Bulimia nervosa is an eating disorder in which a person repeatedly eats a large amount of food in a short time, feels out of control while doing so, then acts to compensate for it. Most people with bulimia nervosa are not underweight, which is the main reason it goes unrecognised.
Key points
- Bulimia nervosa is an eating disorder in which binge eating is followed by behaviour meant to compensate for it.
- Most people with bulimia nervosa are not underweight. This is the main reason it goes unrecognised.
- Restriction drives bingeing, bingeing drives shame and compensation, compensation drives more restriction. Treatment targets that cycle.
- NICE recommends guided self-help first for adults, eating-disorder-focused CBT if that fails, and family therapy for young people.
- Dental erosion is one of the signs NICE tells professionals to look for where purging is repeated.
Symptoms
- Eating much more than usual in a short time, with a sense of being unable to stop; behaviours afterwards intended to undo the eating.
- Restricting food between episodes, avoiding eating with others; strong concern about shape and weight, fear of gaining it.
- Shame or harsh self-criticism after eating; tiredness, sore throat, changes to periods, tooth enamel damage where purging is repeated.
Causes and risk factors
- Extreme dietary restraint, which treatment must address; strong concerns about body shape and weight.
- Difficulty managing distress: bingeing in response to difficult feelings; other mental health conditions, particularly low mood and anxiety.
Treatment
- Adults: bulimia-nervosa-focused guided self-help first, then individual eating-disorder-focused CBT (CBT-ED), typically up to 20 sessions.
- Children and young people: bulimia-nervosa-focused family therapy (FT-BN), typically 18 to 20 sessions over six months.
- Regular dental and medical reviews are recommended for people who purge.
When to speak to a professional
- You think you might have bulimia nervosa, or treatment is not helping.
- Seek urgent advice through NHS 111 or your GP if you feel physically unwell, faint or weak, or are worried about your heart.
If you need help now: Samaritans, call 116 123, free, 24/7. Shout, text SHOUT to 85258. NHS 111, then choose the mental health option. Call 999 if anyone is in immediate danger.