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An eating disorder is when you have an unhealthy attitude to food, which can take over your life and make you ill.
 

It can involve eating too much or too little, or becoming obsessed with your weight and body shape.

But there are treatments that can help, and you can recover from an eating disorder.
 

Men and women of any age can get an eating disorder, but they most commonly affect young women aged 13 to 17 years old.

The most common eating disorders are:

• anorexia nervosa – when you try to keep your weight as low as possible by not eating enough food, exercising too much, or both
• bulimia nervosa – when you sometimes lose control and eat a lot of food in a very short amount of time (binging) and are then deliberately sick, use laxatives (medication to help you poo), restrict what you eat, or do too much exercise to try to stop yourself gaining weight
• binge eating disorder (BED) – when you regularly lose control of your eating, eat large portions of food all at once until you feel uncomfortably full, and are then often upset or guilty
• other specified feeding or eating disorder (OSFED) – when your symptoms don't exactly match those of anorexia, bulimia or binge eating disorder, but it doesn't mean it's a less serious illness

OSFED is the most common, then binge eating disorder and bulimia. Anorexia is the least common.

If you or people around you are worried that you have an unhealthy relationship with food that's affecting your eating habits, you could have an eating disorder.
 

Symptoms of eating disorders include:

• spending a lot of time worrying about your weight and body shape
• avoiding socialising when you think food will be involved
• eating very little food
• deliberately making yourself sick or taking laxatives after you eat
• exercising too much
• having very strict habits or routines around food
• changes in your mood

You may also notice physical signs, including:

• feeling cold, tired or dizzy
• problems with your digestion
• your weight being very high or very low for someone of your age and height
• not getting your period for women and girls

This web page addresses the specific symptoms of bulimia. You can read, on the following links, more about the specific symptoms of:

• Anorexia
• Binge Eating Disorder

It's important to remember that even if your symptoms don't exactly match those for anorexia, bulimia or binge eating disorder, you may still have an eating disorder.

It can often be very difficult to identify that a loved one or friend has developed an eating disorder.
 

Warning signs to look out for include:

• dramatic weight loss
• lying about how much and when they've eaten, or how much they weigh
• eating a lot of food very fast
• going to the bathroom a lot after eating, often returning looking flushed
• excessively or obsessively exercising
• avoiding eating with others
• cutting food into small pieces or eating very slowly
• wearing loose or baggy clothes to hide their weight loss

There is no one specific cause of eating disorders. However many people who have, or have had, an eating disorder, have experienced one or more of the following:

• you or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction
• you have been criticised for your eating habits, body shape or weight
• you're overly concerned with being slim, particularly if you also feel pressure from society or your job – for example, ballet dancers, jockeys, models or athletes
• you have anxiety, low self-esteem, an obsessive personality, or are a perfectionist
• you have been sexually abused

That said, it is also true that experience of one or more of the above does not automatically lead to the development of an eating disorder - this is because people are different and not everyone reacts in the same way to the same things.

Bulimia is an eating disorder and mental health condition. Bulimia is when you sometimes lose control and eat a lot of food in a very short amount of time (binging) and are then deliberately sick, use laxatives (medication to help you poo), restrict what you eat, or do too much exercise to try to stop yourself gaining weight

People who have bulimia go through periods where they eat a lot of food in a very short amount of time (binge eating) and then make themselves sick, use laxatives (medication to help them poo) or do excessive exercise, or a combination of these, to try to stop themselves gaining weight.
 

Men and women of any age can get bulimia, but it's most common in young women and typically starts in the mid to late teens.

People with bulimia are caught in a cycle of eating large quantities of food (called ‘bingeing’), and then vomiting, taking laxatives or diuretics (called purging), in order to prevent gaining weight. This behaviour can dominate daily life and lead to difficulties in relationships and social situations. 

Usually people hide this behaviour pattern from others and their weight is often in a healthy range. People with bulimia tend not to seek help or support very readily and can experience swings in their mood as well as feeling anxious and tense.

They may also have very low self-esteem and self harm. They may experience symptoms such as tiredness, feeling bloated, constipation, abdominal pain, irregular periods, or occasional swelling of the hands and feet. Excessive vomiting can cause problems with the teeth, while laxative misuse can seriously affect the heart. Bulimia in children and young people is rare, although young people may have some of the symptoms of the condition. Bulimia usually develops at a slightly older age than anorexia. In some instances, although not all, bulimia develops from anorexia.

As with other eating disorders, bulimia nervosa can be associated with:

• low self-esteem
• alcohol misuse
• depression
• self-harm

As with all eating disorders, women are much more likely to develop bulimia than men.

However, bulimia nervosa is becoming increasingly common in boys and men. There are an estimated 1.6 million Britons suffering from some form of eating disorder, and reports estimate that up to 25% may be male.

Recent studies suggest that as many as 8% of women have bulimia at some stage in their life. The condition can occur at any age, but mainly affects women aged between 16 and 40 (on average, it starts around the age of 18 or 19).

Bulimia nervosa can affect children, but this is extremely rare. 

