Bulimia Nervosa

Silhouette of woman eating

A person with bulimia nervosa (bulimia) engages in repeated episodes of binge eating followed by behaviours to compensate for what they have eaten and prevent weight gain.

Binge eating is eating a very large amount of food in a short period of time. While eating, the person feels out of control and that they are unable to stop eating. Afterwards they may feel guilt, embarrassment or shame, and worry that what they have eaten will cause them to gain weight. So to prevent the feared weight gain they use compensatory behaviours such as excessive exercise, vomiting, or misuse of diuretics or laxatives. This may be followed by restricting the amount of food they eat or dieting. The person engages in cycles of binge eating, compensatory behaviours, and food restriction. People with bulimia also often struggle with low self-esteem or feel that their self worth is determined by their body weight and shape.

Bulimia is caused by a mix of biological, psychological, and environmental factors. There is a genetic component, meaning those with a family history of bulimia are at an increased risk of developing the condition.

Bulimia can lead to serious physical health complications which can be life threatening. If you think you have bulimia it is important to seek help.

Common symptoms
  • Repeatedly eating very large amounts of food in a short period of time. Known as binge eating.
  • Feeling a loss of control or that you cannot stop eating during these binge eating episodes.
  • Using behaviours after a binge eating episode to prevent weight gain. Such as excessive exercise, self-induced vomiting, misuse of laxatives, diuretics or other weight loss products.
  • Fear of gaining weight.
  • Restricting food intake, avoiding certain “unhealthy”/ high calorie foods, or fasting.
  • Extreme concern about body weight and shape.
  • Feeling shame or guilt around eating habits.
  • Constantly thinking about food.
  • Eating in secret, not wanting to eat in front of others.
  • Negative body image.
  • Low self-esteem.
  • Feeling isolated or lonely.
  • Sudden changes in mood.
  • Irritability
  • Low mood
  • Feeling anxious
  • Difficulty concentrating
  • Fatigue and low energy
  • Changes in weight - losing or gaining weight
How common is in the general population
It is estimated that around 1% of the general population will suffer from bulimia nervosa at some point over their life.
Gender differences
Bulimia is more common in women than men.
Bulimia commonly begins during late adolescence or early adulthood. About half of those with bulimia develop the condition before 19 years old.
Typical Course
With treatment the majority of those with bulimia will recover. For some people the symptoms may reduce but not go away completely. Binge/ purge behaviours may be triggered by high stress.
Common Comorbid (concurrent) Conditions
Depression, anxiety disorders, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), substance use disorders, self-harm, suicidal thoughts or attempts.
Common treatments

Treatment for bulimia usually takes a multidisciplinary team approach with input from a medical professional (e.g. GP), mental health professional (e.g. psychologist), and dietitian.

The physical harm caused by bulimia can have a negative impact on long-term health, and in severe cases can lead to death. Physical health complications include damage to the heart, kidneys and digestive system, and hormonal imbalance. It is important to have regular appointments with a medical professional, such as a GP or nurse, to monitor your physical health. 

Getting support from a dietitian can be helpful in recovery from bulimia. A dietitian can create a meal plan, help you develop regular healthy eating habits to improve your health and avoid binge eating, and teach you about nutrition. 

Psychological Therapy:

Psychological therapy is the recommended treatment for bulimia. It is important to address the thoughts and emotions that led to the development of an eating disorder. Cognitive behavioural therapy (CBT) is the recommended treatment for adults with bulimia. CBT is a form of structured talk therapy which aims to identify unhealthy beliefs, thoughts, and behaviours around eating, replace these with healthy behaviours, and normalise eating patterns.

For children and adolescents with bulimia, family based treatment (FBT) is the recommended treatment. Parents are taught how to support their child/ teen in changing their eating behaviours and creating good eating habits. 


There is no medication for the treatment of bulimia. Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), may be prescribed alongside psychological therapy to treat associated mood and anxiety symptoms.

Residential Treatment or Hospitalisation:
In some cases of bulimia if there are severe physical symptoms or psychological distress, then hospitalisation, residential treatment, or an outpatient day treatment programme may be required.