What is bulimia nervosa?

Bulimia nervosa is an eating disorder and a serious mental health condition.

People with bulimia nervosa binge eat and purge:

• Binge eating is when people regularly eat very large amounts of food very quickly and feel that they can’t control their eating behaviour.
• Purging can include vomiting up food or misusing laxatives, diuretics or enemas.

People with bulimia nervosa often have an unhealthy body image and think their body is bigger than it is.

People with bulimia nervosa need a lot of support from family and health care professionals to recover.

Bulimia nervosa symptoms and signs

People with bulimia nervosa are often within a healthy weight range for their height. Sometimes they’re overweight. And it’s common for them to try to keep their condition a secret. This means that bulimia nervosa can be hard to spot.

Behavioural symptoms and signs

These include:

• binge eating
• eating only small amounts when eating with others
• purging after eating
• fasting or dieting
• excessive exercising.

People with bulimia nervosa might also:

• talk a lot about body weight and body shape
• go to the toilet after meals a lot.

And if someone in your household has bulimia nervosa, you might notice food going missing from the fridge or pantry. You might also find food hidden in their room or other places where food isn’t usually stored.

Psychological symptoms and signs

These include:

• having negative thoughts and feelings about body weight, body shape and food
• feeling out of control, guilty or ashamed about binge eating.

Physical symptoms and signs

These include:

• dehydration
• fatigue
• swollen or puffy cheeks because of enlarged salivary glands
• discoloured or damaged teeth or gums
• redness or sores on the knuckles and backs of the hands
• frequent weight gain or weight loss
• loss of or irregular periods.

The long-term complications of bulimia nervosa can be severe. They include:

• damage to the teeth, gums, mouth and oesophagus
• osteoporosis
• problems with the heart and kidneys
• low self-esteem
• depression or anxiety
• a higher risk of suicide.

What to do if your child has bulimia nervosa symptoms

If you notice that your child’s eating habits have changed, or you see a change in their mood and behaviour in relation to food, it’s important to talk with your child and your GP as soon as you can.

It might be a difficult conversation with your child, but it will help you understand more about what’s going on. Try to stay calm and non-judgmental. Focus on your child’s health and wellbeing, not your child’s weight and appearance.

If you’re not sure how to talk with your child about these issues, you could ask your GP or a mental health professional for help. You can also contact the Butterfly Foundation by calling the free national helpline on 1800 334 673 or using the Butterfly Foundation webchat.

Early assessment and help from a health professional can stop problem eating turning into an eating disorder. It might be easier to get your child to see a health professional now. If you step in early, you might be able to save your child from intensive treatment and a very long recovery time.

How is bulimia nervosa diagnosed?

If your GP thinks your child might have bulimia nervosa, the GP will do a full physical examination. This might include things like a blood test, a urine test or an ECG. The GP will also talk with your child about eating behaviour, habits and thoughts.

The GP might then refer your child to a specialist service to confirm the bulimia nervosa and recommend appropriate treatment.

How is bulimia nervosa treated?

There’s no single treatment for bulimia nervosa.

Bulimia nervosa treatment involves a team of health professionals with expertise in different areas. They’ll prescribe or suggest a treatment plan that’s specific to your child’s needs. The plan will depend on things like:

• your child’s age
• the kind of bulimia nervosa your child has
• the causes, severity and stage of your child’s bulimia nervosa.

The plan will include regular visits to your child’s GP and a dietitian who specialises in eating disorders. It’s also likely to include some of or all the following.

Psychological therapy

This is a common way to treat bulimia nervosa. It can include family sessions, one-on-one sessions with your child, or group-based sessions. This treatment aims to help you and your child understand the eating disorder and how it affects your lives. It also aims to help your child:

• learn about bulimia nervosa and how it develops
• manage their emotions
• develop healthy eating behaviour
• work on things like binge eating, purging and over-exercising
• build self-esteem
• feel more comfortable in their body
• re-engage with family, friends and social activities.

Medicines

Selective serotonin reuptake inhibitors (SSRIs) are antidepressant medicines that are sometimes used to treat bulimia nervosa. The most commonly prescribed SSRI for bulimia nervosa is fluoxetine (Prozac).

If your child has depression or anxiety as well as bulimia nervosa, there are medicines that might help with these other conditions.

Your doctor or dietitian might prescribe nutritional supplements if your child needs them.

Hospital

Your child might need to go to hospital to be treated for the physical effects of bulimia nervosa. This will depend on your child’s weight, symptoms and other health issues.

Hospital treatment usually focuses on supporting people to eat at regular mealtimes and develop healthy eating behaviour. It might also involve close supervision to prevent purging and over-exercising. People might get fluids and medicines for dehydration and electrolyte imbalances.

Early intervention and treatment can help your child recover from bulimia nervosa, but it’s also possible for your child to develop it again. If you notice that your child is showing the symptoms of bulimia nervosa again, see your doctor as soon as possible.

How to help your child with bulimia nervosa at home

One of the most important things you can do to support your child with bulimia nervosa is to show that you love and care for them. This can be as simple as:

• stopping to listen when your child wants to talk
• spending one-on-one time with your child
• giving your child a hug.

It’s also a good idea to ask your child’s mental health professional for specific things you can do at home to support your child’s recovery from bulimia nervosa.

And in addition to any strategies that the mental health professional suggests, here are strategies you can try at home with your child:

• Encourage helpful self-talk. Encourage your child to practise saying things like ‘I’m more than just my appearance’ or ‘My worth doesn’t depend on how I look’.
• Encourage self-compassion. When your child is hard on themselves, encourage them to speak to themselves as they’d speak to a close friend or someone they love in a similar situation.
• Encourage your child to do things they enjoy, like reading or playing soccer. Activities like these shift your child’s focus from their appearance and can improve your child’s self-esteem.
• Use active listening. Let your child tell you how they feel about their appearance. Try to accept your child’s feelings and avoid making judgments.
• Encourage limits on your child’s use of mirrors and scales. This can help if your child spends a lot of time checking their appearance or weighing themselves.
• Talk about social media. Appearance-based social media content can worsen bulimia nervosa. Talk about the type of content that your child sees online, and offer to help your child hide unhelpful content.
• Challenge harmful online and offline appearance-based messages. For example, for a message like ‘You have to be skinny to be beautiful’, you could say, ‘Beauty comes in all shapes and sizes, and it’s about more than appearance. It’s also about the positive things you do, like being kind and helping others’.

Bulimia nervosa causes and risk factors

There’s no single cause of bulimia nervosa. But there are factors that can put young people at higher risk for bulimia nervosa.

These risk factors include:

• low self-esteem
• concerns about weight and body image
• a history of trauma or abuse
• depression or social anxiety
• obesity in childhood and early developmental maturation
• gender – girls are at higher risk than boys
• dieting
• a family history of bulimia nervosa.