Bulimia

There are other eating disorders that involve binge eating. For example:

• Binge Eating Disorder (BED): BED occurs when someone binges without purging afterwards.
• Other Specified Feeding and Eating Disorder (OSFED): Sometimes if a person has only some of the signs, symptoms and behaviours that come with having bulimia, they’ll be diagnosed with “other specified feeding and eating disorder (OSFED),” formerly known as “eating disorder not otherwise specified” (EDNOS).
• Anorexia Binge/Purge Subtype: If the person regularly engages in restriction in between binging and purging that results in them being underweight, they might be diagnosed with anorexia binge/purge subtype.

Eating disorders are complicated, and not everyone fits neatly into a “category”.

Eating disorders like bulimia are complicated and do not have one identified cause. While the symptoms of bulimia may appear to focus on food and body image, they often stem from deeper issues that go beyond the desire to look or eat a certain way.

Risk Factors Contributing to Bulimia

Many influences are involved in the development of eating disorders, such as biological, psychological, genetic and environmental factors. Here are some of these contributing risk factors or “triggers” for bulimia:

• Low self-esteem or self-worth
• Trauma (e.g. abuse, grief, etc.) or feeling a lack of control in life
• Stress or deep emotional difficulties that are avoided or unresolved
• Other mental illnesses
• Social pressure and idealization of thinness
• Bullying
• Dieting
• Perfectionism
• Early puberty
• Family history of eating disorder or mental illness
• Chemical imbalances
• Participating in activities or situations where there’s a focus on appearance, weight or body type (e.g. athletics, dance, etc.)

You might notice that many of these bulimia signs or symptoms could be explained by a number of issues, not just eating disorders. If you are concerned that you or someone you know has bulimia, it is important to talk to a doctor about these symptoms:

• Low and irritable mood
• Anxiety
• Social withdrawal
• Fatigue and weakness
• Intense preoccupation with food, weight, and related subjects
• Refusal to eat certain foods
• Frequent comments about feeling “fat”
• Wearing baggy or layered clothing
• Food rituals (obsessive and abnormal eating patterns such as picking food apart)
• Weight loss or frequent fluctuations
• Rigid exercise
• Frequent trips to the bathroom after meals
• Secretive food behaviours including eating alone or lots of hidden wrappers/food
• Discolouration or staining of the teeth
• Sore throat and swelling of the cheeks or jaw area
• Digestion issues (e.g. constipation, heart burn, etc.)
• Dehydration
• Dizziness
• Poor concentration and memory

Bulimia is a treatable eating disorder. Eating disorders are serious and can be life-threatening, with the highest mortality rate among mental illnesses. That’s why it’s important to get help.

What to Do When Eating Behaviours Interfere with Health and Well-Being

When disordered eating, exercise, or body image concerns are impacting physical health or overall well-being, it’s crucial to reach out for support. This could mean talking to someone you trust, like a friend, teacher, family doctor, counsellor, or a crisis helpline.

If you’re worried about a friend, they may be resistant to help or unaware of the severity of their situation. Someone who has bulimia may have a very distorted view of how they look, and an inability to realize how serious their illness is. They might need you to make the first step.

As always, if you feel like your friend might hurt him/herself or someone else, it’s time to call emergency services.

Visit the Help Section to find out how to get help for yourself or a friend.

Bulimia affects individuals differently. Each person’s experience with the disorder is unique, which means that treatment will also vary from one person to another. Research has indicated that the earlier someone gets help, the better the outcome.

Therapy and Counselling

The most effective and long-term treatment for bulimia is a mix of therapy and counselling coupled with attention to medical and nutritional needs. Treatment options may include medication, outpatient therapies such as individual counseling (e.g., cognitive behavioral therapy), group or family therapy, and medical and nutritional management by healthcare providers like a family doctor and dietitian.

Bed-Based Treatment

In more severe cases, when bulimia has caused life-threatening physical issues or significant psychological distress, residential or hospital-based care may be required. A controlled environment with constant medical attention can help individuals stabilize and work on developing healthier habits and coping mechanisms.
Sometimes bulimia can cause damage to a person’s throat, teeth and stomach and digestive tract, a result of repeated throwing up or misusing laxatives. Medical and dental treatment to address this might be necessary. The disorder is also often accompanied by other mental health challenges, such as anxiety, depression, or self-harm. Treatment plans will often address these co-occurring concerns along with the eating disorder.

