Bulimia Nervosa: Symptoms, Risks & Treatment

Bulimia Nervosa is an eating disorder characterised by an intense preoccupation with body weight and shape, where self-worth is heavily influenced by achieving a specific weight or appearance ideal. People with bulimia often experience low self-esteem, body dissatisfaction, and perfectionistic traits.

Common cognitive distortions include:

• All-or-Nothing Thinking: “I can eat the whole box of chocolates or none at all.”
• Overgeneralisation: “When I ate carbs I gained weight, so I can’t eat them at all.”
• Magnification/Minimisation: “If anyone notices I’ve gained weight, I can’t go out.”
• Disqualifying the Positives: “They say I look healthy, but they really mean I’ve gained weight.”

The Cycle of Bulimia

Bulimia often involves a cycle of restrictive dieting, binge eating, and compensatory behaviours:

1. Extreme dieting or rigid eating rules are developed to prevent weight gain
2. Rules are broken, triggering guilt and loss of control
3. Binge eating occurs, often consuming a large amount of food in a short period
4. Compensatory behaviours such as vomiting, excessive exercise, or laxative use follow

This cycle reinforces negative self-beliefs, low self-esteem, and fixation on body image. Physiological factors like starvation reactions can make binge urges feel uncontrollable, further perpetuating the cycle.

Prevalence of Bulimia

• Around 4% of Australians have an eating disorder, with 12% experiencing bulimia nervosa (Butterfly Foundation, 2012).
• Many sufferers hide their behaviours due to shame, guilt, and disgust.
• Bulimia is increasing among boys and men (NEDC, 2012).

Risk Factors for Bulimia

Factors that may increase vulnerability include:

• Low self-esteem or perfectionistic tendencies
• Overvaluing appearance in self-worth
• Depression, anxiety, or chronic stress
• Trauma or challenging life events
• Social isolation or pressure from peers/family
• Socio-cultural influences (media ideals of thinness/muscularity)
• Participation in activities emphasizing body shape, such as gymnastics, dance, or athletics

Health Consequences of Bulimia

Bulimia is serious and potentially life-threatening. Physical complications can include:

• Erosion of dental enamel and chronic sore throat
• Gastrointestinal issues (constipation, diarrhoea, ulcers)
• Electrolyte imbalances, irregular heartbeat, increased risk of heart failure
• Hormonal disruptions, irregular or lost menstrual cycles, fertility issues
• Osteoporosis due to poor nutrition

Psychologically, bulimia can negatively affect relationships, work performance, and social engagement.

Psychological Treatment for Bulimia

Treatment addresses both cognitive and behavioural aspects, aiming to restore healthy eating and reduce the reliance on compensatory behaviours.

Typical Treatment Process

1. Assessment: Understanding eating patterns, beliefs about body shape and weight, and other life struggles (relationships, anxiety, depression, self-esteem).
2. Broader Life Goals: Exploring values, purpose, and developing a richer sense of self.
3. Understanding Influences: How cultural ideals, family, peers, and exposure to diets or gym programs have shaped beliefs about weight.
4. Self-Monitoring: Keeping a record of eating patterns, emotions, and contexts for bingeing.
5. Weighing Guidelines: Reducing anxiety by limiting weigh-ins to once per week.
6. Education: Understanding healthy body weight, nutrition, and the ineffectiveness of purging.
7. Healthy Eating Plans: 3–4 meals plus 1–2 snacks daily, spaced 3–4 hours apart, mindful eating, and avoiding distractions like TV while eating.
8. Managing Urges: Learning strategies to cope with binge urges, including engaging in pleasurable activities that reinforce self-worth.
9. Cognitive Strategies: Evaluating unhelpful thoughts and encouraging behaviours guided by health and self-care values.

Recovery is possible with early intervention, willingness to change, and multi-disciplinary support, including psychologists, dieticians, and GPs.

Getting Help for Bulimia

If you suspect you have bulimia, speak to your GP for referrals. At CBT Professionals, our experienced psychologists and dieticians on the Gold Coast provide collaborative, evidence-based support to help restore healthy eating, self-worth, and wellbeing.

Next Steps:

1. Download our Referral Information Sheet
2. Take it to your GP during an extended consultation
3. Begin therapy with our clinical psychologists and dietician team 

FAQs 

What is bulimia nervosa?
Bulimia is an eating disorder marked by cycles of binge eating and compensatory behaviours like vomiting or excessive exercise.

What causes bulimia?
Bulimia is influenced by a combination of psychological, social, and cultural factors, including perfectionism, low self-esteem, trauma, and societal pressure.

Is bulimia dangerous?
Yes. Untreated bulimia can lead to serious physical, psychological, and social complications.

Can bulimia be treated?
Yes. Evidence-based psychological therapies, dietetic support, and medical monitoring can help recovery.

How do I start treatment?
Speak with your GP to get referrals to a psychologist and dietician for a multi-disciplinary approach.