Bulimia Nervosa

The warning signs of Bulimia can be physical, psychological and behavioural. It is possible for someone with Bulimia to display a combination of these symptoms.

Psychological Symptoms 

  • Feeling a sense of loss of control while eating (e.g. feeling unable to stop yourself from eating)
  • Preoccupation with eating, food, body shape and weight
  • Fear of weight gain
  • Depression, anxiety or irritability
  • Low self esteem and feelings of shame, self loathing or guilt, particularly after eating
  • Distorted body image or extreme body dissatisfaction

 Behavioural Signs

  • Binge eating (eating large amounts of food within a relatively short period of time, e.g. within two hours)
  • Making yourself sick after food or mealtimes and feeling compelled to do so by emotions such as guilt, fear and anxiety.
  • Using laxatives, enemas, appetite suppressants or diuretics
  • Skipping meals and trying to go without food for long periods of time
  • Eating in private and avoiding meals with other people
  • Secretive behaviour around food, e.g. buying large quantities of high-sugar foods or foods that you believe are forbidden and keeping them in a specific place
  • Compulsive or excessive exercising

Physical Symptoms

  • Frequent changes in weight (loss or gains)
  • Swollen salivary glands - if you have bulimia, your saliva glands can become swollen from frequent vomiting. This makes your face appear rounder.
  • Signs of damage due to vomiting including swelling around the cheeks or jaw, calluses on knuckles, damage to teeth and bad breath
  • Feeling bloated, constipated or developing intolerances to food or experiencing heart burn
  • Loss of or disturbance of menstrual periods in girls and women
  • Fainting or dizziness
  • Feeling tired and not sleeping well
  • Dental problems – persistent vomiting can cause your stomach acid to damage the enamel on your teeth, which may lead to tooth decay.
  • Poor skin and hair – a lack of nutrients through persistent vomiting or laxative use can make your skin and hair unhealthy. Your skin and hair can become dry and your fingernails can become brittle.

Binge eating

Binge eating means eating more food than most people would eat, or what seems to you more than most people would eat, in a similar situation, along with feeling that you lack control over this eating.

A binge is almost always carried out in secret and alone. Some people plan binges very carefully and have foods which they use regularly either because they need no preparation, are easy to eat or easy to expel. Other binges can happen on the spur of the moment and any available food. 

Sometimes the need for bingeing can be triggered unexpectedly. This may occur, for example, because of an upsetting or unsettling event. When binge eating is a symptom of bulimia, it happens regularly, not just once or twice.


Purging is a response to binging. After you have eaten lots of food in a short space of time, you may feel physically bloated and unattractive. You may also feel guilty, regretful and full of self-hatred.

However, the main impulse to purge is a powerful, overriding fear of putting on weight.

The most common methods of purging involve making yourself vomit or using laxatives to encourage your body to pass the food quickly. Less common methods of purging include taking diet pills, over-exercising, extreme dieting, periods of starvation or taking illegal drugs, such as amphetamines.

Minimising harm while vomiting

Vomiting can put you at risk of dehydration and the acid in your vomit can wear away teeth enamel. To minimise this harm while you try to overcome your bulimia, drink plenty of fluids to replace what you have vomited, and avoid brushing teeth immediately after vomiting, as this will make the erosion worse.

There are a number of physical complications associated with bulimia. These can include any of the following:

  • Infertility – your menstrual cycle can become unpredictable, or even stop altogether. You may also find it difficult to become pregnant in the future.
  • Chemical imbalance – excessive vomiting and laxative use can cause chemical imbalances in your body. This can result in tiredness, weakness, abnormal heart rhythms, kidney damage, convulsions (fits) and muscle spasms.
  • Bowel problems – excessive use of laxatives can damage your bowel muscles, resulting in chronic irregular bowel movements, constipation and/or diarrhoea, stomach and intestinal ulcers
  • Heart problems – long-term complications of bulimia can include an increased risk of heart problems.
  • Inflammation and rupture of the oesophagus and stomach

At first, bulimia nervosa can feel like a way of having control over your life - suddenly it seems as if there is a way of eating whatever foods you like and not putting on weight. In reality the opposite is true. When bulimia nervosa takes hold it completely destroys your ability to control what you are eating.

