Bulimia

Summary

Bulimia nervosa is a serious eating disorder and mental health condition that can affect anyone, at any age or body size. It involves a cycle of binge eating and behaviours to compensate for eating, often because someone feels frightened about gaining weight or is experiencing intense concerns about their body shape or weight. Bulimia can have a significant impact on someone’s physical health, emotions, relationships and everyday life.

During a binge, someone may eat a large amount of food over a relatively short period and experience a sense of losing control over their eating. Afterwards, they may feel intense guilt, shame or anxiety about what they have eaten and try to compensate through behaviours such as making themselves sick, fasting, taking laxatives or other medication, or exercising excessively. This can create a difficult cycle that feels increasingly hard to break.

How might bulimia be experienced?

Someone experiencing bulimia might:

  • Eat a large amount of food over a short period of time and feel unable to control how much they are eating.
  • Experience a strong sense of loss of control during or after a binge.
  • Try to compensate for eating through behaviours such as making themselves sick, fasting, restricting food, taking laxatives or other medication, or exercising excessively.
  • Have an intense fear of gaining weight or strong concerns about their weight, body shape or appearance.
  • Think about food, eating, weight or their body a lot, including planning when they might binge or thinking about how to compensate afterwards.
  • Feel guilty, ashamed, anxious, irritable or depressed following a binge.
  • Become secretive about eating or try to hide their eating and compensatory behaviours from other people.
  • Avoid social situations involving food because they feel anxious about eating around other people.
  • Frequently check, criticise or feel dissatisfied with their body shape or weight.
  • Feel trapped in a cycle of restricting, binge eating and compensating, even when they want to change their eating habits.

Physical signs

Bulimia can have significant effects on the body, particularly when binge eating and compensatory behaviours happen regularly. Someone may experience:

  • Feeling very tired, weak or lacking in energy.
  • Dizziness or feeling faint.
  • Difficulty sleeping.
  • Bloating, stomach pain or other digestive problems.
  • A sore throat or irritation in the mouth from repeatedly being sick.
  • Damage to teeth, including sensitivity or erosion caused by stomach acid.
  • Swelling around the cheeks or jaw.
  • Changes to periods, including irregular periods or periods stopping.
  • Feeling dehydrated or experiencing changes in electrolytes, which can affect the heart and other parts of the body.
  • Feeling physically unwell following bingeing or compensatory behaviours.

Physical signs aren’t always obvious, and someone can experience bulimia without noticeable changes in their weight. Bulimia can affect people at any body size.

How might you notice it in someone you care about?

You might notice changes in their eating habits, behaviour or mood, such as:

  • Eating unusually large amounts of food over a short period of time.
  • Eating alone or in secret, or hiding food and food packaging.
  • Becoming secretive about what or when they have eaten.
  • Going to the bathroom frequently, particularly shortly after eating.
  • Exercising excessively or becoming very distressed if they cannot exercise.
  • Frequently dieting, fasting or restricting food.
  • Showing increased concern about their weight, body shape, calories or appearance.
  • Becoming more withdrawn, anxious, irritable or low in mood.
  • Avoiding social situations that involve eating.
  • Experiencing physical symptoms such as tiredness, dizziness, stomach problems or dental problems.

It is important to remember that you cannot tell if someone has bulimia by looking at them. Changes in weight are not always noticeable, and someone may work very hard to hide their eating disorder from the people around them.

The cycle of bulimia

Bulimia can sometimes develop into a cycle of restriction, binge eating and compensatory behaviours. For example, someone may restrict their food during the day because they are worried about gaining weight. This can leave them physically hungry and emotionally preoccupied with food, increasing the likelihood of a binge. Afterwards, they may feel guilty or frightened about what they have eaten and try to compensate by making themselves sick, fasting or exercising excessively. This can then lead back into further restriction and another binge.

This cycle is not a lack of willpower. Bulimia is a serious mental health condition, and the behaviours can become difficult to control even when someone knows they are harming them. Understanding the thoughts, emotions and behaviours that keep the cycle going is an important part of recovery.

How to help myself

If you’re experiencing bulimia, it can be really difficult to break the cycle of restricting, binge eating and compensating, particularly when you’re experiencing guilt or shame around food. Try to remember that these behaviours are not a sign that you lack willpower. Beating yourself up after a binge is unlikely to help, and the cycle can become stronger when you respond by punishing yourself or restricting food further.

