Understanding Bulimia Nervosa inclusive of symptoms, causes, types, risks of, and most importantly what treatment looks like and how recovery is possible

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Eating disorders ravage the mind and the body. They rob you of social joys; freely eating out on a Tuesday, enjoying brunch on a Sunday, and eating ice cream on a Wednesday because it’s scorching hot and simply nothing else will do. Eating disorders are sneaky and manipulative, leaving you with little autonomy and authority over your decisions. They are deceptive and convincing, conjuring a ton of anxiety and even more fear. So why would anyone ever choose any of the above? The simple answer is they don’t. No one chooses to develop an eating disorder; in the same way no one chooses a life of addiction or disease. Eating Disorders are thrust upon us for many reasons, many of which are unknown! We can’t always prevent eating disorders from manifesting or developing, but what we can do however, is help treat them when they’re too much to take on alone. Providing comfort, solace, and compassion, offering support and love, patience, and commitment. Having an eating disorder may make you feel wildly alone and entirely isolated, forcing you to idealistically take comfort in the disorder but the truth is and always will be you are simply never alone. Help is abundant and support is bountiful. 

A particular eating disorder that may need all the above, plus a little extra is that of Bulimia Nervosa. An eating disorder characterized by relentless binge, purge, restrict cycles keeping the individual who is suffering in a cyclical way of living that is frankly, no way to live at all. Bulimia Nervosa keeps the mind in constant upheaval, perpetually committing to “never again!” all the while doing it over, and over, and over again. The exhausting Mary-go-round may seem like a complete circle, no breaks in sight, constantly in motion. But! For those struggling with Bulimia Nervosa, know that it is never necessary to suffer in silence, carrying the burden alone. Sustained and long-term recovery is possible, the future can be brilliant, filled with lightness, brightness, and freedom. 

What is Bulimia nervosa?

Bulimia Nervosa is a serious eating disorder characterized by recurrent and cyclical behaviours inclusive of binging followed by purging, and often restricting. Binging is identified as uncontrolled overeating to the point of extreme discomfort or eating an inappropriate amount of food in an inappropriately small window of time. Purging is the behaviour which directly follows the binge and can include self-induced purging, overuse of laxative, diuretics, extreme exercising, etc. Often those with Bulimia will also severely restrict themselves to compensate for the binging and purging. However, the restriction generally leads almost directly to a binge and thus the cycle continues. Binging and purging can happen multiple times a day. Purging behaviour can also follow any/all consumption, not just a binge. 

What are types of Bulimia Nervosa?

There are two types of Bulimia; Purging type and non-Purging type. Bulimia inclusive of purging is the most prominent type of Bulimia. The purging type encompasses self-induced purging post binge episodes, or after any consumption. Purging type also includes the misuse of diuretics and laxatives. Purging type is an attempt to physically remove all that has been consumed in the prior binge. Non-purging includes heavily restricting consumption and excessive over exercising post binge as compensatory behaviour. Both types follow a binge and are an attempt to mentally and physically compensate, sometimes seen as punishment for the binging. Both types of Bulimia are directly correlated to actively avoiding weight gain. 

What are the causes of Bulimia Nervosa?

Like all other eating disorders, there are no direct causes of. Eating disorders are pervasive and can manifest differently in those who suffer from them. Eating disorders most often develop in adolescence and when left untreated can last a lifetime. Even though there are no definitive causes of eating disorders, there are situations, emotional states, and experiences that are oftentimes shared amongst all who are diagnosed with an eating disorder. They are below however, not limited to:

– Trauma

– Emotional + physical abuse

– Familial influence

– Genetics

– Personality type

  • Ie: perfectionist, obsessive tendencies

– History of dieting

– Comorbid emotional and mental health struggles

  • Ie: anxiety, depression, obsessive compulsive disorder

How is Bulimia Nervosa diagnosed?

