Understanding bulimia

Written by: Dr Catherine Sykes
Published: | Updated: 12/05/2023
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. Leading psychologist  Dr Catherine Sykes talks about the five key characteristics of bulimia that are commonly used for diagnosis.

Scrabble pieces spelling out bulimia, eating disorders and anorexia


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 three 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, which is one of the symptoms of oesophagitis.


Other symptoms of bulimia 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?

I advise people with 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 for bulimia, I advise them to sit down with a pen and paper and write down the advantages of changing. I suggest 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.


I also suggest that the person with bulimia make note of their fears of changing. Then, once all the fears are noted, evaluate how likely it is on a scale of 0 to 100 per cent (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, I suggest that the person having bulimia treatment goes 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 have bulimia? Dr Sykes and her team can help. Visit her Top Doctors profile to book an appointment.

By Dr Catherine Sykes

Dr Catherine Sykes is a highly-regarded chartered psychologist based in central London. Specialising in the psychology of high achievers, Dr Sykes offers therapy and coaching for professionals in high pressurised careers. She provides in-person appointments but also sees clients across the globe via e-Consultation. Dr Sykes developed a solid reputation in the law and finance sectors due to her thorough understanding of how a demanding career comes with its own unique challenges to mental health, physical health, relationships, and performance.

When guiding her patients, she individually assesses each case and uses a range of approaches such as Acceptance and Commitment Therapy (ACT), Cognitive Behavioural Therapy (CBT), hypnosis, neuropsychology and somatic psychology to provide patients with optimal therapy solutions. With these strategies, Dr Sykes helps patients discover the core reasons for their issues and provides the necessary psychological tools to overcome them. Dr Sykes prides herself on her ability to help clients make positive changes so they can be happy, healthy and enjoy and maintain their success. She uses an online brain health assessment service developed by Cambridge Brain Sciences that accurately measure core elements of cognitive function and mood, including memory, attention, focus, reasoning and verbal abilities. This brain health assessment helps to monitor and manage core areas of brain function that are key to mental health and wellness.

Much of her training was at the King's College Hospital. She has sat on NHS boards, worked as a trustee for the charity Pregnancy Sickness Support and lectured at City University, London for 11 years. She is a member of the Health and Care Professionals Council (HCPC) register and she's an Associate Fellow of the British Psychological Society (BPS). She is a recognised provider with WPA, Cigna, Aviva and Healix.

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