Bulimia: what can be done?

What does bulimia actually do to the body, and how can you overcome this eating disorder? Learn more about bulimia nervosa: its diagnosis, causes and possible symptoms such as binge-eating.

22.02.2024 Imke Schmitz 5 minutes

Bulimia: Definition

What is bulimia? Bulimia – more formally bulimia nervosa – is an eating disorder. It is a complex mental health condition associated with self-esteem issues. Bulimia is characterised by a cycle of binging followed by actions of various kinds to avoid weight gain. 

Bulimia and other eating disorders: what are the differences?

People with bulimia tend to be of normal weight or overweight. That contrasts with anorexia sufferers, who usually become underweight with time. However, the central mechanism of both eating disorders is the same: a constant preoccupation with one’s own body weight and body shape.

The difference between bulimia and binge eating is that, although bulimia involves episodes of binging, someone who is “merely” a binge eater does not follow these with steps to avoid gaining weight.

What are the signs of bulimia?

Bulimia has various symptoms, but as sufferers normally try to hide the disorder, the signs are not always obvious. Whatever the form of bulimia, these are some of the most common symptoms: 

  • Binge eating: episodes of binge eating, in which sufferers consume large quantities of food in a short space of time, are characteristic of bulimia. They experience a loss of control during these binges, feeling unable to stop eating or control their intake.
  • Preoccupation with food: another symptom of bulimia nervosa is a fixation with food and nutrition. Sufferers don’t just plan their upcoming meals, but become obsessed by calories and nutritional values.
  • Fixation on weight and body shape: an excessive focus on one’s own weight and body shape. Sufferers may have a distorted image of their own body (dysmorphophobia), perceiving themselves as overweight even if they are of normal weight or underweight.

People with symptoms of bulimia also repeatedly take excessive countermeasures to prevent weight gain:

  • Vomiting: self-induced vomiting after binges is one of the most common ways in which bulimia sufferers control their weight. This can result in a chronic sore throat and injuries to the palate.
    • Bulimia marks on the hand: sufferers can also cause small injuries to the back of the hand from inducing vomiting. These occur from the contact between the hand and the person’s own teeth while trying to trigger the gag reflex. 
  • Taking medication: some sufferers take drugs such as appetite suppressants, laxatives or diuretics in order to lose weight or mitigate the effects of binges. 

How often do bulimia sufferers throw up?

The frequency with which sufferers vomit is highly individual. However, it is regarded as characteristic of bulimia that sufferers take actions like this at least once a week over a period of three months. The same criteria apply to episodes of binge eating.

Bulimia in children and young people

Bulimia typically begins during puberty or early adulthood. However, bulimia can affect younger children too.

As a parent, you should therefore be alert to this possibility and take any warning signs seriously. You should also be aware that children can often go through phases with their eating. You might find that your child rejects foods they used to eat or consumes less than their peers. This is normal and nothing to worry about.

However, if you see that your child is regularly skipping meals or is showing other symptoms, then you should be vigilant – whatever their age. Speak to a doctor if you are at all unsure.

What causes bulimia?

The causes of bulimia are not clear-cut. There are personality, environmental and genetic factors in play, which together can increase the risk of developing this disorder.

  • Personality: worries about one’s weight, low self-esteem, depressive tendencies, social anxiety and over-anxiety in children are risk factors for bulimia.
  • Environment: the ideal of the perfect, slim body leads people to fixate more on their body weight, which in turn increases the risks of developing bulimia. People who suffered physical or sexual abuse in childhood are also at higher risk.
  • Genetics and physiology: childhood obesity in childhood and early onset of puberty increase the risk of bulimia. There can be a family history of bulimia and hence a genetic predisposition towards it, too.

How is bulimia diagnosed?

Eating disorders are normally diagnosed by a psychotherapist. The first step is to speak to your GP. They will make an assessment based on the information you provide and refer you to a specialist doctor or psychotherapist, who will carry out the diagnosis. They will also ask detailed questions about your mental state, as eating disorders often go hand in hand with other conditions such as anxiety.

How can you treat bulimia?

Bulimia is normally treated with psychotherapy, often in the form of behavioural therapy. The aim is to identify the root causes, develop healthy eating habits and promote a positive self-image.

Therapy is generally accompanied by physical rehabilitation overseen by a doctor. Approaches that work on patients’ perception of their bodies can also help. Examples include psychomotor therapy, occupational therapy, meditation, drama and music therapy, relaxation and mindfulness.

Bulimia: what are the chances of recovery?

Bulimia can be successfully treated in about 50% of cases. Other sufferers develop chronic bulimia or see only a small improvement in their condition. As a general rule, the earlier an eating disorder is diagnosed, the better the treatment prospects. Be aware that there may be setbacks along the way: overcoming bulimia takes patience. 

Bulimia in pregnancy

Navigating pregnancy with bulimia is particularly challenging. When you are living with bulimia, the weight gain that is normal in pregnancy can be very hard to deal with emotionally. There is the urge to counteract any weight gain. But despite these conflicting emotions, it is important to look after your own health and that of your unborn child. This period in your life requires close medical care and psychotherapeutic support.

What are the long-term effects of bulimia?

Bulimia can have various consequences for your body and mental state: 

  • Common physical consequences: bulimia often comes with physical side-effects, such as tooth damage caused by repeated vomiting. The acid from your stomach attacks your teeth, leaving them sensitive. Digestive problems are also common, as the cycle of repeated overeating and vomiting places a strain on the digestive system. Bulimia can lead to weight fluctuations, too. They can affect the body’s metabolism, disrupt hormone production and result in irregular periods or amenorrhea. Bulimia is further associated with calcium and potassium deficiencies, potentially leading to osteoporosis (brittle bone disease) or myocardial insufficiency.
  • Rare physical consequences: severe but less common consequences of bulimia include oesophageal tears, stomach perforations and cardiac arrhythmia. Regular consumption of syrup of ipecac to induce vomiting can also lead to severe cardiac and musculoskeletal problems. People who chronically abuse laxatives can become dependent on them to stimulate the movement of the bowel. Cases of rectal prolapse have additionally been reported.
  • Psychological consequences: one possible psychological consequence of bulimia is depression. Anxiety disorders can also result. In addition, sufferers tend to have persistently low self-esteem: they are battling with a distorted image of themselves and are constantly unhappy with their appearance.

As we’ve seen, the after-effects of bulimia are manifold. Just like the eating disorder itself, they require psychotherapeutic and medical care.

If you or your child are showing any signs of bulimia, you must speak to a doctor. They will take the necessary steps to begin treating this disorder.


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