Bulimia nervosa can also be a way of coping with difficult emotions. The pre-occupation with food and weight can have the effect of suppressing these emotional difficulties as you simply do not have the energy to deal with anything other than the bulimia nervosa, but it is clearly a very destructive coping strategy.

People with eating disorders often say it is the only way they feel they can stay in control of their life. But, as time goes on, it is the eating disorder that starts to control you.

If you think you have an eating disorder, talk to someone you trust. You may have a close friend or family member you can talk to. You may be able to ask them to go with you to see your GP.

Before you decide to get help, you must be honest with yourself about whether you are ready. Nobody will be able to help you get better unless you are able to accept that you have a problem. There are all sorts of ways you can approach your condition and you must choose one which suits you. Remember that if you have managed to open up to someone and started to think and talk about your Bulimia Nervosa, you have already taken a big step forward. Do not try to rush your recovery, but feel proud of each advance you make. 

Having awareness about Bulimia and its signs and symptoms can make a huge difference to the duration and severity of the illness. Seeking help at the first warning sign is much more effective than waiting until the illness is in full swing.

It is important to seek help immediately. The earlier you seek help the closer you are to recovery.

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 as this can reduce the urges to binge and vomit.

Treatment usually begins with psychological therapy, which aims to help re-establish healthy attitudes towards eating. People with bulimia need to explore and understand the underlying issues and feelings that are contributing to their eating disorder, and change their attitudes to food and weight. 

You can recover from bulimia. The first step towards getting better is to recognise the problem and have a genuine desire to get well.

Bulimia treatment means building a new relationship with food and your body. Help for bulimia also means emotional strengthening, raising self worth and finding better ways of feeling in control without needing to purge.

Guidelines on treatment for eating disorders provided by the National Institute for Health and Clinical Excellence (NICE) tell you what you can expect from the NHS. Visit NICE for a downloadable leaflet: https://www.nice.org.uk/guidance/ng69/chapter/Recommendations#treating-bulimia-nervosa

There are a number of very good self-help resources available. These resources can tell you about ways other people have found to get better, can suggest some of the reasons why you may be feeling as you do and can give practical suggestions of measures you can take in your life to try to recover.

Northumberland, Tyne and Wear Self-Help

These leaflets developed by the Northumberland, Tyne and Wear NHS Foundation Trust providing information and exercises from a Cognitive Behavioural Therapy (CBT) perspective.


Reading Well Books on Prescription

Reading Well Books on Prescription is an early intervention service to help people understand and manage their mental health. The agency provides a core book list of accredited titles recommended by healthcare professionals that covers a range of common mental health conditions such as anxiety, depression, phobias and eating disorders. These can be recommended/referred to by G.P or health care professional.

For lists of books available go to www.readingagency.org.uk/readingwell/BOPcorelist

Centre for Clinical Interventions (CCI)

A resource designed to provide information, strategies and techniques to change thinking patterns associated with disordered eating. It is organised into modules that are designed to be worked through in sequence, each including information, worksheets and suggested exercise or activities.

Diet or Disorder App

The Diet or Disorder App is an evidence-based app to help you better understand eating disorders, signs and symptoms, treatment and recovery. Available on iPhone and Android, you can find out more here.

Recovery Road App

The recovery road app is an evidence-based recovery-focused app for eating disorders. Delevoped by professionals it helps you to track your recovery progress and learn new coping skills. Find out more by clicking here.

Brain Over Binge

Brain Over Binge is a website created by Kathryn Hansen, author of Brain over Binge: Why I Was Bulimic, Why Conventional Therapy Didn’t Work and How I Recovered for Good. Full of useful tips, advice and podcasts to help you towards recovering from Binge and Emotional overeating.

Wellbeing Services Library 

Take a look at the books available in our library. All books in the Wellbeing Library can be borrowed by providing your student details to staff at the reception desk. You are also able to access e-books, information for how to do this is on the library section of our website. 


Videos can provide you with a wealth of information in a short space of time. Below we have a list of short films/clips and videos which give information about eating disorders, personal recovery stories and tips for taking the first steps towards seeking help.

