Causes & Symptoms
Causes of Bulimia
As with other eating disorders, there is no one definitive cause of bulimia. However, there are certain risk factors that can increase the likelihood of developing bulimia:
- Low self-esteem.
- Depressive symptoms.
- Childhood anxiety.
- Weight concerns based on the thin ideal body type.
- Experience of trauma, including abuse.
- Childhood obesity.
- Early puberty.
- Genetic vulnerability, shown by a family history of eating disorders or other mental health disorders.
Bulimia is the experience of reoccurring episodes of binge eating with an associated loss of control, usually followed by unhealthy compensatory behaviours to prevent weight gain. The binge eating and compensatory behaviours usually both occur on average at least once a week.
Binge eating is defined as eating a significantly large amount of food in a discrete period of time (e.g. within two hours). This is associated with a feeling of loss of control over food consumption during this period (e.g. feeling like they cannot stop what or how much they are eating). Binge eating episodes may be triggered by negative mood, stress (including interpersonal stress), hunger, body insecurity, negative judgments surrounding food, or dieting.
Compensatory behaviours can include:
- Self-induced vomiting.
- Laxative misuse.
- Diuretic misuse.
- Misuse of other medications (e.g. diet pills, insulin).
- Fasting or significant dietary restriction.
- Excessive exercise.
Beyond this, there are further symptoms that are associated with bulimia, which may include the following:
- Binging on food that one would normally avoid.
- Restrictive eating or dieting outside of binge eating episodes.
- Secrecy of binge eating due to shame.
- Fluid disturbances, sometimes leading to oedema (fluid retention shown as swelling).
- Electrolyte disturbances from repeated purging behaviours.
- Gastrointestinal symptoms e.g. bloating and constipation.
- Dental issues.
- Significant impact of shape or weight on self-esteem.
- Being within a healthy weight range, or overweight.
If you are worrying that a friend or loved one is experiencing Bulimia, there are signs you can look out for. These do not guarantee your loved one has bulimia, but can be indicative:
- Evidence of them eating large amounts of food (e.g. food wrappers in the bin, or through food missing in the kitchen).
- Social withdrawal.
- Disappearing during or soon after mealtimes.
- Anxiety around mealtimes.
- Evidence of weight change.
- Evidence of purging behaviours (e.g. finding laxative tablets, smell of vomit).
- Excessive exercise.
- Calluses on backs of hands.
- Dental damage.
- Blood-shot eyes.
- Swollen face or neck.
If you feel these may apply to your friend or loved one, it is always best to talk to them about it in a non-confrontational, non-judgmental manner and support and encourage them in getting the help that they need, making sure you are there for them emotionally throughout their journey to recovery. Try to educate yourself about eating disorders before approaching the topic with your loved one to understand better what they may be going through. Talk somewhere private and comfortable, at a time of low distress (i.e. not directly before or after a meal).
Don’t wait too long to approach the subject with them, as the earlier they get help, the better their chances of recovery. However, you must aim to not be too pushy with how you say this, as saying something along the lines of “you need to get help now” can feel harsh and blunt. Aim for something softer but still motivational, such as “I’ll be here to support you in going to get help when you’re ready to do so”.