Bulimia nervosa is a serious psychiatric illness characterised by recurrent binge-eating episodes (the consumption of abnormally large amounts of food in a short period of time), followed by self-induced vomiting, fasting, over-exercising and/or the misuse of laxatives, enemas or diuretics.

Bulimia nervosa differs from binge eating disorder (BED). While binge episodes in both illnesses are associated with a sense of loss of control and are followed by feelings of guilt and shame, a person experiencing bulimia nervosa will immediately engage in compensatory behaviours such a vomiting or exercise.

A person with bulimia nervosa can be of any body shape, size or weight.

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Bulimia nervosa often starts with weight-loss dieting. The resulting food deprivation and inadequate nutrition can trigger what is, in effect, a starvation reaction — an overriding urge to eat. For some, the desire to eat is uncontrollable, leading to a substantial binge on whatever food is available, followed by compensatory behaviours. A repeat of this behaviour often follows, leading to a binge/purge/exercise cycle, which can become more compulsive over time.

 Some of the more common signs and symptoms of bulimia nervosa are:

• Difficulties with activities that involve food
• Loneliness due to self-imposed isolation and a reluctance to develop personal relationships
• Deceptive behaviours relating to food
• Fear of the disapproval of others if the illness becomes known
• Mood swings, changes in personality, emotional outbursts or depression
• Self-harm, substance abuse or suicide attempts
• Sensitivity to references about weight or appearance
• Guilt, self-disgust, self-loathing
• Anxiety
• Depression
• Frequent trips to the bathroom, especially after eating
• Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
• Food avoidance, dieting behaviour (this may be due to a fear of gaining weight and it may also be to avoid the unpleasant ritual of purging afterwards)
• Fluctuations in weight

Bulimia nervosa can often be missed by health professionals and can go undetected for a long period of time.

Bulimia nervosa affects the mind and body in a multitude of ways:

• Brain – preoccupation with food and weight, low self-esteem, anxiety, depression
• Mouth – erosion of dental enamel, swollen jaw, bad breath, gum disease, tooth decay
• Throat/oesophagus – chronic sore throat, indigestion, heartburn, reflux, inflamed or rupture of oesophagus
• Heart – irregular or slow heartbeat, cardiac arrest, heart failure, low blood pressure, fainting, dizziness
• Stomach and intestines – ulcers, pain, stomach rupture, bowel problems, constipation, diarrhoea, cramps
• Hormones – irregular or absent periods, loss of libido, infertility
• Kidneys – dehydration
• Skin – calluses on knuckles, dry skin
• Muscles – fatigue, cramps caused by electrolyte imbalance, tiredness, lethargy

Full recovery from bulimia nervosa is possible, even if you have been living with it for a number of years.

If you recognise the signs of bulimia nervosa in yourself or someone you know, it’s best to seek professional help as soon as possible. Treatment can include working with a range of health professionals, such as a psychologist and dietitian. You can learn more about evidence-based treatment approaches here.

Don’t forget that recovery also involves ongoing learning, self-help and peer support.

Find out how EDV can help guide and support your recovery:

• EDV Hub – helpline service providing information, navigation and general support. Open Mon – Fri, 9.30am – 4.30pm.
• Telehealth Counselling –  up to five, free 30-45 minute sessions with a trained counsellor to help you take the next step in your recovery. Whether you are just starting to seek help, are on a waitlist for treatment or are wanting to re-engage with support after relapse, EDV’s understanding Counselling team are here to support you. Carers and families are also encouraged to speak to EDV Telehealth Counsellors. 
• Telehealth Nurse – free and expert guidance with registered nurses who specialise in eating disorders. Nurses listen to your unique circumstance and help you navigate and access specialised eating disorder services. Nurses can also support clients and health professionals around medical management for eating disorders.
• Online Support Groups – peer-led groups that provide an open space to discuss what you are struggling with, reflect on current challenges and discuss coping tools. Different groups are available depending on your needs. You are welcome to attend multiple groups. 
• Peer Mentoring Program – 1:1 recovery support with an EDV mentor who has experienced and recovered from an eating disorder. The program allows for 13 mentoring sessions over a six month period.
• Carer and Family Support – carer specific services including Carer Coaching and online courses.
• LearnED eLearning platform – for self-paced education and online courses
• EDV Podcast – for lived experience perspectives and professional insights
• EDV Newsletters – for recovery support delivered directly to your inbox each month