in adolescents and young adults, Bulimia is also noted in women of 50 years of age. It is characterized by an uncontrolled consumption or binging, of a large amount of food (then what would be typically eaten in a single setting) (Abnormal Psychology Fifth Edition). What is also associated with Bulimia Nervosa is the need to compensate for binging and gaining weight by purging or using other techniques to get rid of the excess calorie intake.

If you are affected by Bulimia or you know someone who is struggling with this eating disorder, we take a closer look at the signs of Bulimia and treatment options for long-term recovery and support.

Facts and Statistics

In a 2000 to 2009 UK study concerning the number of men and women aged 18 to 49 years with an eating disorder, the greatest incidence for Bulimia Nervosa was found in girls between 15 to 19 years old in 2009 (BMJ Open). BN incidence rates for the same period were found to increase in the age group 20 to 29 years for both men and women.
If we look at hospital admissions for Bulimia Nervosa in England alone, over 1110 men and women aged 30 to 34 years were hospitalised for BN by 2020, followed by the age group 20 to 29 years involving 1106 people (Statista).>
There is no doubt that Bulimia Nervosa affects thousands of people in the UK each year. Along with the psychosocial impact BN causes, the medical consequences of continuous vomiting can cause electrolyte imbalances, abnormal heart rate, kidney failure, and even seizures leading to hospitalisation and the risk of fatality (Abnormal Psychology). To overcome the challenges of Bulimia Nervosa, it is important that professional treatment and support are sought.

What Causes Bulimia to Develop?

Research concerning the causes of eating disorders is ongoing and no different when it comes to Bulimia Nervosa. Clinicians and researchers have considered the following factors as placing individuals at a higher risk of developing Bulimia (NHS)

  • There is a family history of substance addiction (drugs and alcohol) and/or eating disorders.
  • Criticism concerning your body shape, size, and overall weight.
  • A preoccupation with weight loss or being slim could also stem from peer pressure, society, and the media, or professional industries.
  • Anxiety, depression, and OCD increase the risk of developing BN.
  • You have low self-esteem and negative thoughts.
  • You have experienced sexual abuse or assault.

Bulimia is best described as a constant cycle of binging, purging that is triggered by guilt, shame, frustration, and hunger. Individuals affected by BN are plagued by the need to eliminate the excess calories consumed by binging and often go to extreme lengths to exercise, vomit, or use diuretics to reduce their weight. Again, this leads to extreme hunger sensations and uncontrollable eating which starts the cycle all over again.

Bulimia Nervosa can be a difficult disorder to manage, if not life-threatening. Understanding the signs and how to find help are the best steps you can take to regain control of your life or to help someone else.

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What are the Signs and Symptoms of Bulimia?

The signs of Bulimia Nervosa are as follows:

  • A constant focus or obsession with body weight and shape.
  • Anxiety surrounding weight gain.
  • Eating a large amount of food in one sitting (binging) is uncontrolled and usually includes junk food rather than fruits and vegetables.
  • Purging or vomiting after binge eating for fear of gaining weight.
  • The use of diuretics and laxatives to prevent possible weight gain.
  • Consuming supplements and herbs to prevent weight gain.
  • Restricting the amount of food eaten or controlling calories in between binges.

When meeting with a psychologist or doctor, the extent of Bulimia symptoms will be determined by the frequency of binging and purging each week (Mayo Clinic). It is necessary to see a professional if you are affected by the cycle of Bulimia.

How does Bulimia Affect the Body and Mental Health?

The Medical Consequences of Bulimia Nervosa (Abnormal Psychology)

  • Individuals who suffer from chronic Bulimia will experience many medical issues that could become life-threatening.
  • Constant vomiting is known to erode the enamel of your teeth causing darkening, stains, and tooth weakness.
  • Owing to a loss of fluids and nutrients during purging, the body suffers imbalances in electrolytes that can also damage the kidneys and eventually lead to renal failure, abnormal heartbeats, and seizures
  • People who use laxatives or diuretics without cause can damage the colon.
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    Bulimia and Mental Health

    Most patients who present with BN symptoms have accompanying mood disorders including generalized anxiety, social anxiety, or obsessive-compulsive disorder (Abnormal Psychology). Although the rates of anxiety are higher in both men and women with Bulimia Nervosa.

    The previous theory suggested that Bulimia developed in response to a mood disorder such as depression, but more recent research shows that most individuals develop depression after the presentation of the eating disorder. There is also a higher incidence of substance addiction in people who are diagnosed with Bulimia and Anorexia.

    It seems that Bulimia is intertwined with mood, anxiety, and substance disorders that create emotional instability and difficult psychosocial functioning.

    Diagnosing Bulimia

    The DSM-5 lists the following diagnostic criteria for Bulimia Nervosa (NEDA):

    • Continuous episodes of binge eating include: Eating a significantly large portion of food that would ordinarily be eaten within a 2 hour period.
    • A lack of self-control while binge eating.
    • Consistent behaviours that compensate for weight gain and binge eating including purging (vomiting), the excessive use of diuretics or laxatives at least twice a week for 3 months.
    • Preoccupation and self-criticism concerning body weight, shape, and size that excludes episodes of anorexia nervosa.

    There are also different types of Bulimia such as:

    Purging type:

    During an episode of Bulimia Nervosa, the individual self-includes vomiting or uses laxatives, diuretics, and enemas to prevent weight gain.

    Non-purging type:

    Individuals perform an excessive amount of exercise and fasting along with binge eating but have not purges or unnecessarily used laxatives and diuretics (Abnormal Psychology).

    Treatment and Long Term Recovery from Bulimia

    woman on a weighing scale

    Finding support for Bulimia can help you in your long term recovery from the disorder. If you believe that you have Bulimia Nervosa or someone close to you does, it is important to reach out to a therapist to receive the appropriate treatment.

    Bulimia Nervosa treatment focuses on improving self-esteem and encouraging individuals to learn new behaviours by disrupting the binge and purge cycle. Nutritional therapy, individualised psychotherapy, and residential inpatient treatment are part of a recovery programme (Very Well Mind).

    Both inpatient and outpatient programmes are available for treatment. In an outpatient programme, patients will meet with their therapist once or twice a week to learn new ways of coping and developing a healthy self-image or body perception. The therapeutic approaches that are included in BN treatment are:

    •         Cognitive Therapy
    •         Dialectical Behavioural Therapy
    •         Family-Based Treatment

    For those who have suffered from the symptoms of Bulimia for a long time, residential rehab is recommended. Inpatient treatment assists individuals who are struggling with the health implication of binging, purging, or engaging in compensatory behaviour that risks their overall well-being. Psychotherapy is also included in residential therapy to help individuals identify and manage the psychological conditions, such as anxiety, associated with the disorder.

    Inpatient programmes are suitable for patients with suicidal thoughts or attempts. For those considering or engaging in self-harm, it is important that associated mental conditions are addressed before one can move on to recover. Individuals will be placed in a safe and monitored environment with 24-hour supervision.

    Jason Sheirs
    Author / Jason Shiers / Dip. Psych MBACP
    Jason Shiers is a Certified Transformative Coach & Certified Psychotherapist who is a specialist in addiction, trauma and eating disorders. He has been working in the field of addiction for 25 years now.