10 facts about bulimia nervosa

It's often assumed that an eating disorder is synonymous with an emaciated body and extreme restriction of food. Although people meeting a diagnosis of anorexia nervosa would identify with these symptoms, in fact 85% of people suffering with an eating disorder are normal weight or overweight (BEAT), with diagnoses of bulimia nervosa, binge eating disorder or OSFED (other specified feeding and eating disorder).

This article describes 10 facts about bulimia nervosa, offering insight and understanding into this frequently misunderstood eating disorder.

1. A secret illness

Pre 1980, bulimia nervosa was hardly acknowledged, at least by the medical profession, although many people suffered secretly and alone. Princess Diana did much valued work to raise awareness and understanding of the illness, through her personal sharing and allowing it official recognition as a legitimate problem.

2. Meaning

The term bulimia means ‘ox hunger’, relating to the symptom of an uncontrollable urge to eat vast amounts of food, in a short space of time and beyond the point of physical fullness.

3. Behaviours

Bulimia involves specific behaviours including: 

• Regular binge eating, usually in secret. Foods eaten are normally deemed as ‘unhealthy’, ‘bad’ or ‘forbidden’. People tend to binge on all the foods that they would deny themselves during a dieting phase.
• People binge on an amount of food that is excessive and more than someone would normally eat.
• There is a loss of control around eating. Food may be fleetingly enjoyed but this quickly turns to shame and self-disgust.
• Binge eating is followed by purging, through either self-induced vomiting, laxatives, excessive exercise, or a combination of these.

4. Habit

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.

5. Weight

People with bulimia are generally within the normal weight range or overweight, so it is frequently a hidden illness, which can be incredibly isolating and lonely. If you are underweight and engaging in bulimic type behaviours, you may meet diagnosis for anorexia nervosa (purging sub-type).

6. Self-esteem

Bulimia is usually found in people with low self-esteem, with perfectionist attitudes and a need for approval from others. They may lack self-confidence and self-worth.

7. Harmful

Bulimia is harmful to the body, as there is a disturbance in the balance of body fluids, due to purging. Low potassium levels can cause dehydration and impact the heart, kidneys and brain. Stomach acid can also have a detrimental impact on tooth enamel, whilst overuse of laxatives can damage the gut long-term.

8. A Western illness

Bulimia does not exist in countries where food supplies are limited, being an illness of the Western world, where food is plentiful but a cultural pressure to be slim.

9. Emotional needs

The immense hunger for food and the subsequent rejection of it can be viewed as a signal of unmet needs, accompanied by extreme discomfort in acknowledging these. By gorging food, someone may feel greedy (needing) but the purging rejects the need (I can’t be needy). The bulimic behaviour can mirror the person’s life patterns and relationships.

10. Coping exterior

Someone with bulimia might present an exceptional coping front to the world. The bulimic ritual serves to split off the ‘bad and unacceptable’ parts, whereas the pleasing, coping front, is what others see. Understandably, this brings up severe inner conflict and unhappiness in the sufferer.

Important note: some people may experience aspects of bulimic behaviour eg. purging, without binge eating. This means that they may meet a diagnosis of OSFED (Other Specified Feeding and Eating Disorder), which is still a serious eating disorder and is should be seen as significant problem warranting help.

If you are struggling with bulimia, do not suffer alone. Seek help early and talk to someone you can trust, who can support you. You may feel alone, scared and ashamed. Do not suffer in silence. Bulimia is a treatable condition and usually requires professional support to overcome it. You may wish to consider speaking to your GP and having counselling.

This article was written by Harriet Frew.