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), immediately followed by self-induced vomiting, fasting, over-exercising and/or the misuse of laxatives, enemas or diuretics.

Bulimia nervosa differs from binge eating disorder as the binge episodes are associated with a sense of loss of control and are immediately followed by feelings of guilt and shame, which then leads the person to compensatory behaviours — i.e. to immediately purge themselves of the food they just ate.

A person with bulimia nervosa usually maintains an average weight, or may be slightly above or below average weight for their height, which often makes it less recognisable than serious cases of anorexia nervosa.

Many people, including some health professionals, incorrectly assume that a person must be underweight and thin if they have an eating disorder. Because of this, bulimia nervosa is often missed and can go undetected for a long period of time.

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. Once the person gives in to this urge, the desire to eat is uncontrollable, leading to a substantial binge on whatever food is available (often foods with high fat and sugar content), followed by compensatory behaviours. A repeat of weight-loss dieting often follows, leading to a binge/purge/exercise cycle, which becomes more compulsive and uncontrollable 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
• 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 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. Yet often people live with bulimia for many years before it is detected or they seek help, which can make the cycle harder to break.

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. More often than not, people with bulimia can be treated as an outpatient — that is, they can work through their illness with the help of a psychologist while still living their day-to-day life, rather than being hospitalised. Working with a psychologist can help people experiencing bulimia to develop coping strategies and tackle the root cause of their illness, such as low self-esteem and poor body image.