Bulimia nervosa is an eating disorder involving episodes of over-eating (bingeing) followed by behaviours used to compensate for this over-eating (purging). Purging behaviours most commonly used include extreme dieting, vomiting, excessive exercising or taking laxatives or diet pills. People with bulimia nervosa are not underweight – in fact their weight is usually within the healthy range. As with other eating disorders however, they experience high levels of body dissatisfaction and usually have a strong desire to lose weight.
Bulimia nervosa can sometimes be associated with depression, low self-esteem, binge-drinking and self-harm.
Eating disorders are often associated with extreme fears and anxiety about food or body image. For people with bulimia, what may have started with a desire to lose a bit of weight, can very quickly spiral into a highly distressing cycle of unhealthy eating behaviours. This is because people with bulimia tend to be using their eating habits and behaviours to cope with emotional distress, even if they don’t realise they are. Over time, dieting turns into an unhealthy or unrealistic fear of food, calories and weight gain.
People with bulimia nervosa tend to restrict their food intake. This results in periods of excessive eating and loss of control (bingeing). Bingeing is associated with extreme guilt or anxiety over weight gain which usually causes people with bulimia to try and get rid of the calories that they have consumed during a binge. Bingeing and purging is usually associated with a lot of guilt and shame, meaning that it can often be very hard for people with bulimia to open up about these behaviours.
People with bulimia often go to great lengths to hide their behaviour from family and friends and because bulimia is not associated with low weight, it can often remain a secret for many years before people decide to seek help.
Signs that someone may have bulimia or another eating disorder include:
Bingeing is triggered by both physiological factors (hunger) and emotional factors such as stress, depression or anxiety. Effective treatment for bulimia nervosa needs to target both the physiological and the emotional triggers as well as the underlying causes. Psychological or ‘talking’ therapy is the most common treatment for bulimia and is known to be the most effective way of breaking unhealthy eating cycles. Cognitive Behavioural Therapy is known to be the most effective treatment for bulimia nervosa and so is most commonly recommended by our clinicians.
CBT is the current leading treatment for bulimia nervosa (NICE Guidelines, 2004). CBT focuses on your thinking (cognitions), your behaviours (what you do in response to certain thoughts), and your emotions (how you feel in response to certain thoughts). People can often recognise patterns in their thinking (e.g. I am not good enough, people don’t like me, I need to be thinner to be successful). These thoughts result in familiar emotions and behaviours that often involve manipulation of food or eating. CBT helps individuals to recognise their unhelpful or negative thinking, see the patterns in their behaviours and develop healthy strategies and skills to challenge or cope with their unhelpful thoughts. CBT is a structured skills based therapy that is most suitable for people who want to be guided by their therapist to find new ways of coping.
Family Based Treatment is usually offered to younger people with bulimia nervosa. Involving the family in treatment of young people is known to increase the likelihood that an adolescent will recover quickly from their eating disorder. FBT has three specific phases. The first phase focuses on empowering the parents to assist in implementing a healthy eating plan that will reduce the likelihood of bingeing. The second phase focuses on gradually supporting the adolescent to take more control over their own eating. Additionally, relationships that exist between family members are explored in order to help the family negotiate new, more adaptive way of relating to each other. In the third phase the focus is on maintaining healthy adult or adolescent relationships between family members in which the eating disorder does not form the basis of the relationship.
DBT is an emotional skills based treatment that combines eastern approaches (Bhudist theory, Eastern psychological and spiritual philosophies) and western therapies, including aspects of CBT and dynamic therapy. DBT sees bingeing and purging as having developed as a way of coping with or surviving difficult emotions. DBT focuses on healthy ways of responding to emotions in the here and now. DBT is comprised of 4 modules: mindfulness, distress tolerance, emotional regulation and interpersonal effectiveness.
Beating Your Eating Disorder: A Cognitive-Behavioural Self-Help Guide for Adult Sufferers and their Carers
By Glenn Waller, Victoria Mountford, Rachel Lawson, Emma Gray, Helen Cordery, Hendrik Hinrichsen
Bulimia, Binge-Eating and their Treatment
By Professor J Hubert Lacey, Dr Bryony Bamford, Amy Brown
Anorexia and Bulimia in the Family
By Grainne Smith