What is bulimia?
Someone with bulimia may try to restrict what they eat, often out of fear of gaining weight. This restriction can lead to binge eating, which involves eating a large amount of food in a short space of time. This is often accompanied by feeling like you are losing control. After binging, feelings of guilt, shame, or panic are common. This then leads to trying to ‘undo’ this overeating by purging. This can involve vomiting, taking laxatives or diuretics, fasting, or exercising excessively. Over time, this binge-purge cycle starts to feel deeply ingrained and hard to escape.
In this video, Harriet Frew, an experienced counsellor specialising in eating disorders and body image, shares her experience of overcoming bulimia and explains how counselling can support you in recovery from an eating disorder.
Following bingeing (eating large quantities of food), someone with bulimia may then try to compensate for overeating by vomiting, taking laxatives or diuretics, fasting, or exercising excessively (to 'purge'). Bulimia doesn't have a single look. It can affect people of any age, gender, ethnicity, background, or neurotype, as well as people of any size. Although eating disorders are often stereotyped as mainly affecting one particular group, this doesn’t reflect reality. Many people living with bulimia do not see themselves represented in common portrayals of eating disorders, which can delay recognising that they have a problem, and can delay seeking help.
Signs and symptoms of bulimia
People with bulimia often feel embarrassed or ashamed. This can make it difficult to ask for help. Bulimia is not always visible, and body weight alone is not a reliable indicator of how someone is struggling. As hiding bingeing and purging behaviours is common, it can be difficult for others to spot what is happening from the outside.
There are a number of signs of bulimia you can look out for, in yourself or others.
Emotional and behavioural signs of bulimia
- feeling unhappy or critical of your body
- obsessing over food, calories, body shape or weight
- eating large amounts of food in secret, often accompanied by a sense of loss of control
- feeling out of control around food
- purging after eating or excessively exercising
- feeling guilty, anxious, or ashamed after eating
- fear of putting weight on
- changes in mood (tense, irritable, anxious, depressed)
- avoiding social situations or activities that involve food
- self-imposing rigid restrictions between binges to compensate
Physical signs of bulimia
- stomach pain or bloating
- dizziness or fatigue
- dental problems or sensitive teeth
- sore throat or swollen glands
- trouble sleeping
- irregular or stopped periods
Signs of bulimia in someone else
- eating a lot of food in a short period of time
- hiding food, eating in secret, or avoiding activities that involve food
- going to the bathroom frequently after eating
- excessively or obsessively exercising
Bulimia can have both long-term and immediate effects on you. With the right help, many physical effects are reversible or can be stopped from getting worse.
What causes bulimia?
There is no single cause of bulimia. Eating disorders are often not about the food itself, but rather, underlying thoughts and feelings causing the binge-purge cycle. Bulimia usually develops due to a combination of experiences and influences. These can include:
- Psychological factors such as low self-esteem, perfectionism, or difficulty managing your emotions.
- Social influences like diet culture, weight stigma, or pressure to look a certain way.
- Life experiences such as traumatic events, bullying, or major life changes.
- Biological factors, including genetics.
Research shows that bulimia can affect people from minority ethnic backgrounds, men, LGBTQ+ people and those who are neurodivergent. Cultural attitudes to food, body image and mental health can influence how bulimia develops and whether someone feels able to ask for support. For some, fear of stigma or not being taken seriously can be a barrier to getting help. For neurodivergent people, for example, autistic people or those with ADHD, difficulties with emotional regulation, sensory sensitivity, rigid thinking or coping with change can all play a role.
Remember: Bulimia is not a choice or a lifestyle. It is a mental health condition that deserves understanding, compassion, and professional support.
Getting support for bulimia in the UK
Reaching out for help can feel daunting, but you don’t have to manage bulimia on your own. Many people find talking to someone they trust is the first step towards recovery and accessing the help and support that they need.
Support for bulimia is available to everyone, regardless of background, gender, or neurodivergence. You deserve to be taken seriously when asking for help.
I wish I could go back as the woman I am today and tell my struggling, 17-year-old self that she is perfect in her imperfection. I wish I could tell her that the way to get the body she wants is to start loving and accepting the body she has. I wish I could tell her that her strength and talents are far more than skin deep. And I wish I could tell her that when she learns to love herself, everything will work out better than she could ever imagine.
If you are looking for support for bulimia in the UK, you can:
- Speak with your GP. They can signpost local services, support groups, and charities in your area, as well as refer you for further support.
