Does someone you know have bulimia?

Publication Date:23/04/2008

The eating disorder bulimia has been in the headlines recently, showing that you don’t need to be a teenage girl to have a problem with food. Bulimia is an illness that can cause serious health problems and make people very unhappy. But would you know if a friend or relative had it? And what can you do to help?

What is bulimia?

Bulimia is a condition where people have bouts of uncontrolled eating, after which they try to get rid of the food they’ve eaten. They may make themselves sick, take laxatives or slimming pills, or exercise excessively to work the food off. This is called bingeing and purging.

Unlike anorexia nervosa, people with bulimia may be a normal weight, or even overweight. People often feel very ashamed of the way they binge and purge. They usually try to hide it, and find it hard to ask for help. So it’s not easy for other people to spot.

How would I know if someone had bulimia?

If someone has bulimia, they may have an obsessive interest in eating, staying slim, and counting calories. They may worry a great deal about their weight and size, even if they’re not overweight. People with bulimia crave food and may find food comforting. Most sufferers are women, but the condition also affects some men.

Binge eating is often done secretly. But if you live in the same house as someone who has bulimia, you may notice large amounts of food going missing.

If someone is purging after eating, you may notice that they go to the toilet very often, or immediately after meals. There may be a tell-tale odour if someone is making themself sick repeatedly, or their teeth may be discoloured because the acid will strip away the enamel. Dentists may notice if their patients have bulimia, before other people realise.

What problems does bulimia cause?

As well as causing emotional distress, bulimia can lead to long-term health problems. These include:

Kidney stones, because vomiting upsets the balance of fluids in the body
Damage to the tube that carries food from the mouth to the stomach (the oesophagus)
Constipation, from over-use of laxatives.

People with severe bulimia may also have heart problems, from an imbalance of salts in the body. Women with bulimia may have trouble getting pregnant.

But with treatment, many people with bulimia recover from their condition. About half of people with bulimia recover completely. About 3 in 10 improve a great deal, but still sometimes have problems. And about 2 in 10 still have bulimia.

What treatments work for bulimia?

There are two main types of treatment: a talking therapy (called cognitive behaviour therapy) and medicines. Sometimes people have one or the other, and sometimes they have the two types combined.

Research has found that cognitive behaviour therapy (CBT) is the best talking treatment for bulimia. If you have CBT, you meet regularly with a therapist trained in this treatment. You work with them to find positive ways to think about food. You learn to challenge unhelpful thinking, such as thinking you’re useless because you can’t live up to impossible standards you set yourself. Feeling better about yourself can be the first step to overcoming bulimia.

Research has also found that antidepressant medicines can help some people with bulimia. The antidepressant most often used to treat bulimia is fluoxetine (brand name Prozac). Another medicine which looks promising is called topiramate (Topamax). This drug is more often used to treat epilepsy, but doctors have found it also works well for bulimia.

Bear in mind that all medicines can have side effects and some medicines are not suitable for everyone. Someone with bulimia will need to weigh up the benefits and possible side effects of medicines with their doctor, in order to decide the right treatments for them.

What should I do now?

If someone you know has bulimia, or you think they may have bulimia, the best thing you can do is persuade them to see a doctor. It’s possible to get over bulimia, but it’s much easier with professional help.

If you have bulimia yourself, it’s really important to get help. It’s not easy to admit to having bulimia, but doctors are used to hearing about all sorts of problems. Your GP should be able to help, or refer you to a specialist or counsellor who can.

To find out more about services for bulimia on the NHS, see the National Institute for Health and Clinical Excellence booklet Understanding NICE guidance: eating disorders. It’s available on the NICE website (http://www.nice.org.uk).

To find out more about eating disorders, see our information on bulimia and anorexia.

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This information does not replace medical advice. If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.