​Bulimia Nervosa

Bulimia nervosa (or simply bulimia) is an eating disorder characterized by binge eating followed by purging.

Binge eating means eating a large amount of food very quickly and purging means trying to get rid of everything you ate by vomiting or taking a laxative (a medicine that increases bowel movements). You may also try other methods to lose weight such as diuretics (drugs to increase urine production by your body), stimulants (drugs to enhance body functions), fasting, or excessive exercise.

Bulimia is a serious and potentially life threatening disease. You may have a normal body weight and still be suffering from bulimia. However, suffering from bulimia means that you desperately want to lose weight because you are unhappy with your body image.

The binging and purging process is done secretly because you are ashamed of yourself. You may repeat this process several times a week. Bulimia is not really about weight loss and food management. It’s a much deeper emotional problem where you are unhappy with your self-image and you use it as a way to control your life. Bulimia is often accompanied by other psychological illnesses such as depression​, anxiety and substance abuse problems.

Bulimia can be categorized in two ways:

  • Purging bulimia: This is when you regularly try to induce vomiting or misuse substances to purge after binging.

  • Non-purging bulimia: This is when you use other methods to try to get rid of calories and prevent weight gain. These include fasting, strict dieting or excessive exercise.

Following are the common symptoms of bulimia nervosa:

  • Being overly concerned with your body shape and weight

  • Constant fear of gaining weight

  • Being unable to control your eating behaviour

  • Eating until you feel sick

  • Eating a lot more food in a binge episode than in a normal meal

  • Forcing yourself to vomit, or exercise too much to keep from gaining weight

  • Misusing laxatives, diuretics etc. after eating

  • Using dietary supplements for weight loss

Bulimia also presents physical signs and symptoms such as:

  • Frequent weight fluctuations

  • Puffy cheeks caused by repeated vomiting

  • Scars under knuckles or hands caused by sticking your finger down your throat to induce vomiting

  • Discoloured teeth due to stomach acid from vomiting​

If you or a loved one has an unhealthy attitude towards eating and weight loss, seek help from your doctor working with the Mind and Brain Service Line​ at The Aga Khan University Hospital. If left untreated, bulimia can severely impact your health.
Your time with your doctor may be limited, so make sure to prepare for your visit beforehand. Here​ are some tips to help get you started.

here is no single test to diagnose bulimia. If your doctor thinks that you may have an eating disorder such as bulimia, he/she will check you for signs for malnutrition or electrolyte imbalances. You will also be asked questions about your mental well-being, as bulimia is usually accompanied by other mental health problems such as depression and anxiety.

Some exams and tests for a possible eating disorder include:

  • Questions about your medical history, including your physical and emotional health, both present and past

  • A physical exam to examine your heart, lungs, blood pressure, weight, mouth, skin, and hair for diet problems

  • Screening questions about your eating habits and how you feel about your health

  • A mental health assessment to assess for depression or anxiety

  • Blood tests to check for signs of malnutrition, such as low potassium levels or other chemical imbalances

  • X-rays, which can show whether your bones have been weakened (osteopenia) by malnutrition

You can have bulimia and be underweight, average weight, or overweight. If you have bulimia, you binge in secret and deny that you have a problem. These factors can make bulimia hard to diagnose. Early, accurate diagnosis and treatment of bulimia can decrease the chances of long-term health problems and even death in severe cases. However, if you suffer from bulimia, you will attempt to try to hide symptoms, which can make it hard to detect. If you are experiencing any of these symptoms, you can book an appointment with your physician and be assured of receiving quality medical care at The Aga Khan University Hospital.​

Treatment for bulimia involves psychological counselling and sometimes medicines such as antidepressants. There are long-term treatments that may require weeks or months before you notice significant results.

Bulimia that occurs with another condition may take longer to treat, and you may need more than one type of treatment. If you have another condition that commonly occurs with bulimia, such as depression or substance abuse, your doctor may want to treat that condition first.

If you have had bulimia for a long time without treatment, or if you have used substances such as laxatives, diuretics, or cough syrup to purge, then you may have a health problem such as dehydration that needs treatment first. Treatment for bulimia usually consists of:

  • Medicines: antidepressants, such as fluoxetine are sometimes used to reduce the cycle of binge and purge and relieve symptoms of depression that occur along with eating disorders. They work best when combined with counselling.

  • Psychological counselling: two types of counselling are useful in treating bulimia. They are CBT (Cognitive Behavioural Therapy) and IPT (Interpersonal Psychotherapy). In CBT you learn how to change negative thoughts that you may have about food, your weight, your body, or beliefs about yourself. In IPT you learn how relationships, and feelings about those relationships, affect binge eating and purging.

Sometimes living with bulimia can get very discouraging because recovery can take a long time and relapse is common. If you feel like you need additional support, call and set up an appointment with your doctor at the Mind and Brain Service Line​ at The Aga Khan University Hospital, immediately to get help.​

The Aga Khan University Hospital offers various support services to help with managing or recovering from the disease or condition. These include but are not limited to nutrition, physiotherapy, rehabilitation, specialized clinics and some patient support groups. Your doctor or nurse will advise you accordingly.

The Aga Khan University Hospital offers financial assistance to those who are in need and fulfil the eligibility criteria. For further information, you can contact the Patient Welfare Department. You can find the contact number of the Patient Welfare Department in the ‘Important Numbers’ section on the website homepage.
The financial counselling staff is available during office hours, at the main PBSD (Patient Business Services Department), to answer your financial queries on treatments’ costs and authorize admissions on partial deposit as per hospital policies allow. The financial counsellor in the emergency room is open 24/7. You can find the contact number of the Patient Business Services in the ‘Important Numbers’ section on the website homepage.
Your doctor and or nurse will give you specific instructions about the prescribed medication. Please ensure that you take or use the prescribed medicine as advised. It can be dangerous to your health if you self-prescribe. Please inform the doctor or nurse beforehand if you have experienced any adverse reactions to any medications in the past. If you experience any symptoms of drug poisoning, overdose or severe reaction please contact the Pharmacy Service at The Aga Khan University Hospital immediately. You can find the contact number of the Pharmacy Services in the ‘Important Numbers’ section on the website homepage.

The information provided on our website is for educational purposes and not intended to be a substitute for medical advice, diagnosis or treatment. You should always seek the advice of your doctor or other healthcare professional provider.