Understanding Bulimia Nervosa


Exploring the history of and misconceptions around a prevalent eating disorder.

Eating disorders (ED) are serious mental health conditions likely to affect young people. There are many different types of ED, including anorexia, bulimia, binge eating disorder, orthorexia, and avoidant restrictive food intake disorder (ARFID). Each of these disorders carries unique characteristics and symptoms, and no two conditions are the same. Nevertheless, some are more prevalent than others: bulimia – also known as bulimia nervosa (BN) – affects 2-5% of adolescents and young adults worldwide.[1]

Research suggests that BN’s prevalence outweighs that of other eating disorders such as anorexia and ARFID. According to updated research conducted in 2022, the only eating disorder more statistically common than bulimia nervosa is binge eating disorder (BED).[2]

This condition affects and will affect many young people throughout their lives. It is therefore critical to understand bulimia nervosa and know how it differs from other eating disorders to provide support for young people who may be struggling with BN.

What Is Bulimia Nervosa?

Originally, BN was defined as an ominous variant of AN (anorexia nervosa) when it was first identified as a discrete condition in 1972. However, more research indicated that bulimia nervosa carried its own distinct characteristics and required equally distinct treatment, which differed from that of AN. Since then, bulimia has been officially designated as a mental health condition distinct from other eating disorders.[3]

Bulimia has many behavioural, mental, and physical symptoms to be aware of. However, some of these symptoms can be difficult to spot, as young adults with bulimia often try to hide their actions.

Some signs of bulimia include:

  • A frequent sore throat
  • Cuts and abrasions on the back of the hands from inducing vomiting (also known as Russell’s sign)[4]
  • Stomach aches
  • Stealing food
  • Visiting the bathroom soon after meals
  • Over-exercising even when it interferes with other activities
  • Depression
  • Irritability

BN involves three behavioural and cognitive components:

  • Binge eating
  • Inappropriate compensatory measures
  • Body image disturbance[5]

Binge eating is characterised by eating a large amount of food in a short amount of time but also by feeling intensely negative emotions during that time. A binge can be triggered by various emotions or situations, such as anger, sadness, and hopelessness, and is then followed by a purge or an inappropriate compensatory measure.

Inappropriate compensatory measures refer to the ways in which an individual attempts to correct the behaviour of the binge – this is often (and most frequently imagined to be) making themselves vomit to purge the food consumed during the binge, but can also be in the form of intense exercising to the point of exhaustion, or the taking of laxatives or other expulsory medications to expel the food from the body.

The third cognitive component, body image disturbance, refers to a disconnect in the way in which the individual perceives their body. It may be that they feel different to how they look, are extremely unhappy with how they look or even perceive themselves as completely different from how others describe them.

For bulimia to be diagnosed, bingeing and compensatory behaviours must occur at least once a week for three months. There is a misconception that those suffering from BN must be severely underweight for a diagnosis, but in reality, many people maintain a normal weight.

Treating Bulimia Nervosa

Bulimia nervosa is treatable, and recovery is possible. Although it can be difficult, at The Wave, we can help. Some of our treatment approaches to BN include:

  • One-to-one therapy – individual therapy offers young people a safe space to share their thoughts and worries about their eating disorder. Therapy also provides young people with healthy coping mechanisms to manage their emotions and aims to improve their relationships and associations with food.
  • Group therapy – community is incredibly important in recovery, and a strong support network can help young people learn from others on a similar journey.
  • Nutritional programmes – these programmes help to educate young people about nutrition and food groups, which helps them to learn about healthy eating and meal planning. Our eating disorder experts take these groups slowly, assisting young adults in adjusting to changes smoothly and reducing the chances of relapse.
  • Cookery school – at The Wave, we involve our young people in activities that promote a healthy relationship with food. Cookery school gets everyone involved in prepping, cooking, and learning new recipes to help them associate eating with positive experiences rather than negative ones.
  • Gardening groups – looking after their own bed of flowers and plants helps our young people see the power of care and compassion and allows them to use the skills they learn to look after themselves.

There is no one approach to recovery from BN. At The Wave, we tailor our programmes to each young person who comes to us, allowing them to recover at their own pace and develop new skills to help them on their journey.

Bulimia nervosa is a common eating disorder that affects many young adults. Without treatment, it can lead to severe health consequences, and it can feel impossible to escape the cycle. The Wave is here to help young adults break the cycle in a healthy, supportive environment, surrounded by their peers and eating disorder professionals. Contact us today to learn more about our unique approach and personalised programmes.


[1] Julie E.B. Nolan, Thomas D. GeraciotiJr., in Encyclopedia of Gastroenterology, 2004

[2] Qian J, Wu Y, Liu F, Zhu Y, Jin H, Zhang H, Wan Y, Li C, Yu D. An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eat Weight Disord. 2022 Mar;27(2):415-428. doi: 10.1007/s40519-021-01162-z. Epub 2021 Apr 8. PMID: 33834377; PMCID: PMC8933366.

[3] Rushing JM, Jones LE, Carney CP. Bulimia Nervosa: A Primary Care Review. Prim Care Companion J Clin Psychiatry. 2003 Oct;5(5):217-224. doi: 10.4088/pcc.v05n0505. PMID: 15213788; PMCID: PMC419300.

[4] Mehler PS, Rylander M. Bulimia Nervosa – medical complications. J Eat Disord. 2015;3:12. doi:10.1186/s40337-015-0044-4

[5] J.E. Mitchell, … J. Marino, in Encyclopedia of Human Behavior (Second Edition), 2012

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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