Bulimia Nervosa (BN)

What is Bulimia?

Bulimia nervosa is an eating disorder in which people find themselves binge eating followed by some sort of compensatory behaviour. Binge eating refers to when people eat a large amount of food in a short period of time, and experience a sense of loss of control. This is typically foods that are avoided as part of the person’s day to day diet, such as carbs, or foods that are seen as “sugary” or “fatty”. However, some people may find that they binge on “healthy” foods, for example eating large amounts of fruit or veg. Crucially, this must be accompanied by a sense of loss of control - that it’s not possible to stop - rather than someone choosing to eat a large bar of chocolate or sharing in a large meal with others.

Bingeing may initially give a sense of relief, release or numbness, but is often followed by feelings of guilt or shame. People then try and “compensate” for the bingeing. Often it is assumed that this is by vomiting or taking laxatives (both purging behaviours). Whilst that is very common, people can also compensate for bingeing by exercising or restricting (for example skipping their next meal). All of these behaviours would be indicative of bulimia nervosa.

People with bulimia nervosa typically have some sort of body image disturbance - whether that is an overwhelming desire to lose weight, a fear of gaining weight, or a very negative view of their current body. This often reinforces the eating disorder, by feeding back into the drive to try and lose weight or follow strict dietary rules, or by feeding into self-critical thoughts or feelings.

What is the best treatment?

The typical treatment for bulimia is CBT-E, a form of CBT designed specifically for eating disorders. Research trials have shown this to be an effective form of treatment for many. However, alternative treatments can be considered, especially when people have not found CBT to be effective in the past, or do not feel CBT is the right fit for them. These include schema therapy, compassion focussed therapy and dialectical behaviour therapy.