Understanding bulimia

Written by: Dr Catherine Sykes
Edited by: Lisa Heffernan

Bulimia nervosa (bulimia, for short) was first identified as a problem in the early 80’s. It has attracted a variety of different definitions. Dr Catherine Sykes talks about the five key features of bulimia that are commonly used for diagnosis.

All five of these features should be present for a diagnosis of bulimia:

  1. Binge eating: eating more food in a single episode of eating than most people would normally eat in similar circumstances, there is a sense of loss of control overeating.
  2. Some action is taken to prevent weight gain such as self-induced vomiting, taking large quantities of laxatives or diuretics, extreme dieting, fasting, excessive exercising. This is often called ‘compensatory behaviours’.
  3. Binge eating and the compensatory behaviour both occur at least twice a week and have been going on for at least 3 months.
  4. Weight and shape play a large part in how the person evaluates themselves.
  5. The person is not very underweight.


What are the long-term effects of bulimia?

Bulimia affects many different parts of the body, including:

  • Teeth: vomiting exposes the teeth to acid which erodes the dental enamel and rots the teeth
  • Mouth: causes sore throats, mouth ulcers and bad breath
  • Face: the glands around the mouth swell and this makes the face round and chubby
  • Stomach: repeated vomiting weakens the oesophageal sphincter (the set of muscles at the top of the stomach) which can result in the contents of the stomach returning spontaneously into the mouth


Other symptoms include:

  • Low electrolytes: low potassium levels lead to heartbeat irregularities, extreme thirst, dizziness, fluid retention, weakness, lethargy, muscle twitches and spasms.
  • Osteoporosis: there is some research to suggest that bulimia may be associated with osteoporosis
  • Fatigue
  • Loss or disruption of the menstrual cycle


What can trigger bulimia?

Thoughts about your body, comparing yourself dis-favourably to someone else, having a bad day and restricting food can all trigger episodes of bulimia.


What is the best way to overcome bulimia?

CBT (cognitive behavioural therapy) is a good, established treatment for bulimia, with strong evidence for its effectiveness. It supports people with bulimia to consider and change the links between their thoughts, feelings and behaviour. It is a practical, problem-solving approach.


The triggers for a binge are considered and how this can be overcome by changing the person’s pattern of thoughts, feelings and behaviour. Some more experienced therapists will also help people with bulimia to understand how they have established the thought patterns that link to their episodes of bulimia.


What advice do you have for someone suffering from bulimia?

Dr Sykes advises someone suffering from bulimia to seek help. This can be a scary step but with the right support, addressing bulimia can be life-changing and the impact that vomiting has on the body can be reversed once bulimia is addressed.


To help someone to consider seeking help, Dr Sykes advises them to sit down with a pen and paper and write down the advantages of changing. She suggests paying attention to these advantages on a daily basis. Sometimes having a photo that reminds you of the advantages, as a screensaver can be motivational.


Dr Sykes also suggests that the person make note of their fears of changing. Then, once all the fears are noted, evaluate how likely it is on a scale of 0 -100% (0=highly unlikely, 100 = highly likely) that their fear will happen. To help evaluate the likelihood of their fear happening, the person should ask themselves:

  • What makes me think this?
  • Am I basing this prediction on one isolated incident?
  • Are others really concerned about my weight and shape as much as I am?
  • Could I be exaggerating?
  • Is this fear-based on other problems in my life?
  • Is it worth trying to change or even trying again to change?


Lastly, Dr Sykes suggests that the person go back to their fears and write new responses to them. Sometimes when we revisit what scares us or what once scared us, we realise that those fears aren’t so bad after all.


Do you or does someone you know suffer from bulimia? Dr Sykes and her team can help. Visit her Top Doctors profile to book an appointment.

By Dr Catherine Sykes


I'm  a chartered psychologist based in central London. I love my job. I feel very privileged to work with some wonderful people and help them work through difficult periods in their life. It is very rewarding. I understand how daunting it can be, to make the first step to talking to a psychologist. I've been doing this job for over 20 years and I never under-estimate what it might feel like to be a client sitting in a chair opposite me. My approach is compassionate, encouraging and honest. This means that I aim to understand what is going on for you but I also focus on giving you the right tools to change and recover. I go beyond giving you insight into your problems, I support you to take the right steps to get you out of your problems.

To assure you that you are in experienced hands, here is some information about my professional experience. I am an expert in cognitive behavioural therapies (CBT). I am accredited by the British Association for Behavioural and Cognitive Psychotherapies (BABCP). I've spent years researching how to optimise CBT techniques so they work best for a diverse range of people's needs. I'm the author of a best-selling self-help series as well as a co-author of 4 academic textbooks. My work has been published in scientific journals. I also get asked to give expert opinions for magazines and newspapers.

You should also know that I'm on the Health and Care Professionals Council (HCPC) register and that I am an Associate Fellow (AFBPsS) of the British Psychological Society (BPS). 

Furthermore, I'm a Coaching Psychologist. I'm on the BPS Register of Coaching Psychologists. This brings an extra benefit to working with me, especially when it comes to dealing with work-related stress. Quite often clients experience stress at work because they don't have the appropriate skills to lead, manage, influence, be assertive, communicate, draw boundaries or deal with difficult people. Sometimes this goes on for years which can lead to burnout, stagnation or even unexplained illnesses. I use evidence-based psychological theories and personalised techniques which enables people to understand what blocks them from reaching their full potential and move on to achieving the life they want.

You may be also interested to know that despite being based in London, I regularly see clients from around the world, especially from the Middle East and The Gulf. They see me on their visits to London and we communicate via e-consultation in between.

I have a professional team to support my practice. This means that booking appointments, answering queries, dealing with invoices, insurance claims, writing reports etc is all responsive and smooth which takes away any added administrative stress of arranging to see a psychologist.

Do get in touch or visit my websites if you want to find out more.


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