Bulimia Nervosa

Bulimia is a psychological eating disorder with an associated loss of control followed by unhealthy compensatory behaviours. Discover more about bulimia and the highly individualised treatments programme we offer at Schoen Clinic Chelsea.


Bulimia Nervosa (Bulimia) is an eating disorder incorporating episodes of binge eating with an associated loss of control, usually followed by unhealthy compensatory behaviours to prevent weight gain (e.g. self-induced vomiting, use of laxatives). Treatment is primarily psychological therapy. The most evidence-based treatment for Bulimia is Cognitive Behavioural Therapy.

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 Symptoms

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, medication for the treatment of diabetes).
  • 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).
  • Dehydration.
  • 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.


Warning Signs

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”.


The treatments and support we provide

We provide a very comprehensive and holistic range of interventions and support. This means we are able to find the mechanisms for recovery, which will be different for each patient. Everyone will have a highly personalised treatment programme. 

The programme is reviewed every week by the patient’s multi-disciplinary team (MDT), encompassing the different professionals involved in their care. Our MDT consists of: consultant psychiatrist, psychotherapist/psychologist, family therapist, occupational therapist, dietician. The MDT is at the centre of our approach, ensuring all the progress made across the programme is understood, built upon and applied. Our model provides consistency and continuity. 

Individual programmes are tailor-made to each patient’s needs and progress. The following provides a guide to the typical building blocks of our day treatment programmes, all of which include a number of weekly 1:1 sessions with members of the MDT.

  Full-day Programme Half-day Programme
Days Monday to Friday Monday to Friday
Hours 8 hours per day 4 - 5 hours per day
Programme Length Up to 6 weeks Up to 6 weeks
Detail group therapy 5 - 6 sessions  3 - 4 sessions
Daily meals
  • Breakfast
  • Lunch
  • Snack
  • Dinner
  • Snacks

We provide the following therapies and interventions. These may be delivered on a 1:1 or group basis by members of the MDT.


Psycho-education Cognitive behavior therapy (CBT) Mindfulness
Relapse prevention Self-esteem / resilience Movement
Body Image  (Over-) Exercising  Food preparation / cooking
Applied relaxation Art / drama Interpersonal therapy
Social issues Family therapy Maudsley Anorexia Treatment for Adults (Mantra)

Treatments are available at the following locations

Schoen Clinic Chelsea

Our Address
Schoen Clinic
Centre for Mental Health Chelsea
13a Radnor Walk
London SW3 4BP
General Telephone Enquiries
0203 146 2300
Specialist Areas
Anorexia Nervosa Binge Eating Disorder Bulimia Nervosa Other Specified Feeding and Eating Disorders (OSFED) +7 More


Dr Helen Murphy

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