How to Support Someone with Bulimia

Family members of someone who has an eating disorder may participate in therapy or support groups, or benefit from learning about the disorder and ways to support their loved one at home.

Every story is different, and sometimes people need to try different types of treatment supports before they find the right plan for them.

A person living with bulimia, like any other person, will benefit from maintaining wellness and having good supports in their life.

Supporting someone with bulimia can be challenging. If you’re helping a friend or loved one with this eating disorder, here are some ways you can provide support:

1. Understand the Signs and Symptoms

Familiarize yourself with the signs of bulimia. Recognizing these symptoms will help you offer the right support and ensure your friend or loved one receives the appropriate care.

2. Encourage Professional Help

Encourage your friend to seek professional help when necessary. Whether that be through doctors, therapists, or counsellors, you can guide them to resources or treatment options.

3. Visit If They’re in the Hospital

If your friend is hospitalized, visit them if possible. Hospitals can be overwhelming, and having a familiar, supportive face can be comforting. Always check visitor rules first.

4. Navigate Social Situations

Social situations, especially those involving food, can be difficult for someone with bulimia. Here are some ways to make these situations more manageable:

• Talk to Them: Ask how they’re feeling and reassure them you want to include them, but you’re unsure of how certain situations make them feel. Listen and check in regularly.
• Don’t Make a “Big Deal” Out of Food: When planning meals or outings, avoid focusing on food. If they don’t eat much or seem uncomfortable, don’t single them out. Quietly check in to see if they’re okay.
• Avoid Discussing Food or Dieting: Conversations about calories, dieting, or skipping workouts can make someone with bulimia feel uncomfortable. Try not to discuss these topics in front of them.
• Be Mindful of What You Say: Avoid commenting on weight, body shape, or eating habits, even if the comments seem positive (e.g., “You look so healthy!” or “Your clothes fit you better now!”). Such remarks can be misinterpreted, especially by someone struggling with bulimia.
• Avoid Criticizing Their Eating Habits: While you may be concerned about their health, comments like, “Do you think you should eat that?” or “Maybe you should choose something healthier” can be harmful. Remember, eating disorders often stem from underlying issues, not just food. Offer support without pushing them to change their behaviours.

H4: 5. Be Alert for Signs of Relapse

If you’re concerned your friend is slipping into unhealthy behaviours, express your concern in a caring way and encourage them to speak with a doctor or family member. If you’re deeply worried about their well-being, reach out to a trusted adult.

6. Be Patient with Treatment

Recovery is a process. Therapy and medications may take time to show behavioural changes. Be patient and supportive as your friend navigates their treatment for bulimia.

7. Offer Emotional Support

Sometimes, the best way to help is by simply being there. Listen without judgment and avoid trying to fix their problems. Sometimes, just offering a safe space to talk can make a big difference.

8. Ask How You Can Help

Your friend may need simple distractions or relaxing activities. Ask them how you can best support them, whether it’s hanging out, watching a movie, or just being present.

9. Stay Calm and Don’t Take It Personally

Bulimia can distort how a person perceives situations. If your friend acts out or seems upset, try not to take it personally. They may be overwhelmed or struggling with their emotions.

10. Set Boundaries and Take Care of Yourself

Supporting someone with bulimia can be emotionally taxing. Set personal boundaries and take care of your own well-being. Don’t hesitate to seek support if you feel overwhelmed.
By being patient, understanding, and compassionate, you can provide meaningful support while also respecting your own limits.

See the Help Section for more info about helping a friend and self-care.

A list of Wellness Tips related to recovering from an eating disorder.

More about Eating Disorders and Bulimia.

The information on this page about bulimia is a simple overview of a complicated health issue. For more in-depth information, please visit these resources and references or speak to a medical professional.

Ontario – call ConnexOntario to find out where there are mental health supports in your community.

Crisis – in any situation where someone is at risk of hurting themselves or others, call 911 or a local crisis line. You can find resources near you on the free and confidential Be Safe App.

Please see the Help Section for more information and resources.

References

1. National Eating Disorder Information Centre (NEDIC)
2. National Eating Disorders Association (NEDA)
3. Diagnostic and Statistical Manual of Mental Disorders (DSM) Library
4. Centre for Addiction and Mental Health (CAMH)
5. Canadian Mental Health Association (CMHA)