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Bulimia Nervosa

Many clients enquire about therapy because they have concerns about their eating.  I have previously worked for many years within an NHS Specialist Eating Disorder service. Therefore, if you or someone you care about is worried about their eating, I hope that you find these  ‘Eating and Body Distress’ articles helpful. You may also be interested in the teaching sessions on Eating Disorders and Body Distress at Nine Teaching.



What is Bulimia Nervosa?


Bulimia is a serious mental illness where people feel that they have lost control over their eating and evaluate themselves according to their body shape and weight. People with bulimia are caught in a cycle of eating large quantities of food (called ‘bingeing’), and then vomiting, taking laxatives or diuretics (called purging), in order to prevent gaining weight. This behaviour can dominate daily life and lead to difficulties in relationships and social situations. Usually people hide this behaviour pattern from others and their weight is often in a healthy range. People with bulimia tend not to seek help or support very readily and can experience swings in their mood as well as feeling anxious and tense.


They may also have very low self-esteem and self harm. They may experience symptoms such as tiredness, feeling bloated, constipation, abdominal pain, irregular periods, or occasional swelling of the hands and feet. Excessive vomiting can cause problems with the teeth, while laxative misuse can seriously affect the heart. Bulimia in children and young people is rare, although young people may have some of the symptoms of the condition. Bulimia usually develops at a slightly older age than anorexia. In some instances, although not all, bulimia develops from anorexia.



Early warning signs of Bulimia Nervosa include:


•   Bingeing and purging

•   Secretive eating and/or missing food

•   Visits to the bathroom after meals

•   Preoccupation with food

•   Weight fluctuations

•   Self-injury

•   Excessive and compulsive exercise regimes — despite fatigue, illness, or injury

•   Abuse of laxatives, diet pills, and/or diuretics

•   Swollen parotid glands in cheeks and neck

•   Discoloration and/or staining of the teeth

•   Broken blood vessels in eyes and/or face

•   Calluses on the back of the hands/knuckles from self-induced vomiting

•   Sore throat

•   Heartburn/reflux

•   Feelings of shame and guilt

•   Self-criticism and low self-esteem

•   High levels of anxiety and/or depression


Health Complications of Bulimia Nervosa


•   Electrolyte imbalances that can lead to irregular heartbeat and seizures

•   Swelling

•   Dehydration

•   Vitamin and mineral deficiencies

•   Gastrointestinal problems

•   Chronic irregular bowel movements and constipation

•   Inflammation and possible rupture of the esophagus

•   Tears in the lining of the stomach

•   Chronic kidney problems/failure

•   Tooth decay


Treatment Recommendations


NICE recommendations:


Patients with Bulimia Nervosa (B/N) can experience physical problems as a result of a range of behaviours associated with the condition. Awareness of the risks and careful monitoring should be a concern of all healthcare professionals working with people with this disorder”


Physical Management:

Patients with B/N who are vomiting frequently or taking large quantities of laxatives (especially if underweight) should have fluid and electrolyte balance assessed


Patients should be encouraged to follow an evidence-based self- help programme:

•   Direct encouragement and support to patients undertaking self-help as may improve outcomes

•   CBT-BN (now CBT-E), specially adapted form of CBT offered to adults with BN, 16-20 sessions over 4-5 months

•   No response, or refusal of CBT, other psychological treatments to be considered

•   IPT can be offered as an alternative, but can take 8-12 months to achieve results comparable with CBT


What to expect from therapy for Bulimia Nervosa


If you have a diagnosis of Bulimia Nervosa, or symptoms that are consistent with this diagnosis, we may need to agree that your GP or other healthcare professional will need to be involved with your care.  This is to manage the physical health complications associated with the disorder. Whilst this may sound daunting, it does not mean that your GP will know anything about what you discuss in therapy, the content of your sessions will remain confidential between you and your therapist.


You will be offered an initial consultation which will look at your symptoms, and what is troubling you most at the moment. We will also consider your motivation levels and whether you are ready to make changes at this stage. We understand that talking about food and behaviours around food can be embarrassing and it may be that your treatment focuses on other areas of your life to begin with, to help you to improve your confidence and self esteem.


Sometimes, an eating disorder can develop due an earlier traumatic experience. You may or may not link the development of your eating disorder feelings and behaviours with this experience. By treating the trauma, it is possible that the current eating difficulties begin to resolve.


Therefore, what you can expect from your therapy is that you will not be discussing food and weight at each of your sessions.  Neither will you be weighed during your sessions, However, if your weight is at a critically low point (this will be discussed with you at consultation), then it may be that therapy is not the right course of action at this time. Furthermore, if your weight is very low, we will make an agreement about how your weight is reported back to therapy, to ensure that all the associated physical health risks can be taken care of by your GP or other health professional.


The NICE approved psychological therapies that are available to help you with your Eating Disorder include:


Cognitive Behaviour Therapy - adapted for Eating Disorders (CBT-E)

Guided Self Help

Eye Movement Desensitisation and Reprocessing (EMDR) for trauma and phobias

Motivational Therapy

Dialectical Behaviour Therapy (DBT)

Cognitive Analytic Therapy (CAT)


I would like to get help for my eating disorder, what shall I do?


First and foremost, contact your GP.  You may live in an area where you can receive free care from an NHS specialist eating disorder service.


B-EAT is a leading eating disorder charity. Please consult their pages for more information and sources of support.


If you are in the North West area, and you are looking for private therapy, then please contact Nicola at Nine Wellbeing to find out more.




Please note that if you are making contact about someone you are concerned about, we will try to answer any queries, but should your loved one engage in therapy with us, unless they are at an immediate risk of serious harm, or we believe that they lack capacity to make treatment decisions, the content of their therapy sessions will remain confidential, We understand that this can be very stressful and frustrating for loved ones and carers, but please be assured that if we thought there were immediate risks, we would be liaising with their GP or their named contact.

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