Try to eat regularly throughout the day. Skipping meals, fasting or severely restricting what you eat can leave you physically hungry and may increase the likelihood of binge eating. Having regular meals and snacks can help make eating more predictable and reduce extreme hunger. If you have a binge, try to return to your usual eating pattern rather than skipping your next meal.

Try to avoid compensating for eating by making yourself sick, fasting, excessively exercising or using laxatives or other medication. These behaviours can be harmful to your physical health and can keep the binge–purge cycle going. If you are currently using these behaviours, it is important to speak to a healthcare professional rather than trying to stop everything suddenly without support.

It can help to notice what happens before and after a binge or purge. You might notice that certain situations, emotions, thoughts or physical feelings tend to make the urge stronger. This could include stress, loneliness, arguments, boredom, body-image worries or feeling overwhelmed. Keeping track of these patterns can help you identify what you need and find alternative ways of coping.

When you notice an urge to binge or compensate, create some space before acting on it. Try moving somewhere away from the bathroom or food, contacting someone you trust, listening to music, watching something familiar, going outside or using a grounding technique. You don’t have to make the urge disappear — even delaying a behaviour gives you an opportunity to choose something different.

Try to reduce the influence of diet culture and body-focused content. Social media, calorie tracking, restrictive diets and frequent weighing can sometimes reinforce fears around food and body image. Unfollowing accounts that make you feel guilty about eating or your body can help create a more supportive environment.

Most importantly, get professional support. Bulimia can cause serious physical health complications, even when someone’s weight appears healthy. A GP or eating disorder service can assess your physical health and help you access appropriate psychological and nutritional support. You don’t need to wait until your eating disorder becomes severe before asking for help.

How to help a loved one

If someone you care about is experiencing bulimia, try to approach them with understanding rather than judgement. They may feel a lot of shame, guilt or fear about their eating and may work hard to hide their behaviours. Let them know that you care about them as a person rather than focusing on their weight, appearance or what they have eaten. Avoid comments about whether they look “healthy” or encouraging them to diet, as these can unintentionally reinforce their eating difficulties.

Create a supportive and non-judgemental environment around food. Try to avoid monitoring their meals, commenting on portion sizes or asking them to prove what they have or haven’t eaten. Eating together can provide routine and company, but keep conversations focused on things other than calories, weight or dieting. If they experience a binge, avoid criticism or encouraging them to compensate afterwards. Supporting them to return to their usual eating routine can be more helpful.

It can also be useful to learn about the binge–purge cycle. Restricting food can increase physical hunger and make binge eating more likely, while purging or other compensatory behaviours can keep the cycle going. Understanding this can help you respond with compassion rather than seeing the behaviours as a choice or a lack of self-control.

Encourage professional support and offer practical help with accessing it. You could encourage them to speak to a GP or eating disorder service, help them arrange an appointment, go with them or help them explain what has been happening. If they are already receiving treatment, support them to engage with it without taking over their recovery.

Be aware of physical warning signs that may need medical attention. Repeated vomiting, laxative misuse and other compensatory behaviours can cause dehydration and changes in the body’s electrolytes, which can become serious. If they are fainting, experiencing severe weakness, confusion, chest pain, an abnormal heartbeat or other worrying physical symptoms, seek urgent medical help.

Try to keep the relationship bigger than the eating disorder. Spend time together doing things that have nothing to do with food, eating or their body. Continue inviting them to activities and checking in, even if they sometimes withdraw. Recovery can take time, and setbacks do not mean that treatment isn’t working.

Finally, look after yourself too. Supporting someone with an eating disorder can be emotionally exhausting, and you don’t have to manage their recovery alone. Seek advice from a healthcare professional or eating disorder support service if you’re worried, even if your loved one isn’t ready to seek help themselves.

Myth Buster

Myth: “Bulimia is all about food and weight.”

Truth: Bulimia can involve worries about weight and body shape, but it is about much more than food or a number on the scales. Bingeing and purging can be connected to distress, low self-esteem, shame, difficult relationships or social situations, and attempts to manage overwhelming emotions. Reaching a particular weight does not make these underlying difficulties disappear. In fact, someone may continue to feel dissatisfied with their body or keep setting a lower target weight. Focusing only on weight can therefore miss the wider reasons why someone is struggling.

