Bulimia – Eating disorders
Eating disorders are characterised by an abnormal attitude towards food that causes someone to change their eating habits and behaviour.
A person with an eating disorder may focus excessively on their weight and shape, leading them to make unhealthy choices about food with damaging results to their health.
Types of eating disorders
Eating disorders include a range of conditions that can affect someone physically, psychologically and socially. The most common eating disorders are:
anorexia nervosa – when someone tries to keep their weight as low as possible, for example by starving themselves or exercising excessively
bulimia – when someone tries to control their weight by binge eating and then deliberately being sick or using laxatives (medication to help empty their bowels)
binge eating – when someone feels compelled to overeat
Some people, particularly young people, may be diagnosed with an eating disorder not otherwise specified (EDNOS). This is means you have some, but not all, of the typical signs of eating disorders such as anorexia or bulimia.
Causes of eating disorders
Eating disorders are often blamed on the social pressure to be thin, as young people in particular feel they should look a certain way. However, the causes are usually more complex.
There may be some biological or influencing factors, combined with an experience that may provoke the disorder, plus other factors that encourage the condition to continue.
Risk factors that can make someone more likely to have an eating disorder include:
having a family history of eating disorders, depression or substance misuse
being criticised for their eating habits, body shape or weight
being overly concerned with being slim, particularly if combined with pressure to be slim from society or for a job (for example ballet dancers, models or athletes)
certain characteristics, for example, having an obsessive personality, an anxiety disorder, low self-esteem or being a perfectionist
particular experiences, such as sexual or emotional abuse or the death of someone special
difficult relationships with family members or friends
stressful situations, for example problems at work, school or university
Do I have an eating disorder?
Doctors sometimes use a questionnaire called the SCOFF questionnaire to help recognise people who may have an eating disorder. This involves asking the following five questions:
Sick: Do you ever make yourself sick because you feel uncomfortably full?
Control: Do you worry you have lost control over how much you eat?
One stone: Have you recently lost more than one stone (six kilograms) in a three-month period?
Fat: Do you believe yourself to be fat when others say you are too thin?
Food: Would you say that food dominates your life?
If you answer “yes” to two or more of these questions, you may have an eating disorder.
Spotting an eating disorder in others
It can often be very difficult to realise that a loved one or friend has developed an eating disorder.
Warning signs to look out for include:
complaining of being fat, even though they have a normal weight or are underweight
repeatedly weighing themselves and looking at themselves in the mirror
making repeated claims that they have already eaten, or they will shortly be going out to eat somewhere else
cooking big or complicated meals for other people, but eating little or none of the food themselves
only eating certain low-calorie foods in your presence, such as lettuce or celery
feeling uncomfortable or refusing to eat in public places, such as a restaurant
the use of "pro-anorexia" websites
If you are concerned about a friend or family member, it can be difficult to know what to do. It is common for someone with an eating disorder to be secretive and defensive about their eating and their weight, and they are likely to deny being unwell.
You can also talk in confidence to an adviser from eating disorders charity Beat by calling their helpline on 0845 634 1414. They also have a designated youth helpline on 0845 634 7650.
Who is affected by eating disorders?
Although eating disorders tend to be more common in certain age groups, it is not uncommon for eating disorders to affect people of any age.
Around one in 250 women and one in 2,000 men will experience anorexia nervosa at some point. The condition usually develops around the age of 16 or 17.
Bulimia is around five times more common than anorexia nervosa and 90% of people with bulimia are female. It usually develops around the age of 18 or 19.
Binge eating usually affects males and females equally and usually appears later in life, between the ages of 30 and 40. Because of the difficulty of precisely defining binge eating, it is not clear how widespread the condition is.
Treating eating disorders
If it is not treated, an eating disorder can have a negative impact on someone’s job or schoolwork, and can disrupt relationships with family members and friends. The physical effects of an eating disorder can sometimes be fatal.
Treatment for eating disorders is available, although recovering from an eating disorder can take a long time. It is important for the person affected to want to get better, and the support of family and friends is invaluable.
Treatment usually involves monitoring a person’s physical health while helping them to deal with the underlying psychological causes. This may involve:
using self-help manuals and books, possibly under guidance from a therapist or other healthcare professional
cognitive behavioural therapy (CBT) – therapy that focuses on changing how someone thinks about a situation, which in turn will affect how they act
interpersonal psychotherapy – a talking therapy that focuses on relationship-based issues
dietary counselling – a talking therapy to help people maintain a healthy diet
psychodynamic therapy – counselling that focuses on how a person’s personality and life experiences influence their current thoughts, feelings, relationships and behaviour
family therapy – therapy involving the family discussing how the eating disorder has affected them and their relationships
medication – for example, a type of antidepressant called selective serotonin reuptake inhibitors (SSRIs) may be used to treat bulimia nervosa or binge eating
There is a range of other healthcare services that can help, such as support and self-help groups, and personal and telephone counselling services. See the "Useful links" on this page for more information.
Media last reviewed: 09/03/2015
Next review due: 09/03/2017
Overcoming eating disorders
Find out about eating disorders and the support available for people who have problems with food