What is bulimia nervosa?

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

Signs and symptoms of bulimia nervosa

People with bulimia nervosa are often close to a normal body weight or even 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.

General signs and symptoms of bulimia nervosa include:

• binge-eating or eating a larger amount of food than normal – you might notice food going missing
• purging after eating – this might include self-induced vomiting, over-exercising or taking laxatives
• having negative thoughts about body weight and body shape.

People with bulimia nervosa might also talk a lot about body weight and body shape, and always go to the toilet after meals. They often feel out of control, guilty and ashamed.

Physical signs and symptoms of bulimia nervosa include:

• dehydration
• fatigue
• swollen or puffy cheeks
• discoloured or damaged teeth or gums
• sores on the knuckles and back of hands
• frequent changes in weight (weight gain or weight loss)
• loss of menstrual periods or irregular menstrual periods.

The long-term consequences of bulimia nervosa can be severe and include:

• damage to the teeth, gums, mouth and oesophagus
• osteoporosis
• problems with the heart and kidneys
• a higher risk of suicide.

What to do if you notice the signs of bulimia nervosa

If you notice that your child has changed eating habits, mood and behaviour, particularly in relation to food, you need to talk with your child and a health professional as soon as you can.

It’s best to keep your conversations with your child calm and non-judgmental. Emphasise your concerns about 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 first visit your GP or a mental health professional and ask for help. You can also contact the Butterfly Foundation by calling the free national helpline on 1800 334 673, or using email or 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 than later on. If you step in early, you might be able to save your child from intensive treatment and a very long recovery time.

Diagnosing bulimia nervosa

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 your child has bulimia nervosa and recommend appropriate treatment.

Treatments for bulimia nervosa

There is no single treatment that will work for all cases of bulimia nervosa. Treating bulimia nervosa requires a team of health professionals who have expertise in different areas.

Doctors will prescribe different treatment plans for different children, depending on age, the stage of the illness, the type and severity of the bulimia, the underlying causes and many other factors.

Psychological therapy
If your child has bulimia nervosa, he might need psychological therapy. This kind of therapy might include:

• one-on-one sessions with a psychologist or therapist
• group therapy – working with a group of people who also have eating disorders
• family therapy – having the whole family or part of the family come in and work with a psychologist or therapist.

Medications
Selective serotonin reuptake inhibitors (SSRIs) are antidepressant medications that are sometimes used in the treatment of 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 some medications that might help treat these conditions.

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

Hospital treatment usually focuses on providing support at regular mealtimes to encourage children to eat healthy food and gain weight. It might also involve close supervision to help prevent purging. Children might be given fluids and medication to treat dehydration and electrolyte imbalances.

With treatment, people can recover from bulimia nervosa, but it’s also possible to relapse. If you notice that your child is showing the symptoms of bulimia again, see your doctor as soon as possible.

Causes of bulimia nervosa

There is no single cause of bulimia nervosa. But there are some factors that can put children and teenagers 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
• gender – girls are at higher risk than boys
• dieting
• a family history of bulimia nervosa.