Bulimia nervosa: Myths, treatment, and self-help strategies

Bulimia nervosa is a complex eating disorder characterised by cycles of binge eating followed by behaviours aimed at compensating for excessive food intake, such as self-induced vomiting, misuse of laxatives or diuretics, fasting, or excessive exercise.


It affects individuals across various demographics, typically manifesting in adolescence or early adulthood. This article explores the nature of bulimia nervosa, its causes, impact on individuals, and the proven strategies used in its treatment, with a focus on cognitive behavioural therapy (CBT) as a primary therapeutic approach.

Understanding bulimia nervosa

Bulimia nervosa is marked by a pervasive preoccupation with body weight and shape, leading to episodes of binge eating. Binges are often followed by intense feelings of guilt, shame, or distress, prompting individuals to engage in compensatory behaviours to avoid weight gain or alleviate emotional discomfort.

These cycles can perpetuate a harmful cycle of negative thoughts and behaviours, severely impacting physical health, mental well-being, and overall quality of life.

Causes of bulimia nervosa

The development of bulimia nervosa is influenced by a combination of genetic, psychological, environmental, and social factors. Some common causes include:

Genetic factors:

Individuals with a family history of eating disorders or other mental health conditions may have a higher risk of developing bulimia nervosa.

Psychological factors

Low self-esteem, perfectionism, and difficulties in coping with stress or negative emotions can contribute to the onset of bulimia nervosa.

Environmental factors

Societal pressures to attain a certain body shape or weight, as well as cultural attitudes towards food and appearance, can play a role in the development of the disorder.

Social factors

Peer influence, especially during adolescence, and exposure to media images promoting unrealistic body ideals can contribute to the development of unhealthy eating behaviours.

Psychoeducation: The vicious cycle of bulimia nervosa

Understanding the vicious cycle of bulimia nervosa is crucial for individuals and their loved ones. This cycle typically includes the following stages:

Binge eating episode

Individuals experience an overwhelming urge to consume large quantities of food within a short period, often in a secretive manner. Binges are driven by emotional triggers such as stress, anxiety, or feelings of inadequacy.

Feelings of guilt and shame

After a binge episode, individuals experience intense negative emotions, including guilt, shame, and self-loathing. These emotions may stem from the perceived loss of control over eating behaviours and fear of weight gain.

Compensatory behaviours

To counteract the perceived caloric intake and prevent weight gain, individuals engage in compensatory behaviours such as self-induced vomiting, excessive exercise, fasting, or misuse of laxatives or diuretics.

Temporary relief

Initially, compensatory behaviours may provide a sense of relief or control over body weight and shape. However, this relief is often temporary and often followed by a cycle of increased distress and heightened preoccupation with food and body image.

Maintenance of disorder

Over time, the vicious cycle of bulimia nervosa becomes self-perpetuating, reinforcing unhelpful beliefs and behaviours related to food, body image, and self-worth. Without intervention, the disorder can lead to severe physical complications and psychological distress.

Myths about bulimia nervosa

Despite increased awareness, several myths and misconceptions about bulimia nervosa persist. It's important to 'debunk' these myths to promote understanding and accurate information:

Myth: Bulimia nervosa is just a phase or lifestyle choice.

Fact: Bulimia nervosa is a serious mental health condition with complex underlying factors. It is not simply a phase or a lifestyle choice, but a medical disorder that requires professional treatment.

Myth: Only young women experience bulimia nervosa.

Fact: While bulimia nervosa is more commonly diagnosed in young women, individuals of any gender, age, or background can develop the disorder.

Myth: Bulimia nervosa is solely about food and weight.

Fact: While food and weight are central concerns, bulimia nervosa is also characterised by psychological and emotional factors, such as low self-esteem, perfectionism, and difficulties in managing emotions.

Myth: People with bulimia nervosa can easily stop bingeing and purging if they choose to.

Fact: Bingeing and purging behaviours are often driven by complex psychological and physiological factors. It is not simply a matter of willpower; individuals may require professional help to overcome these behaviours.

Treatment approaches for bulimia nervosa

Effective treatment of bulimia nervosa typically involves a multidisciplinary approach, including medical management, nutritional support, and psychotherapy. Among the psychotherapeutic interventions, cognitive behavioural therapy (CBT) has emerged as one of the most widely recognised and evidence-based treatments for bulimia nervosa.

Cognitive behavioural therapy (CBT) for bulimia nervosa

CBT for bulimia nervosa focuses on identifying and modifying the unhelpful thoughts and behaviours that contribute to the disorder. Key components of CBT include:

Psychoeducation: Educating individuals about bulimia nervosa, its symptoms, and the factors that contribute to its maintenance.

Monitoring: Keeping track of eating behaviours, emotions, and triggers to identify patterns associated with bingeing and purging.

Cognitive restructuring: Challenging and modifying distorted beliefs and thought patterns related to body image, self-worth, and food.

Behavioural strategies: Introducing alternative coping mechanisms and skills to manage emotions and reduce the urge to engage in binge-purge cycles.

Relapse prevention: Developing strategies to anticipate and cope with potential setbacks or triggers, empowering individuals to maintain recovery in the long term.

Self-help tips for managing bulimia nervosa

In addition to professional treatment, individuals with bulimia nervosa can benefit from incorporating self-help strategies into their daily routines, such as the following:

Develop a support network

Surround yourself with supportive friends, family members, or support groups who understand your challenges and can provide encouragement.

Practice mindfulness

Engage in mindfulness techniques such as deep breathing, meditation, or yoga to help manage stress and improve self-awareness.

Establish regular eating patterns

Aim to eat balanced meals and snacks at regular intervals throughout the day to reduce the likelihood of binge episodes.

Challenge negative thoughts

Identify and challenge negative thoughts about food, body image, and self-worth using techniques learned in CBT, such as keeping a thought diary.

Engage in positive activities

Pursue hobbies and activities that bring joy and fulfillment, helping to distract from negative thoughts and reduce the urge to engage in binge-purge behaviours.

By combining professional treatment with self-help strategies, individuals can enhance their recovery journey and improve overall well-being. It's important to seek help from qualified healthcare professionals, such as therapists specialising in eating disorders, to receive personalised guidance and support in managing bulimia nervosa effectively.

The views expressed in this article are those of the author. All articles published on Counselling Directory are reviewed by our editorial team.

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Birmingham, West Midlands, B18
Written by Laura Gwilt, BSc(Hons), PGDip, Accredited
Birmingham, West Midlands, B18

Laura is an experienced CBT psychotherapist specialising in anxiety disorders, trauma, and eating disorders. With a background in providing support within inpatient hospitals, Laura's commitment to early intervention is fueled by a passion for promoting well-being and resilience.

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