Bulimia nervosa is a serious mental illness characterised by recurrent binge-eating episodes (the consumption of 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 engage in compensatory behaviours such a vomiting or exercise. When identifying bulimia nervosa, it’s important to remember that: 

• Bulimia nervosa occurs in people of all genders 
• Bulimia nervosa impacts people of all body shapes and sizes 
• Bulimia nervosa is serious and requires medical and psychological intervention  

There is no single cause of bulimia nervosa, but there are risk factors that increase the likelihood of it developing. These can be biological, psychological and social.

Biological risk factors

Bulimia can develop at any age or stage of life for people of any gender, including  males.

Evidence tells us that bulimia nervosa has a moderate-high genetic heritability. Ongoing research into this field is analysing hundreds of genes that may influence the chance of developing an eating disorder with the hope of improving treatment and even preventing illness. You can learn more about the Eating Disorders Genetic Initiative (EDGI), the world’s largest ever genetic investigation of eating disorders, here.    

Psychological risk factors

Some psychological risks for bulimia nervosa encompass feelings of inadequacy, personality traits of perfectionism and anxiety, heightened sensitivity or inability to cope with negative evaluations, low self-esteem, and impulsive or obsessive behaviours.  

Social risk factors

The cultural emphasis on ‘thinness’ or smaller bodies as a moral and health imperative, along with the normalisation of intentional dieting for the ‘thin ideal,’ contributes to the valuation of individuals based on outward appearance and can be an influencing factor in the development of eating disorders.  

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. 

You can learn about risk factors for all eating disorders here. 

Some of the more common signs and symptoms of bulimia nervosa are listed below. Remember, bulimia nervosa is a mental illness. You can’t tell if someone has an eating disorder based on physical appearance alone.

Mental health symptoms

• 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 

Behavioural symptoms

• 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)  
• Frequent trips to the bathroom, especially after eating 
• Excessive exercise, such as exercise that interferes with other life commitments  
• Changes in food preferences 
• Repetitive or obsessive body-checking behaviours 
• Deceptive or secretive behaviour around food 

Social symptoms

• Difficulties with activities that involve food 
• Loneliness due to self-imposed isolation and a reluctance to develop personal relationships 

Bulimia nervosa can affect the functioning of the entire body. The below graphic outlines some of the key systems and organs that can be impacted when someone is experiencing bulimia nervosa.

Physical signs and effects of bulimia nervosa

There are several evidence-based treatments available for bulimia nervosa. Full recovery from bulimia nervosa is possible.

At EDV, we understand that recovery from an eating disorder is an individual and unique process. How someone defines and experiences recovery is often inclusive of their life stage, intersectional life experiences, priorities, responsibilities, support systems, and access to services. You can read more about recovering from an eating disorder here.   

The first step towards recovery is to talk about what you are experiencing. This may start with a health professional, a helpline, a trusted family member or friend, a teacher, a coach, or a spiritual leader. If you find that the person you speak to doesn’t validate your feelings, or have much knowledge about eating disorders, it’s important not to ignore your symptoms. We encourage you to reach out to Eating Disorders Victoria (EDV) for a conversation, which can include next steps for receiving treatment.   

Types of treatment for bulimia nervosa  

Treatment for bulimia nervosa can involve working with a range of health professionals and trying several different approaches. While formal treatment is important, ongoing recovery also involves personal exploration and commitment. This can include learning to identify triggers for your eating disorder and to take actions to avoid or counteract them, reading and learning about your disorder, learning and applying coping skills, attending support groups and developing a support system to rely on when necessary.   

In Australia, commonly prescribed treatment approaches for bulimia nervosa include:  

• Cognitive Behavioural Therapy for Eating Disorders (CBT-ED) 
• Dialectical Behavioural Therapy (DBT)  
• Specialist Supportive Clinical Management (SSCM) for eating disorders 
• Interpersonal Therapy (IPT) for Bulimia Nervosa and Binge Eating Disorder 

You can learn more about evidence-based treatment approaches here. 

Accessing treatment for bulimia nervosa

Accessing treatment requires navigating different parts of the health care system. Treatment options are available in both the public and private health system. We understand this can be confusing and encourage you to reach out if you have any questions. 

For most people, treatment will start with a visit to a GP. A GP is normally a central point of contact during treatment and recovery, and can provide diagnosis, medical monitoring and referral to specialist services. 

We encourage you to learn more about accessing treatment by visiting the following pages:  

• Talking to my doctor   
• Treatment pathways for children and young people  
• Treatment pathways for adults  
• Medicare and eating disorders   

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.   
• Telehealth Nurse – free and expert guidance with registered nurses who specialise in 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.  
• Severe and Enduring Eating Disorder Program (SE-ED) – group-based program focusing on quality of life for those with long-term eating disorders 
• Carer and Family Support – carer specific services including 1:1 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