What is bulimia nervosa?

Bulimia nervosa is an eating disorder and mental health issue where a person regularly eats large amounts of foods in a short space of time (bingeing), then tries to get rid of the food and the calories they contain (purging). Purging can take be done in many ways, e.g. vomiting, taking laxatives or doing too much exercise.
Bulimia nervosa is often linked to low confidence and anxiety. As with other eating disorders, food is used as a way of dealing with emotional problems. Bulimia nervosa is thought to be more common than anorexia nervosa, but is just as serious. It has been estimated that 4 in 100 women experience bulimia nervosa at some point in their lives (Royal College of Psychiatrists August 2015). Recently there has been more awareness of eating disorders in men. This has meant that doctors have been better able to identify eating disorders in men. Although men are still more likely to be underdiagnosed, misdiagnosed and under-referred.
In anorexia nervosa, it was often hard to tell when restricting food turned into a full blown illness. However, people we spoke with who had bulimia nervosa could often remember the first few times that they had binged or purged. Looking back, people often connected bingeing and purging to certain events or ‘triggers’, often emotional. Purging often became a way of dealing with anxiety, upset, anger or even boredom. Typically people said that they would binge to ‘cover’ up negative feelings of anger or sadness. Guilty feelings resulted from eating too much, and purging was a way to try to get rid of the guilt. The cycle of bingeing and purging was damaging and could lead to feelings of guilt and shame.

Emily describes the cycle of bingeing and purging and the emotions that kept the cycle going.

Age at interview 21

Gender Female

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It would be like a mental tally in my mind what I’d eaten throughout the day, and if say for instance I had something that I class as bad like a chocolate bar or something, then, and I didn’t make myself sick, then that would kind of weigh on my mind for the rest of the time and I’d go through the rest of the day feeling really rubbish about myself and thinking

And sometimes it’ll be a case of like Oh well I’ve had a rubbish day now anyway like going to, it’s, I’ve done really badly I might as well eat whatever I want because it’s not so then I’d eat a lot of really bad things for me, and then it would be inevitable that I’d make myself sick anyway. So it was kind of, like it would get worse like that. But if, yeah, so it was a constant weighing on your mind that you’d eaten something bad and if, knowing that if you’re, if I made myself sick then I wouldn’t have that weighing on my mind. It was like it never happened, so I got to kind of enjoy eating whatever it was but I now don’t even have to have the bad consequences of it. So it was, it’s like in a warped kind of way I made it into a kind of a win win situation in my head. Like I didn’t see anything wrong with it, I kind of thought it was you know a good thing to be doing, or not a good thing but it made sense to be doing and.

Yeah like immediately beforehand it would just be like I couldn’t think of anything else but like I knew I just had to do it, there was, it was like I had no choice, so I just felt so like fat and disgusting and like just un it was just unbearable and like yeah unbearably kind of greedy, and like overindulgent and things. So I’d be like well if I make myself sick then it won’t like, I won’t feel like this anymore, I’ll, I’ll have the opportunity of getting skinnier and you know it won’t happen again. I won’t do something that stupid, like eat that much again. That was like, I’ll just get this, get this one out of the way and then I’ll start again, I won’t do this again.

And then I’d make myself sick and then I’d like, it would immediately be off my mind, like immediately like a relief, like I wouldn’t, I didn’t have all this fatty horrible food inside me and I wasn’t like, okay I’d messed up and not eaten the right things and I, like I’d done wrong by eating lots of really bad fatty things, but at least I didn’t have to kind of pay the consequences for it. And I didn’t have to yeah I didn’t have to have all these extra calories inside me, they were now forgotten about, they were out of the way. They weren’t in me anymore so I can now go on and, and like build and have it, and just eat good things for now and it would be better, and I’d be skinny and life would be brilliant.

But yeah, so after the feeling, like relief and like it was out of the way and it would, things would get better, like inevitably if you eat something else bad or that you class as bad you know that last time you felt so much better after making yourself sick and you felt like you didn’t have to worry about it. So you eat something and then the worry’s there again.

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People often described bulimia nervosa as ‘habitual’, and as something that became a normal part of their lives. It soon took over and they described how the ‘binge & purge’ cycle controlled every aspect of their lives becoming ‘life-absorbing’. Sam said that maintaining bulimia nervosa was like ‘a full time job with overtime’. It would often get worse at particular times. People could binge several times a day, followed by weeks or months of not bingeing as frequently. Bulimia nervosa often goes unnoticed for a long time as it is not usually associated with dramatic weight loss, and people often hide it from others.