Bulimia Nervosa can be officially diagnosed by a healthcare profession, be it family physician, psychiatrist, or psychologist. There are few physical tests that can be administered to categorically diagnose someone with an eating disorder. However, someone who engages in frequent purging may show signs of degraded tooth enamel and an irritated esophagus as a result, often appearing puffy with sores or calluses on their knuckles. Bulimia Nervosa can be diagnosed in consultation with the individual; typically, they are engaging in frequent binging and purging, have intense and intrusive thoughts related to the cycle, and an irrational albeit real fear of gaining weight. 

What are signs and symptoms of Bulimia Nervosa?

Bulimia Nervosa, unlike the late stages of Anorexia, can be much more challenging to identify in an individual. Those with Bulimia can have fluctuating weight, appearing typical or unproblematic to an unaware or unobservant individual. However, eating disorders have a way of presenting themselves so that they become increasingly challenging for the individual to hide or disguise. Typical signs of Bulimia are as follows however, not limited to:

  • Intense preoccupation with weight, in particular gaining
  • Changing one’s wardrobe to wear baggy, loose clothing – hiding behind their clothes
  • Eating in private
  • Frequent bathroom use during and after meals
  • Eating large quantities of food in small or inappropriate windows of time
  • Over and excessive exercise closely following consumption

What are the health risks of Bulimia Nervosa?

The health risks associated with Bulimia Nervosa are at best, very serious. However, like all eating disorders, the health risks can become life altering and permanent if the eating disorder is not dealt with in a sustainable way. The following is a list of health risks associated with Bulimia:

– Tooth decay and/or erosion

– Irritated esophagus, possible esophagus tear or lesions

– Thinning hair

– GI upset

  • Bloating, constipation

– Interrupted sleep

– Swollen salivary glands

– Swollen face

– Sores or calluses on hands, specifically knuckles

– Dehydration 

What is the treatment for Bulimia Nervosa?

The treatment for Bulimia Nervosa follows a similar structure to that of treatment for other eating disorders. However, eating disorders are as unique as the individual who suffers from them, it is therefore critical that each treatment plan is tailored to the individual’s needs to guarantee recovery is sustainable for the long term. The team at EatWell ensures that all individuals in need of help, support, and guidance receive specific treatment that is best suited to them. In general, however, treatment for Bulimia Nervosa will encompass psychological support and nutritional support; EatWell is equipped to provide both. Getting to the root cause of Bulimia Nervosa may be an intensive process but critical to ensure sustained recovery and a future free of eating disorders. Nutritional support is also an important part of recovery to provide foundational information that the patient can refer to and use as support when making food choices in the future.


Q: Who does Bulimia nervosa affect the most?

A: Bulimia most often affects women, typically developing in adolescent girls. However, it is inaccurate and stereotypical to believe that eating disorders only impact women. Men are also susceptible to and suffer from eating disorders. It is believed that boys and men are underreporting their eating disorders due to the intense stigma and shame our society has placed on males who suffer from and are diagnosed with eating disorders. Eating disorders do not discriminate, they are found in all genders, races, religions, and cultures.

Q: When is Bulimia considered severe?

Bulimia is considered severe when there are 14 or more compensatory behaviours a week. Compensatory meaning purging, exercising, the misuse of diuretics and laxatives, etc. Quantifying Bulimia as severe, moderate, or mild is precarious as no amount of the above behaviours are healthy or acceptable, regardless of how often (or not) they are engaged in. 

Q: How does Bulimia affect pregnancy?

A: Bulimia can impact pregnancy greatly. An individual engaging in purging behaviour is removing and withholding critical vitamins, minerals, and sustenance from not only their body but the growing fetus. Complications can ensue for the fetus, pregnant individual, or both if Bulimia is active. An individual who is in recovery, with their eating disorder firmly in the past, can most certainly have a happy and healthy pregnancy though! 

Q: Why is Bulimia common in girls?

A: Eating disorders impact all genders, however they are seen most in girls. Young girls who are developing, experiencing rapid and at times, uncomfortable changes with their physical body and mental functioning. Puberty is a tremendously tricky time for both genders, however young girls are particularly susceptible to the societal pressures of what it means to be a woman today, with very specific and prescribed ways to look, dress, eat, and generally be. Eating disorders are at times a coping mechanism and a way for young girls to gain some semblance of control, in a world that feels entirely out of their control.