Eating Difficulties Peer Support Group

An Eating Difficulties Peer Support Group run by students at the University of Exeter. For more information click here.

Exeter Depression and Anxiety Service (DAS)

A free, confidential, NHS talking therapy service, offering effective treatments and therapies, including Cognitive Behavioural Therapy (CBT), which can help you get your life back on track. You may self-refer for a range of difficulties including eating disorders, by completing their online registration form. Click here for the website.

Telephone: 01392 675630


Somerset & Wessex Eating Disorders Association (SWEDA) offers a range of services throughout Somerset and the surrounding area. 

Based at Shepton Mallet in Somerset, in the Southwest of England (UK), they provide support to anyone affected by eating disorders, including anorexia nervosa, bulimia nervosa, compulsive eating, binge eating disorder and all related conditions.

Their services include Counselling Services, and a monthly Self-help Support Group.


British Association of Counselling and Psychotherapy (BACP) 

If you would like to find a private counsellor who specialises in eating disorders to help you cope with your difficulty and make positive change, you can find a qualified, experienced therapist in your area by using the Find a Therapist search tool - http://www.itsgoodtotalk.org.uk/

British Association for Behavioural and Cognitive Psychotherapies (BABCP)

The BABCP provide details for accredited therapists working within the Cognitive Behavioural Therapy model - www.babcp.com

Mental Health Foundation

The Mental Health Foundation provides up-to-date research and studies to help people understand, protect and sustain their mental health. There are links to articles, blogs and research.

NHS Choices

The NHS Choices website has information about conditions and treatments as well as services and hospitals.

NHS Direct

NHS Direct provide 24-hour medical advice and information. They have comprehensive information and advice on all types of eating disorders, videos of people’s experiences, an eating disorder forum, and other useful links.

Telephone: 111

Student Minds

Student Minds is the UK’s student mental health charity. Its aim is to empower students with the knowledge, confidence and skills to look after their own mental health and support others.


There is an excellent section written for school leavers and students with experience of eating disorders. The information here has been written by individuals with experience of eating disorders and health care professionals to help you think proactively about what you can do to support yourself through university or college. It also includes some inspirational recovery stories.



Mind are a national charity who offer information on all mental illnesses. They have specific leaflets and information sheets on eating disorders.

Tel: 020 8519 2122

Information Line: 0845 660163

You can download a booklet entitled, Understanding Eating Problems here:



Fixers offer online support and have a range of young people’s stories, family’s personal experiences and expert information about eating disorders.


If you have an eating disorder or know someone who does, you may find it useful to contact a support group such as B-eat for information and advice.

Beat provides:

  • a confidential helpline on 0808 801 0677 – they also have a designated youth helpline on 0808 801 0711 (all year round, 4– 10pm)
  • live chat and online support groups, where you can talk to others in a similar situation
  • a national network of volunteer support groups

You can also use the Beat HelpFinder directory to find eating disorder support services in your local area.

National Centre for Eating Disorders (NCFED)

NCFED provides information and advice about eating disorders, including recommendations for treatment options as well as support for carers, recovery workshops, residential treatment and professional training.

Anorexia and Bulimia Care (ABC)

Provide on-going care, emotional support and practical guidance for anyone affected by eating disorders. We support and care for those struggling personally and resource and equip parents, families, friends and professionals. There is also a helpline run by trained staff, who have both professional and personal experience of eating disorders.

Telephone: 03000 11 12 13

Eating Disorder Hope

Pro-recovery movement for Christians and people of faith.

Eating Disorder Hope are passionate about helping eating disorder sufferers find hope, health and healing. They believe that each individual is precious and uniquely designed by God. Eating disorders hinder the sufferer in their journey of life by crippling their ability to use their gifts and talents in ways that provide personal fulfilment and happiness. Recovery from anorexia, bulimia and binge eating disorders allows individuals to meaningfully participate and contribute to the world.


Samaritans offer a 24 hour online and telephone support service, when you need emotional support and someone to talk to anytime. You can call their free and confidential helpline 24/7 on 116 123.