Bulimia can be a very secretive illness – perhaps due to its very nature. Sufferers will often binge on food in a short amount of time, and then purge – either by throwing up, taking laxatives or diuretics, fasting, or exercising excessively.
Even in a world where mental health is becoming less stigmatised, there is not much discussion of bulimia, despite its prevalence – a study found it accounts for 19% of eating disorder cases (while anorexia accounts for around 8%).
The illness has been highlighted this week after Fearne Cotton disclosed, for the first time, that she had an “intense” 10-year struggle with bulimia, during a time where she didn’t feel “cool enough, smart enough or good enough” at her job.
Speaking with writer Elizabeth Day on her How To Fail podcast, the former Radio 1 DJ said it had been a “weird secret” in her life that she had hidden from everyone apart from her mother.
“In the beginning of my 20s it was quite intense and sort of ruled everything,” she said. “In my later 20s it was more like a bad habit I’d kick into if something emotional was happening or if I felt out of control. It was my go-to thing but wasn’t as regular.”
What are the symptoms of bulimia?
Bulimia’s binge/purge cycles can disrupt day-to-day life and, in turn, impact relationships and social situations. It can be difficult for others to spot the signs as sufferers tend to maintain a relatively “normal” weight, says eating disorders charity Beat.
The illness can easily be hidden. Both bingeing and purging will often take place behind closed doors and those with the eating disorder might avoid eating in front of people.
Symptoms of bulimia can include:
:: Eating very large amounts of food in a short time, often in an out-of-control way
:: Making yourself vomit, using laxatives, or doing an extreme amount of exercise after a binge to avoid putting on weight
:: Having a fear of putting on weight
:: Being critical about your weight and body shape
:: Having intense mood changes – for example, feeling very tense or anxious, and feeling guilty or ashamed after a binge.
Sufferers may also experience other physical symptoms, as a consequence of bingeing and purging:
:: Feeling bloated
:: Tummy pain
:: Irregular periods
:: Dental issues (if a person tends to purges through being sick)
:: Hair loss.
How is bulimia treated?
Firstly, recovery is possible. Treatment will differ between adults and children, and people are usually treated as outpatients unless they are at risk of suicide or self-harm. They may be admitted to hospital if they have other serious health complications.
For those aged 18 and over, bulimia treatment usually involves guided self-help involving a healthcare professional. This aims to help a person monitor what they’re eating to try and change behavioural patterns, make realistic meal plans, learn about triggers and discover the underlying causes of the disorder.
Therapies recommended to help treat bulimia include cognitive behavioural therapy (CBT) – on the NHS, this will usually be 20 sessions over 20 weeks. Other therapies, such as interpersonal psychotherapy may also be offered.
Some patients might be given medication to cope with co-existing mental health conditions like anxiety or depression, but this should always be offered in addition to therapy and support, not instead of it.
Children and young people will usually be offered family therapy – ie. the child and their family talking to a therapist – and they may be offered CBT as well.
Sufferers are advised to attend support groups, where they’re able to talk to and learn from others going through similar experiences.