Myth: “Only girls and young women get bulimia.”

Truth: Although bulimia nervosa is often associated with girls and young women, people of any gender and age can experience it. Social media and popular representations of eating disorders can make it seem as though they only affect young women, but this does not reflect the full picture. Boys, men and older women can also experience bulimia and may be less likely to recognise their experiences as an eating disorder or seek support. Anyone experiencing symptoms of bulimia deserves to be taken seriously and supported.

Myth: “Bulimia is less serious than anorexia.”

Truth: Both bulimia and anorexia are serious eating disorders that can have significant effects on someone’s physical and mental health. It is unhelpful to compare which eating disorder is “worse”, as the risks and experiences can be different for each person. Bulimia can cause serious complications, particularly when someone is regularly vomiting, fasting or using laxatives or other compensatory behaviours. Someone does not need to be underweight or visibly unwell for their eating disorder to be serious. Both conditions deserve appropriate treatment and support.

Myth: “You would be able to tell if someone had bulimia by looking at them.”

Truth: You cannot tell whether someone has bulimia by looking at their body. People with bulimia can be any weight or body size, and their weight may not change noticeably. Someone can be experiencing serious physical and psychological effects while appearing completely well on the outside.

Myth: “People with bulimia choose to binge and purge.”

Truth: Bulimia is a serious mental health condition, and the cycle of bingeing and purging can become very difficult to control. Someone may desperately want to stop but feel overwhelmed by urges, anxiety or distress around food and their body. Shame and secrecy can make the cycle even harder to break. This is why support and treatment are important rather than blame or criticism.

Myth: “Making yourself sick gets rid of all the calories.”

Truth: Vomiting does not remove all of the food or energy consumed during a binge and cannot reliably prevent weight gain. Purging can also cause serious health problems, including dehydration, changes in electrolytes, damage to teeth and the throat, and problems with the heart. It is not a safe or effective way of controlling weight.

Myth: “If someone really wanted to recover, they would just stop purging.”

Truth: Recovery isn’t simply a matter of deciding to stop. Bulimia can involve powerful physical urges, difficult emotions and deeply held beliefs about food and body image. Someone may need professional support to understand what is keeping the cycle going and develop safer ways of coping. Recovery can take time, and setbacks don’t mean someone isn’t trying.

Myth: “Once someone starts treatment, they should recover quickly.”

Truth: Recovery from bulimia takes time and isn’t always a straight line. Someone may make progress and then experience setbacks, particularly during stressful periods. This doesn’t mean treatment has failed. With appropriate support, people can learn to break the binge–purge cycle and develop a healthier relationship with food and their body.

Therapy

Therapy for bulimia usually focuses on breaking the cycle of binge eating and purging, understanding what drives these behaviours, and developing healthier ways of managing difficult emotions. Treatment can also address body image, self-esteem and worries about food and weight. The approach will depend on someone’s age, symptoms and individual circumstances.

  • Cognitive Behavioural Therapy for Eating Disorders (CBT-ED) -Helps someone understand the thoughts, feelings and behaviours that maintain bulimia. It can focus on reducing strict food rules, establishing more regular eating patterns, challenging concerns about weight and shape, and breaking the binge–purge cycle.
  • Guided self-help -A structured programme based on CBT principles, supported by a trained professional. It can help someone understand their eating patterns, develop regular eating habits and learn strategies for managing urges to binge or purge.
  • Interpersonal Psychotherapy (IPT) – Explores how relationships and life events may contribute to binge eating and purging. It can support difficulties such as conflict, loneliness, bereavement, relationship changes and problems with communication.
  • Dialectical Behaviour Therapy (DBT) – Can be useful when bingeing or purging is linked to intense emotions or difficulties coping with distress. It teaches skills for emotional regulation, distress tolerance and managing difficult situations without relying on harmful behaviours.
  • Family-based therapy – Particularly useful for children and young people. It involves parents or carers in treatment and helps families support regular eating, reduce conflict around food and respond to eating disorder behaviours in a helpful way.
  • Body image work – Can help someone explore negative beliefs and worries about their body, weight and appearance. Therapy may focus on reducing body checking, comparison and behaviours that reinforce dissatisfaction with their body.
  • Nutritional support – A dietitian can work alongside psychological therapy to support regular, balanced eating and help someone understand how restriction can contribute to binge eating. They can also help monitor and address nutritional or physical health concerns.

