Bulimia Nervosa

What is it?

Bulimia nervosa is characterized by recurrent and frequent episodes of eating unusually large amounts of food and feeling a lack of control over these episodes.

This binge-eating is followed by behaviour that compensates for the overeating such as forced vomiting, excessive use of laxatives or diuretics, fasting, excessive exercise, or a combination of these behaviours.

Unlike anorexia nervosa, people with bulimia nervosa usually maintain what is considered a healthy or normal weight, while some are slightly overweight.

But like people with anorexia nervosa, they often fear gaining weight, want desperately to lose weight, and are intensely unhappy with their body size and shape.

Usually, bulimic behaviour is done secretly because it is often accompanied by feelings of disgust or shame.

The binge-eating and purging cycle happens anywhere from several times a week to many times a day.

Other symptoms include:

  • Chronically inflamed and sore throat
  • Swollen salivary glands in the neck and jaw area
  • Worn tooth enamel, increasingly sensitive and decaying teeth as a result of exposure to stomach acid
  • Acid reflux disorder and other gastrointestinal problems
  • Intestinal distress and irritation from laxative abuse
  • Severe dehydration from purging of fluids
  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium and other minerals) which can lead to heart attack.

CBT can help!

Cognitive-Behavioural Therapy is recognized worldwide by doctors as an effective means of treating the disease, and thus is the most common therapy given for it.

CBT helps a person focus on his or her current problems and how to solve them.

The therapist helps the patient learn how to identify distorted or unhelpful thinking patterns, recognize, and change inaccurate beliefs, relate to others in more positive ways, and change behaviors accordingly.

CBT that is tailored to treat bulimia nervosa is effective in changing binge-eating and purging behaviors and eating attitudes.

The treatment produces rapid changes in the eating patterns of individuals with bulimia nervosa, and its effects have also been found to be well-maintained over time.

Therapy typically consists of weekly hour-long sessions for 20 weeks.

CBT treatment can be divided into three stages.

Stage 1

In the first stage, the cognitive view on the maintenance of bulimia is presented; which stresses that there is more to an individual’s eating problem then just binge eating (and purging).

Low self-esteem, extreme concerns about shape and weight, and strict dieting are all implicated in perpetuating the vicious cycle of bulimia. Also, behavioral techniques are implemented to replace binge eating with more stable eating patterns.

Stage 2

In the second stage, healthy eating habits are further established, and an emphasis is placed upon the elimination of dieting.

Cognitive processes are focused upon extensively in this stage; the therapist and the individual examine his/her thoughts, beliefs, and values which maintain the eating problem.

Final Stage

The final stage is concerned with maintaining the gains made in therapy once the treatment has been terminated.

There are no known risks to Cognitive Behavioural Therapy, and as such, national UK guidelines recommend the use of CBT as a method to treat bulimia nervosa.


NIMH (National Institute of Mental Health), WebMD.