David’s bulimia nervosa started as a one off, making himself sick after eating a takeaway…

Age at interview 22

Gender Male

Age at diagnosis 19

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I remember just eating a massive Chinese on my own, purely on my own. And I’d had, you know, I just, I’d got to the point where I sort of was rewarding myself I guess for having lost lots of weight, so I went, Okay I’m gonna have a Chinese and I didn’t just have a Chinese, I had about a three person portion of Chinese. And then felt so horrendously guilty for doing it and I remember doing it, I still remember that, that evening. Just what, I wonder if I made myself sick if it’s gonna make a difference

So I did, and it was a purely a one off. I then went back into the, just eating, I say healthily, dieting, carrying on. And I didn’t do it again for, for a long time. And then I wasn’t getting the comments again I guess, or I wasn’t losing weight as much as I wanted to and so it happened again. And, and somehow, I don’t, I can’t even pinpoint when it became a habit that was happening at all the time, on a daily basis. I can’t remember when that started. It, I just remember suddenly realising one day, this is happening everyday now, it’s, this is a little out of control. it’s not just a, I’ve eaten lots and it’s a one-off. This is, I’ve eaten hardly anything all day and yet I still want to do it, which is obviously an unhealthy aspect of it.

And soon before I guess I knew it became a habit. A habit that my parents worked quite a lot and aren’t often home, so it wasn’t anything hard for me to hide. Again at work, I worked for a very lenient company where if I disappeared off to a toilet, you know, so on for a little period of time it wasn’t really noticed. So that it just became an essential part of my life and at the age of 19 it, it was just part of my life. I would eat a lot of food and then I would make myself sick. To the point where I stopped the dieting. It was having the effect I wanted it to so I was eating as I pleased, gorging on food if I wanted to and then obviously purging myself in the evenings or at lunchtimes at work.

And it did after I’d say about a year, you know I was still 19, probably coming onto 20, that’s when I first realised it had become a part of my life and I remember it scaring me. And thinking actually this isn’t normal. This isn’t actually what other people do. And then kind of wanting to, to talk about it, but not wanting anyone close to me, friends or family, knowing what I was doing or what was happening, you know, they, they were congratulating me for weight loss which as far as they were concerned was down to me dieting and exercising, not down to the real reason.

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There are similarities and differences between the types of eating disorder but many of the thought patterns and feelings are similar. It could also be the case that two people who have been diagnosed with the same eating disorder might experience different symptoms. One person’s diagnosis could change over time from bulimia nervosa to anorexia nervosa, or vice versa. Many had experienced both restricting (limiting the amount of food eaten) and bingeing and purging. People often said they had found bulimia nervosa harder to deal with, because there were less services and help available but also because they found it emotionally harder. Also, it could be difficult for other people to realise that a person with bulimia was ill because they would expect them to be underweight. People felt that bulimia, particularly bingeing, showed a lack of control while restricting was often the result of needing to exercise control over their lives. They commonly described bulimia nervosa as a ‘disgusting’ condition and felt they were being ‘greedy’ and ‘overindulgent’.

When Rebekah was ill with anorexia nervosa there was much more help available than when she tried…

Age at interview 18

Gender Female

Age at diagnosis 16

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But what I realised with bulimia was that, you know when I was ill with anorexia you know, they all sort of, like they, oh there was so much more help available, and when I was trying to get help for bulimia it just wasn’t any sort of availability, there wasn’t any services, there weren’t any resources, there wasn’t nothing, and so I found it really like angry and frustrated like. You know I’m, I may seem okay but really I’m struggling.

And I just think there should be something for people that are suffering with bulimia, because it is kind of hard to break that cycle of the whole binging and purging, and I know if you’ve not got the support at home, and you’ve not got anyone you know sitting you down with meals and afterwards, it can be quite hard to not do it, so I think even if like some sort of outpatients sort of help, like you know go for your meals or, but I don’t, if there isn’t, well not where I live there isn’t, I’m not sure about the rest of the country.

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Zoe found it harder to cope with bulimia than anorexia. Restricting gave her a sense of control,…

Age at interview 23

Gender Female

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Why do you think it (bulimia) was worse for you or made you feel worse than anorexia or restricting?

I think because when you arewell, I think several reasons. Because my whole my whole thing is about control, you know. It still is and it probably always will be. I like to be in control and this was not in control. This was disgusting, out of control. I, even though my whole anorexia thing wasn’t about being thin, the fact that I started to feel very disgusting and actually, started to feel a lot worse about my body. And also, I think it was hard, inside I was really sort of crumbling and quite distressed and quite like psychologically still having a lot of issues. But everyone else thought, Oh, she’s done so well. She beat anorexia. Gosh, she’s, you know, this case casebook, you know. She’s done such a great job with the anorexia And they didn’t realise what was going on behind the scenes as it were.

And I really and it wasn’t and because it sort of, it felt quite disgusting and quite greedy. It wasn’t something I wanted I felt comfortable talking about, whereas anorexia, you know, you’re not eating. it’s not good but it’s not you’re not sort of over indulging and, yeah.

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Different aspects of the experience of Bulimia nervosa have been covered across this section of the website.

What is anorexia nervosa?

Anorexia Nervosa is an eating disorder and mental health condition where the person will severely limit or 'restrict' the amount of food they have, for...