Helplines

Beat 

Beat is a charity providing information, advice and support for people affected by eating disorders. They support people experiencing eating disorders and provide support for families, friends and carers.

England: 0808 801 0677
Scotland: 0808 801 0432
Wales: 0808 801 0433
Northern Ireland: 0808 801 0434
Opening times: 3pm–8pm, Monday–Friday
Website: www.beateatingdisorders.org.uk

Childline
Childline is a free service for young people to talk to a counsellor about anything. The service is available 24 hours a day, 7 days a week. Childline is available to anybody who is 18 years old or younger.

Phone: 0800 1111
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
You can also find helpful resources, speak to a counsellor online or send a message on their site.
Website: www.childline.org.uk

For adults concerned about a child, the NSPCC can be contacted 

NSPCC

NSPCC is a children’s charity that works to protect children and prevent abuse and neglect. They provide support and advice for adults about child abuse, neglect, child safety, online safety and children’s mental and emotional wellbeing. 

Phone: 0808 800 5000
Opening times: 10 am–4 pm, Monday–Friday
Email: help@nspcc.org.uk
Email opening times: 11 am–4 pm, 7 days a week
Website: www.nspcc.org.uk

YoungMinds

YoungMinds is a national charity supporting the mental health and wellbeing of children and young people. They provide information, advice and support for parents and carers who are concerned about a young person’s mental health, and help people understand mental health difficulties, find appropriate support and access useful resources. Their Parents Helpline can provide information, advice, emotional support and signposting to other services. 

Parent helpline: 0808 802 5544 (9:30 am – 4 pm on Mondays, Thursdays and Fridays, and from 9:30 am – 6 pm on Tuesdays and Wednesdays)
Email: parents@youngminds.org.uk
Webchat: https://www.youngminds.org.uk/parent/parents-helpline/

Shout

Shout is a free, confidential text messaging service that provides support to anyone who is struggling to cope. It can help with a wide range of issues, including stress, anxiety, low mood, loneliness, relationship difficulties, bullying, self-harm, suicidal thoughts, feeling overwhelmed and other mental health challenges.

Text: SHOUT to 85258
Opening times: Available 24 hours a day, 7 days a week, 365 days a year
Website: www.giveusashout.org

The Mix 

The Mix is a charity providing free information, advice and support for young people on all sorts of issues that can affect their lives and wellbeing. This includes mental health, relationships, money, housing, work and education, drugs and alcohol, bullying, social media, family difficulties and many other challenges. They offer information and practical advice to help young people understand what they are going through, make informed decisions and find further support when they need it. 

Phone: 0808 808 4994
Opening times: 11 am–11 pm, 7 days a week
Website: http://www.themix.org.uk
Crisis Messenger: Text THEMIX to 85258 – available 24 hours a day, 7 days a week.

Mind

Mind is a mental health charity providing information, advice and support for people experiencing mental health difficulties. They cover a wide range of mental health and wellbeing issues, including anxiety, depression, stress, relationships, loneliness, coping with difficult experiences and managing everyday life. Mind provides information to help people understand what they are experiencing, know their rights, find appropriate support and feel less alone.

Phone: 0300 123 3393
Opening times: 9am–6pm, Monday to Friday (excluding bank holidays)
Email: info@mind.org.uk
Website: www.mind.org.uk 

Samaritans

Samaritans is a charity providing emotional support to anyone who is struggling to cope or needs someone to talk to. They are there for people experiencing all sorts of difficulties, including stress, anxiety, loneliness, relationship or family problems, bereavement, feeling overwhelmed and concerns about mental health or suicide.

Phone: 116 123
Opening times: 24 hours a day, 7 days a week, 365 days a year
Website: www.samaritans.org

Anxiety UK

Anxiety UK is a charity providing information, advice and support for people experiencing anxiety, stress and other anxiety-related difficulties. They support people with issues including panic attacks, phobias, obsessive-compulsive disorder (OCD) and other anxiety disorders. 

Phone: 03444 775 774
Opening times: Available 24 hours a day, 7 days a week
Website: www.anxietyuk.org.uk