Bulimia nervosa

Bulimia nervosa often becomes a cycle. There may be restriction or attempts to eat “perfectly”, followed by a point at which eating feels out of control. Binge eating may then bring panic, shame or guilt, followed by an attempt to undo what has happened through vomiting, fasting, excessive exercise or other compensatory behaviours. The relief can be powerful but temporary, and often leads straight back to restriction and another attempt to regain control. What can look from the outside like a series of separate behaviours is usually one interconnected system.

This is why bulimia is not a problem of willpower. The behaviours make sense within the cycle, even when they are causing considerable distress. Treatment involves understanding what is maintaining that cycle and working through it systematically. Using approaches such as CBT-E, we work with eating patterns, restriction, binge eating and compensatory behaviours, alongside the rules, fears and beliefs about food, weight and shape that may be keeping them in place.

Bulimia can also be remarkably easy to hide. Someone may appear to be functioning well, eat normally around other people and live in a body that gives no indication of how much they are struggling. You do not need to look unwell, binge or compensate every day, or wait until things become more severe to deserve help. If eating and trying to undo eating are beginning to organise your life, that is enough to take seriously.