Bulimia

Bulimia is an eating disorder involving eating a large amount of food in a short time, followed by doing things to make up for the binge, such as vomiting, excessive exercise or misusing laxatives.

Key points

Bulimia can affect people of any gender and at any age. It is most likely to develop during your late teens or early twenties, and it is more common among women.
Binge eating involves eating a large amount of food in a short space of time, often feeling as though you are out of control, and also feeling shame and guilt.
Behaviours to make up for the effects of binge eating can include vomiting, fasting, excessive exercise, misusing laxatives, diuretics and prescription medication, or illegal drug use.
Bulimia can affect the long-term health of your teeth, digestive system, hormones, fertility, heart and kidney function.
People with bulimia over-value the importance of their body weight or shape in determining their self-worth.
If you get treatment from an eating disorder specialist, you have a very good chance of getting better, even if you have had this condition for a long time.

What causes bulimia?

Many factors contribute to developing bulimia, including genetic (inherited from your parents), environmental, psychological and cultural influences. Many people report that their bulimia began after dieting or restricting the amount and/or type of food they were eating. Other causes can include growth spurts, illness and intense athletic training.

Those at risk include people who:

are dissatisfied with their body image
have experienced stigma or bullying about their body weight
have dieted and pushed their body weight below where it naturally sits
restrict their food intake
have a close relative with a history of an eating disorder
have unhelpful skills for coping with negative thoughts and emotions
are depressed, have issues with self-esteem and identity or are a perfectionist
have experienced a trauma including childhood sexual abuse or neglect
have had (or have) drug and alcohol problems.

A personal crisis can be the trigger for someone to start using bulimia as a way of coping with their feelings.

What are the symptoms of bulimia?

The main symptoms of bulimia are:

binge eating (eating large amounts of food over a short period of time, which is different from overeating)
compensatory behaviours – eg, vomiting, excessive exercise, laxative misuse, food restriction to get rid of the food or control your weight
feeling your eating is out of control
low self-esteem and excessive concern about body image, weight and shape
focusing on or being secretive about food and eating.

You may be concerned about a friend or family members eating habits but it can be hard to tell whether they have bulimia. Some clues might be:

a focus on their weight and body shape
anxiety about certain foods or food groups
limiting how much food they eat
spending a lot of time in the bathroom after meals
their weight going up and down
saying things that show they have low self-esteem.

How is bulimia diagnosed?

Your doctor will ask questions to help find out whether you might have bulimia. They will check out how binge eating and the related behaviours have affected your physical health, which may include blood tests. They will help you find an eating disorders specialist, who can confirm the diagnosis and offer you treatment.

What is the treatment for bulimia?

The best treatment for bulimia is therapy with someone experienced in eating disorders who you like and trust. They can affirm your feelings, help you explore the causes of your bulimia and support you to get back to normal eating behaviours. Cognitive behaviour therapy (CBT) is the leading treatment for bulimia. It may also be helpful to seek support from a registered dietitian who is experienced in the treatment of bulimia.

If you also have anxiety or depression, your doctor or a psychiatrist may recommend medication.

Self-help for bulimia

Get help early, as this makes recovery much easier.
Educate yourself through self-help books and online forums.
Tell your family and friends – they can help.
Avoid dieting and trying to lose weight.

Where can I find support?

Talk to your doctor, who if you need it, can refer you to the eating disorders service in your area, or they can help you get therapy from an eating disorders specialist. You can also contact the Eating Disorders Association (EDANZ) to find out about local self-help groups on 0800 2 EDANZ, 09 5222679 or info@ed.org.nz.

Learn more

Eating Disorders Association of NZ For information, resources and support
Canopy Eating Disorders Support Services, NZ
Bulimia nervosa Mental Health Foundation, NZ
Just a thought NZ
Bulimia nervosa – fact sheet National Eating Disorder Collaboration
Overcoming disordered eating Centre for Clinical Interventions, Australia
Reach out and recover Interactive website
FEAST Families Empowered and Supporting Treatment of Eating Disorders

References

Hay P, Chinn D, Forbes D, Madden S, Newton R, Surgenor, L, Touyz S, Ward W. Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of eating disorders. Australian and New Zealand Journal of Psychiatry 2014, 48(11) 1-62.
Mehler P, Rylander M. Bulimia Nervosa – medical complications. Journal of Eating Disorders 2015 April 3; 3 (12).
Morgan JF, Reid F, Lacey JH. The SCOFF questionnaire: assessment of a new screening tool for eating disorders. BMJ. 1999 Dec 4;319(7223):1467-8.

Reviewed by

	Dr Eve Hermansson-Webb works as a senior clinical psychologist and the coordinator of the adult treatment team at Tupu Ora Eating Disorder Service within the Auckland DHB. She co-facilitates a treatment group for bulimia nervosa, and has a specialist interest in treating negative body image and promoting Health At Every Size.
	Sylvia Pyatt works as a specialist dietitian at the Tupu Ora Eating Disorder Service within the Auckland DHB. She works with both adults and adolescents. She co-facilitates a treatment group for bulimia nervosa. Sylvia has a special interest in a non-diet approach to nutrition.

Credits: Health Navigator Editorial Team . Reviewed By: Dr Eve Hermansson-Webb, Clinical psychologist, and Sylvia Pyatt, Registered dietitian Last reviewed: 05 Mar 2019 Page last updated: 07 Jun 2022

	Languages
	Range of mental health topics in over 20 languages Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
	Eating disorders – about more than food National Institute of Mental Health, US, 2018 Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
	Eating disorders - information for youth Children’s Hospital of Eastern Ontario, Canada, 2014 Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
	Tupu Ora – starship inpatient eating disorders service Starship Children's Hospital, NZ, 2016
	What is an eating disorder? Resources available in different languages Mental Health in Multicultural Australia Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
	Body image and body dissatisfaction Centre for Clinical Interventions, Australia Note: This resource is from overseas so some details may be different in New Zealand, eg, phone 111 for emergencies or, if it’s not an emergency, freephone Healthline 0800 611 116.
	A guide to talking therapies in NZ Te Pou, NZ, 2009
	He rongoā kei te kōrero – talking therapies for Māori Te Pou, NZ, 2010
	Talking therapies for asian people Te Pou, NZ, 2010
	Talking therapies for pasifika peoples Te Pou, NZ, 2010

Information for healthcare providers on bulimia

The content on this page will be of most use to clinicians, such as nurses, doctors, pharmacists, specialists and other healthcare providers.

Consultation

Early detection and treatment leads to better outcomes.

DSM-5 criteria:

Recurrent episodes of binge eating. An episode of binge eating is characterised by both of the following:
- Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances;
- A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for three months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.

The SCOFF Questionnaire can help with diagnosis. Score 1 point for every ‘yes’ answer. A score of ≥ 2 indicates a likely case of anorexia nervosa or bulimia nervosa.

Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (>6 kg) in a 3-month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

If patient meets diagnostic criteria, refer to your DHB’s eating disorder service. If patient doesn’t meet criteria but has disordered eating, refer for psychotherapy with private practitioner specialising in eating disorders. Contact EDANZ for names of private providers

Guidelines

Clinical practice guidelines for the treatment of eating disorders Royal Australian and New Zealand College of Psychiatrists
Eating disorders – a professional resource for GPs National Eating Disorders Collaboration

Regional HealthPathways NZ

Access to the following regional pathways is localised for each region and access is limited to health providers. If you do not know the login details, contact your DHB or PHO for more information: