Bulimia nervosa

Learn about bulimia nervosa, including how to spot the symptoms and how the eating disorder impacts on a person's life.

Media last reviewed: 18/03/2013

Next review due: 18/03/2015

NICE guidelines

The National Institute for Health and Care Excellence (NICE) has issued guidance to the NHS on eating disorders. It is mainly aimed at people with eating disorders, but the information may also be helpful for family members and those who care for people with eating disorders.

The NICE guidelines contain information on:

  • caring for someone with an eating disorder
  • what you can expect from the NHS if you have an eating disorder
  • support and treatment if you have bulimia nervosa
  • support and treatment if you have anorexia nervosa
  • support and treatment if you have another type of eating disorder, including binge eating

For more information, see the NICE guidelines on eating disorders.

Bulimia nervosa is an eating disorder and mental health condition.

People who have bulimia try to control their weight by severely restricting the amount of food they eat, then binge eating and purging the food from their body by making themselves vomit or using laxatives

As with other eating disorders, bulimia nervosa can be associated with:

Learn more about the causes of bulimia nervosa.

Binge eating and purging

Eating disorders are often associated with an abnormal attitude towards food or body image.

Everyone has their own eating habits  for example, people with a food intolerance need to avoid eating certain foods to stay healthy. However, people suffering from eating disorders tend to use their eating habits and behaviours to cope with emotional distress, and often have an abnormal or unrealistic fear of food, calories and being fat.

Because of this fear, people with bulimia nervosa tend to restrict their food intake. This results in periods of excessive eating and loss of control (binge eating), after which they make themselves vomit or use laxatives (purging). They purge themselves because they fear that the binging will cause them to gain weight, and usually feel guilty and ashamed of their behaviour. This is why these behaviours are usually done in secret.

Such binge-purge cycles can be triggered by hunger or stress, or are a way to cope with emotional anxiety.

Warning signs

Signs of bulimia nervosa include an obsessive attitude towards food and eating, an overcritical attitude to their weight and shape, and frequent visits to the bathroom after eating, after which the person might appear flushed and have scarred knuckles (from forcing fingers down the throat to bring on vomiting).

Read more about the symptoms and warning signs of bulimia.

Bulimia can eventually lead to physical problems associated with poor nutrient intake, excessive vomiting or overuse of laxatives. Read more about these complications of bulimia.

Who is affected by bulimia nervosa?

As with all eating disorders, women are much more likely to develop bulimia than men.

However, bulimia nervosa is becoming increasingly common in boys and men. There are an estimated 1.6 million Britons suffering from some form of eating disorder, and reports estimate that up to 25% may be male.

Recent studies suggest that as many as 8% of women have bulimia at some stage in their life. The condition can occur at any age, but mainly affects women aged between 16 and 40 (on average, it starts around the age of 18 or 19).

Bulimia nervosa can affect children, but this is extremely rare. 

What to do

If you have an eating disorder such as bulimia, the first step is to recognise that you have a problem. Then, you need to visit your GP for a medical check-up and advice on how to get treatment.

If you think someone you know has bulimia nervosa, talk to them and try to persuade them to see their GP.

There are also many support groups and charities you can approach for help, including:

Read about diagnosing bulimia.

The first step towards getting better is to recognise the problem and to have a genuine desire to get well.

There is strong evidence that self-help books can be effective for many people with bulimia nervosa, especially if they ask a friend or family member to work through it with them.

If this is not suitable or is unsuccessful, your GP can refer you for treatment to an eating disorder service, where you may be offered a structured programme of cognitive behavioural therapy (CBT). Some people may also benefit from antidepressant medication (fluoxetine), as this can reduce the urges to binge and vomit.

Read more about the treatment of bulimia.

Page last reviewed: 12/08/2014

Next review due: 12/08/2016


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The 10 comments posted are personal views. Any information they give has not been checked and may not be accurate.

smarties24 said on 17 November 2014

I have had bulimia for about 2 years now but im still considered over weight because i don't restrict all the time only when my depression gets out of control then i go through cycles of binging and purging. because im not underweight im scared to seek help as i dont feel i will be taken seriously. do i have to be underweight before someone will help me?

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Loupy92 said on 25 August 2014

Lil Lizzie: I have had bulimia for 3 and a half years and recently went to see my GP, recognising that I had a problem. It's important that your step-daughter wants help, in my opinion the first step to getting better is wanting to do it yourself - not just because everyone is telling you to - which can make you feel trapped. Not that I think you should not try and help her but maybe think of gentler ways to do it. Try and gently suggest going to the GP if she hasn't been already. It's important for all the family to understand that it is an illness and not something we can just switch off.

It can start anywhere - for me personally it was a fear of failing and I used it as a means of control - it quickly escalated to controlling me all day, everyday but everyone is completely different - she may not know how it started herself yet.

When I went to my GP she was lovely, very understanding and non-judgemental, asking a few questions and getting blood tests sorted to check for any issues. She arranged a referral to a counselling service and I started that very recently.

I hope this helps a little and I wish you all much luck, particularly your step-daughter.

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Lil Lizzie said on 12 August 2014

Hi. My step daughter has recently been diagnosed with bulimia. I really would like to understand more about it & what causes it. At the moment everyone's just telling her to eat & every conversation seems to revolove around what she's eaten 7 kept down that day. I feel that this is the wrong way to deal with it has she's just going to feel like we're ganging up on her. I want to understand more about it so I can support her constructively.
Any help/advice anyone can give would be greatly appreciated.
Many thanks, Lisa

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spottydog123 said on 08 June 2014

Please ignore my user name, I literally made this account to comment here.

I did this because of the comment bellow, and how similar my experience was. I am 21 years old, and have been bulimic since around my 18th birthday. Severity has varied, but at around 19 I became incredibly depressed, and never left the house. I binged and purged 6 or 7 times a day, spending the rest of the time exhausted. I gained weight, from the calories absorbed, and so appeared to be quite chubby.
I eventually decided to go to the doctor, but when I explained that I had an eating disorder she looked rather unimpressed and uninterested. I didn't 'look' like I had an eating disorder. She said she would refer me for help, but I doubted her sincerity, and indeed when I called 6 weeks later to check on my referral it had never been submitted.

I do blame that doctor for denying me access to the help I desperately needed at that time, (technically still do... though truthfully I don't have the desire any more). That said, I understand that in an over-taxed under-resourced operation such as the NHS one has to make face-value judgements on a patients priority to treatment. But if this is a repeated error (i.e. that those who are not underweight don't get treated), then perhaps we should make efforts to re-educate doctors on the common characteristics and emotional severity of bulimia. And then again, as someone has said bellow, perhaps we should completely renovate our methods to treat it anyway.

Just my thoughts. Whatever it is, currently, it is not something we are getting right.

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Scaly93 said on 30 March 2014

I'm 20 and have been bulimic for 3 years now. I'm not sure how it all started but I can't remember ever having such a regular obsession with my weight and food. I weigh myself three times a day and I constantly think about what my next meal will be and how many calories I should eat and if I can be sick after.
I compare myself with other, thinner people and I wanting to be like them by not eating or making myself sick and at the same time feel guilty of I do eat.
I went to the dr initially for anxiety but when I mentioned my bulimia they didn't see it as worry or take it any further because I have a healthy bmi at 8st 3 and 5ft 2 so it was ignored. I now feel embarrassed because I'm not skinny yet I've had this problem for a while.
I feel as if the NHS left me more humiliated then helped and they will only help you if you are underweight which from my experience has accelerated the problem.

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weight matters said on 03 January 2014

hi just another brick.
please dont stop trying to get help, have you tried to get
counselling? Sometimes talking helps, if nothing else it
might help sort out your options

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just_another_brick said on 02 January 2014

I've been bulimic since I was 17, I'm now 30.

I've been to four GPs about the issue.

The first referred me to a clinic - I was young and 'I didn't need help' so I didn't go.

When I got particularly bad I saw the second GP. They gave me fluxotine and the citralopram. They made me feel better but I gained a lot of weight very quickly.

When I began to purge again the third doctor I saw for help said I was too obese to be a concern.

I'm now quite ill, vomiting blood at every purge. Since the third doctor's assessment I have lost 7st. When I visited the forth doctor I rejected fluxotine on account of my previous experience, she recommended a book.

I have no hope in the NHS and their treatment of eating disorders.

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Chris Davis Jones said on 08 December 2013

Hi Dan,

I can identify with you on this. I have had Bulimia for 2 years now. since the death of my partner. I was until recently continually visiting the gym and worried about my weight, I still am. I do visit my GP often and we are working together to help me through the condition.

My advice to you would be to visit your GP as soon as you can so that you can get some help with the condition. If you leave it too long it will (from my experience) take over your life.

I hope everything gets sorted out for you and that you are able to get some sort of advice and help. There are a lot of books out there to help with Bulimia too.

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Butterfly13 said on 25 July 2013

Hi Dan,
If I were you I would stop now before you lose control of it. It starts off feeling like you're making the choice to make yourself sick bt you soon lose a handle on it and you feel unable to have a meal without doing it. At that point you are no longer in control of the illness. I have suffered with Bulimia for ten years now and I know how much it can take over your life. You wrote this in January so I am really hoping that you managed to overcome these issues before they took hold of you.

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DanWhitmore said on 14 January 2013

I've been making myself be sick for over a week now after eating but without sticking my fingers down my throat. I'm aged 20 but since the age of around 16 I've always been aware about my body and afraid to gain weight even though I have a six pack I always believe and passionately want to be skinnier so sometimes I stop eating too.

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Getting help for bulimia

Find out about bulimia, including some of the common causes and how to get help