Bulimia nervosa is an eating disorder where a person develops an obsessive attitude with food and their body weight. People with bulimia find themselves trapped in a cycle of binging and purging. Generally, this cycle is the result of low self-esteem and body image.

Often individuals with bulimia can struggle to admit they have a problem. They will also often go to great lengths to hide their condition. As a result, it can be very difficult to identify whether someone has bulimia. Bulimia nervosa can cause serious complications for a person’s mental and physical health. Therefore, it is vital that people with bulimia nervosa seek treatment.

Bulimia nervosa is characterised by “binging” large amounts of food in short periods and then “purging” to prevent weight gain. This purging can take multiple forms. Someone with bulimia may deliberately induce vomiting, take laxatives or exercise obsessively in an attempt to lose weight and counteract or ‘undo’ any binging.

What’s the psychology behind it?

People with bulimia struggle with a negative self-image that’s focussed on weight and body shape. Bulimia sufferers often exhibit feelings of shame and worthlessness. The binge and purge cycle revolves around feelings of control. Bulimic individuals will deprive themselves of food to avoid gaining weight but will binge upon losing control. Purging is thus both an attempt to regain control, and a method of self-punishment. This helps us understand bulimia as not only a negative relationship with food but a cycle of self-destructive behaviour.

Like other eating disorders such as anorexia, bulimia nervosa is more commonly diagnosed in women. The ratio of women to men diagnosed with eating disorders is roughly ten to one. The symptoms of bulimia show little variation across genders. That being said, in those diagnosed, bulimic men are more likely to use compulsive exercise as a method of purging than women.

What causes bulimia?

While there’s no single cause for bulimia, it often stems from low self-esteem and negative perceptions of oneself. People can focus on their weight to try and control how they view themselves. This need for control could be due to events such as trauma and abuse, the end of a relationship or bereavement. This is something that can be examined via psychoanalytic therapy. Social factors can also contribute to bulimia, with people losing weight in an attempt to fit a specific desired body image.

Is it congenital?

Evidence also suggests that genetics might increase the likelihood of a person developing bulimia nervosa. Studies of families with a history of eating disorders found that mutations in two specific genes, ESRRA and HDAC4, greatly increased the risk of eating disorders.

How does bulimia nervosa affect the body?

Malnutrition isn’t the only risk of binging and purging. The cycle can seriously disrupt how the body regulates itself. Potential consequences of this range from low heart rate and blood pressure to abnormal heart rhythms. This can increase the likelihood of cardiovascular problems such as heart failure.

The cycle of binging and purging can lead to a range of physical complications. Long term inducing of vomiting may cause extensive damage to the esophagus. The esophagus begins to lose control, creating a build-up of acid which can then cause gastrointestinal problems. Excessive retching and vomiting can lead to the esophagus tearing, causing internal bleeding. Regular vomiting is also damaging to dental enamel and can lead to poor dental health.

If someone uses laxatives as a method of purging, they could become reliant on them to have normal bowel movements. Continued purging via laxatives may also rupture blood vessels near the anus, causing haemorrhoids.

Frequent vomiting or bowel movements caused by purging will lead a person to become dehydrated. Dehydration can severely damage the kidneys, causing kidney disease or even kidney failure.

Physical symptoms of bulimia nervosa

The most prominent physical symptom of bulimia is weight loss. The binge and purge cycle manifests itself in a variety of ways, dependent on the method of purging. If someone regularly induces vomiting, the continued exposure to acid will damage a person’s teeth and gums. They may also have sores or calluses on their hands or knuckles. Forced vomiting can lead to swollen salivary glands or red eyes due to burst blood vessels.

Behavioural signs of bulimia nervosa

There is no ‘right’ or ‘wrong’ way to approach someone who may have an eating disorder. Confronting them, however, can cause them considerable distress. Their self-esteem is likely to be very fragile, and the fear of being ‘discovered’ may lead them to escalate their behaviour. However, if you are concerned that someone you care about has bulimia, there are various signs to be aware of:

  • Frequently weighing themselves or looking at themselves in mirrors, or directly avoid weighing themselves. This may seem contradictory, but either behaviour can show a preoccupation with weight or body shape.
  • Going through periods of not eating, and then suddenly eating large amounts. Soon after eating, they may disappear or excuse themselves in order to purge.
  • Being very secretive about their eating habits. Signs of binging include eating alone and hoarding food.
  • Common signs of low self-esteem or depression such as acting withdrawn or having frequent mood swings.
  • Self-destructive behaviours such as substance abuse and self-harm.

Bulimia treatment

A person with bulimia nervosa will begin their treatment with an eating disorder specialist. They will also be examined by a doctor to determine if there is any long-term physical damage. Once this has been carried out, they can then commence one of several psychological treatments.

Psychoanalytic therapy for bulimia

Psychoanalytic therapy centres on an understanding of the self. Since bulimia stems from a negative opinion of one’s self, psychoanalytic therapy is an effective means of treating bulimia. Psychological issues such as bulimia often represent a deep-seated internal conflict. The cycle of binging and purging is, therefore, an attempt to restore balance and a sense of self. A person will believe that if they reach a goal weight, they will feel happier within themselves. However, a warped sense of self-image often makes this ‘goal’ unattainable.

Psychoanalysis is a highly individualistic method of treatment. The nature and length of treatment depend entirely on the person’s state of mind. Long-term psychological problems can take a considerable amount of time to resolve. For instance, a person with bulimia may also be experiencing anxiety or depression. Their bulimia may also be a consequence of past trauma. These circumstances must be identified and treated for eating disorders to be rectified. Ultimately, psychoanalytic therapy will help someone understand why they are bulimic. From there, they can begin to rebuild their sense of self and maintain healthier attitudes towards food and body image.

You can find out more about psychoanalytic therapy by visiting this page.

Cognitive behavioural therapy for bulimia

Whereas psychoanalytic therapy examines past reasons for bulimia, cognitive behavioural therapy looks to treat present signs of bulimia.

The first step of cognitive behavioural therapy for bulimia is to help someone develop healthy eating habits. This involves a degree of education surrounding the adverse effects of binging and purging. This is vital, as the most immediate goal of treatment is to restore the person’s physical wellbeing.

The binge and purge cycle represents a series of negative thought patterns which govern a person’s relationship with food. Cognitive behavioural therapy seeks to break these thought patterns. This is so people can understand the long-term damage caused by bulimia. Once these thought patterns are broken, the focus then shifts to reducing the likelihood of relapse.

Visit this page for further information about cognitive behavioural therapy.