Bulimia nervosa is a type of eating disorder that involves eating large quantities of food (known as bingeing) and then purging to 'get rid' of the food. Here we will look at bulimia in more detail, including signs to look out for, getting support and how to help someone you care about if they’re struggling with an eating problem.
What is bulimia?
Eating disorders affect the way you think about yourself and your approach to food. People with an eating disorder tend to use their eating habits to cope with underlying emotional distress, and there is often a great fear of gaining weight, eating high-calorie/fatty foods and losing control of what they eat.
For those with bulimia nervosa, that fear causes them to try and restrict what they're eating. This can then lead to binge eating, where large quantities of food are eaten in a short space of time. Feelings of shame, guilt and fear of gaining weight are common after a binge, leading to a desire to ‘undo’ the eating. This purging can take many forms, from over-exercising to forced vomiting.
The cycle of binging and purging is central to bulimia nervosa and for those caught up in it, it can feel as if they are trapped. Thoughts about food, body weight and image can become all-consuming.
These binge-purge cycles can be triggered by stress, hunger or even anxiety and sadness. Someone with bulimia may feel they have lost control over an aspect of their life, and aim to control their diet as a coping mechanism. This cycle can take over other aspects of their life and be difficult to break out of alone.
Bulimia can rapidly become an entrenched habit, with an addictive feel. Whilst binge eating triggers tend to be physiological initially, due to restrictive eating and extreme dieting, emotional triggers soon take hold, and it can feel a complex problem to dissect.
Signs and behaviours of bulimia to look out for
People with eating problems can feel ashamed or even embarrassed by their behaviours and tend to be very secretive about it. Because of this, and because they're worried about what getting help would involve, many don’t seek help early enough. Below we list some of the signs and behaviours to look out for. If you recognise them in yourself or in someone you know, please keep reading for more advice.
If you have an eating problem such as bulimia, you may experience the following:
- feeling that you're overweight/hating the appearance of your body
- feeling low or anxious
- obsessing over food (i.e. when/what to eat)
- worrying about gaining weight
- restricting what you eat to avoid gaining weight
- storing food and eating lots in one go
- feeling guilty/ashamed
- purging food you’ve eaten during a binge (vomiting, over-exercising, laxatives)
Your weight may fluctuate or stay roughly the same. Because your weight may seem ‘normal’ in the eyes of others, it can be hard for people to notice you need help.
We know that when you’re in the grips of an eating disorder, getting support can be a scary prospect. Fighting this fear and reaching out is an important step to help you free yourself from the cycle.
In this video, Harriet Frew, an experienced counsellor specialising in eating disorders and body image shares her experience of overcoming bulimia and explains how counselling can support you in recovery from an eating disorder.
Getting support for bulimia
As with most eating disorders, bulimia often develops because of an underlying issue. Understanding this and getting help to change unhelpful thoughts and behaviours is key to overcoming and recovering from an eating disorder.
Even if you’re not sure whether or not you have a problem, talking to someone about the way you feel can lighten your load. Getting help and support early on is really important. The longer you avoid it, the harder it will be to overcome. Recognising that you aren’t happy with the way things are is the first step.
Here are some ways you can get support:
- Talk to a friend or family member about the way you’re feeling.
- Speak to your GP.
- Consider talking with a counsellor.
- Approach an online support group or charity for advice - be sure to stay safe online and avoid sites that promote eating problems as these can make you feel worse.
What can help – bulimia treatment
The most important thing to realise if you have an eating problem is that it can be overcome. For many, reaching out and gaining support paves the way to recovery. Below are some examples of what can help if you’re suffering from bulimia.
Creating a support network
Going through any mental health problem alone is tough, but it needn’t be that way. Surround yourself with people who you trust and who you feel happy talking to. This can include friends, family, your doctor or even online support groups.
Having someone to talk to when you’re struggling is invaluable. It’s easy to become consumed with your thoughts and getting them out can be helpful. Try and create a network and don’t be shy about asking for help.
