Bulimia Nervosa
Bulimia nervosa is an eating disorder defined by repeated cycles of uncontrolled binge eating followed by compensatory behaviours, self-induced vomiting, laxative use, or excessive exercise, aimed at undoing perceived overeating. It differs from anorexia in that body weight is often within a normal range, which means the condition can go unrecognised for years.
Key points
- Because weight often stays in a normal range, the disorder can escape notice for years, unlike anorexia.
- Physical clues can include worn tooth enamel, swelling near the cheeks, and calluses across the knuckles.
- Fluoxetine, the best-studied medicine for reducing binge frequency, tends to work better combined with structured talking therapy than alone.
Recognising the pattern
The core feature is a loss-of-control feeling during eating episodes, followed by guilt and a strong urge to compensate. Physical signs include tooth enamel erosion, swollen cheek glands, and knuckle calluses. Mood shifts, secrecy around food, and frequent trips to the bathroom after meals are common behavioural signs. Bulimia often goes unreported due to stigma.
How it is managed
Cognitive behavioural therapy is the most evidence-based treatment. Medication is often used alongside it: fluoxetine is the best-studied option and sits within the broader class of antidepressants shown to reduce binge frequency. The two approaches together tend to produce better outcomes than either alone.
If you or someone close to you is struggling, speaking with a doctor or mental health professional is the right first step. For immediate support, international crisis lines such as Befrienders Worldwide (befrienders.org) are available in many countries.