- Open up to someone you trust. Speaking with a friend or family member can be a positive step towards acknowledging that you have a problem and need help.
- Get in touch with a charity or helpline. Beat Eating Disorders is a UK-based charity. Beat has a free, confidential helpline, offers webchat, and support via email and letters.
- Explore counselling for bulimia. Working with a therapist can help you to uncover underlying causes, tackle unhelpful behaviours, and find new coping strategies.
Treatment and support for bulimia
Bulimia is a serious mental health condition with both psychological and physical risks. Recovery is possible with the right support.
A number of different treatment options are available for bulimia. Treatment usually focuses on a combination of emotional well-being and physical health. Different approaches are suggested based on your individual needs and circumstances.
Talking therapies for bulimia
Psychological therapies are the main treatment offered for bulimia. In the UK, cognitive behavioural therapy for bulimia (CBT-BN) is often recommended. This approach can help you understand patterns around food, thoughts, and behaviours, helping you to develop healthier coping strategies. The National Institute for Health and Care Excellence (NICE) guidelines recommend:
- CBT-based approaches as a first-line treatment for bulimia. These can often include introducing regular eating patterns.
- Guided self-help programmes that use cognitive behavioural self-help materials, and/or supplement self-help with brief support sessions.
- Bulimia-nervosa-focused family therapy (FT-BN) for children and young people.
Other therapies, such as interpersonal therapy, may be offered if CBT isn’t suitable.
Bulimia counselling offers a confidential, non-judgmental space to explore what may be influencing or causing your current eating behaviours. A trained professional can help you to:
- understand emotional triggers
- reduce binge-purge cycles
- develop healthier coping strategies to manage how you are feeling
- rebuild your trust in your body
There are a number of different types of therapy recommended to help support with eating disorders and bulimia nervosa specifically. If guided self-help doesn’t help or is ineffective, NICE recommends CBT-ED. In Scotland, SIGN (Scottish Intercollegiate Guidelines Network) recommend CBT-ED or CBT-BN.
Cognitive behavioural therapy for bulimia (CBT-BN) or eating disorders (CBT-ED)
CBT-ED is a form of CBT developed to help with eating disorders. CBT-BN is also a form of CBT, designed to specifically help those with bulimia nervosa. These types of CBT are recommended to take place over 20 sessions across 20 weeks.
Bulimia-nervosa-focused family therapy (FT-BN)
For children and young people with bulimia, NICE guidelines recommend FT-BN. Typically consisting of 18-20 sessions over six months, the therapist aims to establish a good therapeutic relationship with the individual and their family members or carers.
Therapy can involve more information around the adverse effects of attempting to control weight by purging, using a collaborative approach between parents/carers and the young person to establish regular eating patterns and minimise purging behaviours. If FT-BN doesn’t help, CBT-ED may be recommended.
Recovery from an eating disorder is not a linear journey. There will be ups and downs, moments of doubt, and times of triumph. The key is perseverance. Each step forward, no matter how small, is a victory. Over time, the cumulative effect of these steps leads to significant and lasting change.
-Psychotherapist Laura Gwilt, BSc(Hons), PGDip, Accredited, explains more about the importance of perseverance in ED recovery.
Medication for bulimia
There is no specific medication that treats bulimia on its own. However, antidepressants are sometimes prescribed alongside therapy to help support anxiety and low mood. According to NICE, medication should not be the sole treatment option offered for bulimia.
Medical care
If bulimia is affecting your physical health, you may need medical monitoring or more intensive treatment. In some cases, this may mean a short stay in a hospital or a specialist clinic. This can help stabilise health and provide additional support.
Multidisciplinary care
Treatment for bulimia often involves multidisciplinary care. A combination of medical, psychological, and nutritional support helps address both the physical health complications and the underlying emotional and behavioural factors that maintain the disorder. This coordinated approach can help improve recovery outcomes and support the development of healthier coping strategies and eating patterns.
How to help someone with bulimia
If you’re worried someone may be experiencing bulimia, your support can make a meaningful difference. You can:
- Let them know that you’re there to listen, without pressuring them to talk immediately.
- Avoid making comments on their weight or appearance.
- Encourage them to speak with a professional and seek help when they are ready.
- Learn more about bulimia to gain a better understanding of what they are going through, and to be able to offer your support.
Supporting a loved one with an eating disorder is critical because the involvement of family and friends significantly improves recovery outcomes.
- Integrative Therapist Matthew Frener, MBACP (Accred), MNCPS (Accred), Advanced Member - AP, explains more about how to support with an eating disorder.