Psychological treatment is often required to help recover from and overcome eating disorders. There are many different talk therapies available, however, the most common ones used for eating problems like bulimia are:
Mindfulness and relaxation techniques
Because eating problems affect the way you think and can be linked to anxiety and depression, trying a technique that helps to calm and slow thoughts can be helpful. Mindfulness is a technique that encourages you to pay attention to the present moment.
Originating as a meditation technique, mindfulness can involve you paying attention to the way you feel physically and emotionally, or noticing your surroundings. For those with bulimia, being mindful when eating can help you to slow down, realise that you deserve food and eat it in a healthy way.
Recovery from an eating disorder can feel like a daunting prospect. You may feel scared that recovery means losing control over your body. The aim however is to help you take control and drive your own recovery.
With the guidance of your doctor or mental health professional, you can try taking some small steps to change your behaviours. For example, you could schedule in time to do something fun after eating so you don’t feel worried about purging.
While talking therapies should always be the initial treatment offered, your doctor may offer medication too. There are no drugs to help specifically with eating disorders, however, antidepressants or medications to help with anxiety may be offered.
When used alongside talking therapies, these can be helpful, but it’s important to discuss this in more detail with your doctor to decide if it's the right course of action for you.
Spending time in a clinic
When eating problems are prolonged, it quickly puts your physical health at risk. In these instances, you may need to spend some time in a hospital or clinic. If you're admitted as an inpatient, you will stay at the clinic whilst receiving treatment. If you're an outpatient, you will be able to go home most evenings and at the weekend.
The amount of time you spend at a clinic will depend on your individual case and how much help you need to get better.
I wish I could go back as the woman I am today and tell my struggling, 17-year-old self that she is perfect in her imperfection. I wish I could tell her that the way to get the body she wants is to start loving and accepting the body she has. I wish I could tell her that her strength and talents are far more than skin deep. And I wish I could tell her that when she learns to love herself, everything will work out better than she could ever imagine.
How to help someone with bulimia
Having an eating disorder is a very scary thing, and many find it hard to reach out for support. Because of this, it's important for all of us to be aware of the signs and to reach out if we suspect someone we know may be struggling.
If you're worried about someone, try the following:
- Let them know you’re there for them. This is perhaps the most important thing you can do. Rather than forcing a discussion on your terms, let them know you're available to listen whenever they feel ready to talk.
- Understand that, while you see their behaviour as a problem and wrong, they may not view it in the same way. Many people with eating problems don’t see them as problems, but rather as solutions to dealing with difficult feelings.
- Don’t force behaviour change. If you begin to dictate behaviour, it can backfire into making the person more secretive about their behaviour.
- Encourage them to seek professional support from their GP or a counsellor. You could even offer to go with them if they're nervous about it.
- Help them find information and support online. There are lots of support groups and information sources online that can help people with eating problems understand why they're thinking a certain way. Educating yourself on the conditions will also help you understand them more.
- Avoid making plans for social occasions that involve food. These can be very stressful for someone going through an eating disorder. Encourage socialising in different environments that don’t involve food.
Helping someone going through a mental health problem can be tough on you too, so don’t forget to look after yourself. Schedule time for self-care and have your own support network. If the person is a member of your family, you may find it helpful to try family counselling.
What should I be looking for in a counsellor or psychotherapist?
As it stands, there is no law stipulating a required level of training for counsellors treating individuals with bulimia nervosa. However, the National Institute for Health and Care Excellence (NICE) has developed a set of clinical guidelines that issue advice on types of psychological treatment, medication and available services.
Key recommendations include the following:
- Cognitive behaviour therapy for bulimia nervosa (CBT-BN), a specifically adapted form of CBT, should be offered to adults with bulimia nervosa. The course of treatment should be for 16 to 20 sessions over four to five months.
- Adolescents with bulimia nervosa may be treated with CBT-BN, adapted as needed to suit their age, circumstances and level of development, and including the family as appropriate.
- When people with bulimia nervosa have not responded to or do not want CBT, other psychological treatments should be considered.
- Interpersonal psychotherapy should be considered as an alternative to CBT, but patients should be informed it takes eight to 12 months to achieve results comparable to cognitive behaviour therapy.
For more information, please visit the full NICE guidelines:
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