Patient information from BMJ

Bulimia: what is it?

Last published:Feb 01, 2022

Bulimia is a serious medical condition that can damage your health. Many people find it difficult to talk about this illness, which can make it hard to get help.

But getting help is the most important thing you can do. Treatment can help you feel better about yourself and stop bulimia taking over your life.

What is bulimia?

Many of us worry about our weight and try to control what we eat. But if you have bulimia it means you're so worried about your weight that you think about it constantly.

This affects your attitude to food. People with bulimia sometimes eat huge amounts. They then take extreme steps to avoid putting on weight.

The most common thing people do is make themselves vomit after they eat. This is called purging.

Bulimia has a lot to do with your feelings about yourself and your life. Purging yourself of food to control your weight might make you feel that you are in control of other things in your life.

People with bulimia often keep their illness secret. But it may help to know that you're not alone. Bulimia is common. About 3 in 100 women have it at some point in their lives. And men can get it, too.

Conditions that affect how you eat are called eating disorders. Another eating disorder you may have heard of is called anorexia (its full name is anorexia nervosa). People with anorexia eat so little that it puts their health in danger.

What are the symptoms?

The two main symptoms of bulimia are bingeing and purging.

Bingeing means eating a lot of food at once, usually in secret. If you have bulimia you may spend your whole day deciding what to eat, where to get it, and how to eat it without being found out.

The urge to binge may come on after an argument, a bad day, or just because you're hungry at the end of a day.

Some people say they feel as if they lose control during a binge. Others feel excited or rebellious while they're planning what they're going to eat. Then afterwards they may feel guilty.

Purging is how people try to avoid putting on weight after a binge.

Most people who have bulimia purge by making themselves vomit. Others take laxatives to make them go to the toilet.

Some people try other ways to stop putting on weight, like exercising too much or going on very strict diets.

In the short term, purging may give you a feeling of control over your body. But in time, bingeing and purging can become a big part of your life and can damage your health. These are some of the problems it can cause:

• The acid in vomit can damage your teeth

• A lack of nutrition can cause muscle cramps and weak vision

• The stress that purging puts on your body and the loss of fluids can cause heart palpitations

• Repeated purging can rupture your oesophagus (food pipe)

• Repeated purging can damage your stomach and cause heartburn or bleeding. Some people vomit blood.

• Losing water through vomiting can increase your chances of kidney stones

• Vomiting or using laxatives a lot can change the balance of chemicals in your body, which can damage your heart.

Getting treatment for bulimia can help prevent these problems.

Worried that someone you know may have bulimia?

It can be hard to tell whether someone close to you has bulimia. People usually keep it a secret, and they tend to be of normal weight. But there are some signs you can watch out for.

• People with bulimia may talk about weight and body shape a lot more than is normal.

• They may insist that they're overweight, even if they're obviously not.

• They may talk often about how they'd feel much happier if they could lose weight.

• Women with bulimia usually focus on being slim. Men are more likely to talk about wanting to be muscular or athletic.

• Someone with bulimia may go to the toilet more than most people, or they might go straight after meals, to make themselves vomit.

  But not everyone with bulimia makes themselves vomit. Some people go for long periods without eating, or they exercise more than is healthy.

If you live with someone who has bulimia, there may be times when you notice large amounts of food going missing. This could be something like a whole packet of biscuits.

If you're a parent, bear in mind that many children and teenagers are picky eaters at times. This isn't necessarily a sign of an eating disorder.

But if you're worried that your child might have a problem with food, remember that they can’t help their behaviour. Your child may be scared or embarrassed and will need your support.

Talking to a friend or family member about a possible eating disorder can be hard. They may not want to admit that they have a problem, or they may say that they don't want help. You may end up feeling as if you don't know what to do.

The most important thing is to encourage them to see a doctor. You could offer to go with them if they feel that would help.

But even if your friend or relative isn’t ready to see a doctor you can still be there for them and keep offering your support.

What will happen to me?

With treatment, between half and three-quarters of people who have bulimia recover completely. And many others improve greatly.

The sad thing is that many people with bulimia don't seek treatment at all.

If you seek help, no one will expect you to change overnight. Changing behaviour and negative thoughts takes time. The most important step is talking to someone and getting the help and support you need.

Where to get more help or support

Bulimia is a serious condition, and you may find that getting help and support makes your life easier in many ways. Talking to a friend or family member is a good place to start.

There may also be charities and support groups where you live that can help, or online support groups.

For example, in the UK, a charity called Beat provides advice and support for people with all kinds of eating disorders, including bulimia. You can find out more on their website (b-eat.co.uk).

You can ask your doctor about support groups in your area.