This is a list of notable people who have had bulimia nervosa. Often simply known as bulimia, this is an eating disorder which is characterized by consuming a large amount of food in a short amount of time, followed by an attempt to rid oneself of the calories consumed, usually by self-induced vomiting, laxatives, diuretics or excessive exercise.

Eating disorders are known to be more common in people whose occupations involve significant focus on appearance, like athletes or celebrities.

Music

• Elton John, British musician
• Demi Lovato, American singer and actress
• Katharine McPhee, American singer
• Alanis Morissette, Canadian-American musician
• Shelby Starner, American singer-songwriter
• Lynda Thomas, Mexican musician
• Amy Winehouse, British singer-songwriter, (1983–2011)

Other

• David Coulthard, British Formula One racing driver
• Katie Couric, American television journalist
• Diana, Princess of Wales, British royal family, (1961–1997)
• Michelle Duggar, American reality television star on 19 Kids and Counting
• Jocelyn Golden, author
• Marya Hornbacher, American author
• John Prescott, British politician
• Richard Simmons, American fitness instructor and television personality
• Shane Dawson, American YouTube personality
• Bryony Gordon, English journalist

Within the NHS use is made of  the 'SCOFF' questionnaire as screening tool for the diagnosis of eating disorders, for possible cases of anorexia or bulimia.

The SCOFF questions

• Do you make yourself Sick because you feel uncomfortably full?
• Do you worry you have lost Control over how much you eat?
• Have you recently lost more than One stone in a 3 month period?
• Do you believe yourself to be Fat when others say you are too thin?
• Would you say that Food dominates your life?

*One point for every "yes"; a score of >=2 indicates a likely case of anorexia nervosa or bulimia.

Symptoms of bulimia include:

• eating very large amounts of food in a short time, often in an out-of-control way – this is called binge eating
• making yourself vomit, using laxatives, or doing an extreme amount of exercise after a binge to avoid putting on weight – this is called purging
• fear of putting on weight
• being very critical about your weight and body shape
• mood changes – for example, feeling very tense or anxious

These symptoms may not be easy to spot in someone else because bulimia can make people behave very secretively.

Signs of bulimia nervosa include an obsessive attitude towards food and eating, an overcritical attitude to their weight and shape, and frequent visits to the bathroom after eating, after which the person might appear flushed and have scarred knuckles (from forcing fingers down the throat to bring on vomiting).

The main signs of bulimia are eating a large amount of food over a very short time (binge eating) and then ridding your body of the extra food (purging) by making yourself vomit, taking laxatives or exercising excessively, or a combination of these.

Other signs of bulimia include:

• fear of putting on weight
• being very critical about your weight and body shape
• mood changes – feeling very tense or anxious, for example 
• thinking about food a lot
• feeling guilty and ashamed, and behaving secretively
• avoiding social activities that involve food
• feeling like you have no control over your eating

You may also notice physical signs like:

• feeling tired
• a sore throat from being sick
• bloating or tummy pain
• a puffy face
• self-harming

There may also be psychological symptoms, such as:

• an obsessive attitude towards food and eating
• unrealistic opinions about body weight and shape
• depression and anxiety
• isolation – losing interest in other people

The following warning signs could indicate that someone you care about has an eating disorder:

• eating a lot of food, very fast
• going to the bathroom a lot after eating, often returning looking flushed
• excessively or obsessively exercising

Bulimia can eventually lead to physical problems associated with not getting the right nutrients, vomiting a lot, or overusing laxatives.

Without treatment, bulimia can lead to a number of physical complications. These can include any of the following:

• Dental problems – persistent vomiting can cause your stomach acid to damage the enamel on your teeth, which may lead to tooth decay. Excessive vomiting can also cause bad breath and a sore throat,.or even tears in the lining of the throat from making yourself vomit.
• Irregular periods – your menstrual cycle can become unpredictable, or even stop altogether. You may also find it difficult to become pregnant in the future.
• Poor skin and hair – a lack of nutrients through persistent vomiting or laxative use can make your skin and hair unhealthy. Your skin and hair can become dry and your fingernails can become brittle.
• Swollen glands – if you have bulimia, your saliva glands can become swollen from frequent vomiting. This makes your face appear rounder.
• Chemical imbalance – excessive vomiting and laxative use can cause chemical imbalances in your body. This can result in tiredness, weakness, abnormal heart rhythms, kidney damage, convulsions (fits) and muscle spasms.
• Bowel problems – excessive use of laxatives can damage your bowel muscles, resulting in permanent constipation.
• Heart problems – long-term complications of bulimia can include an increased risk of heart problems.
• Feeling tired and weak
• Brittle fingernails
• Bone problems – you may be more likely to develop problems such as osteoporosis, particularly if you have had symptoms of both bulimia and anorexia

There is no one specific cause of bulimia. However many people who have, or have had, an eating disorder, have experienced one or more of the following::

• you or a member of your family has a history of eating disorders, depression, or alcohol or drug addiction
• you have been criticised for your eating habits, body shape or weight
• you're overly concerned with being slim, particularly if you also feel pressure from society or your job – for example, ballet dancers, jockeys, models or athletes
• you have anxiety, low self-esteem, an obsessive personality, or are a perfectionist
• you have been sexually abused

That said, it is also true that experience of one or more of the above does not automatically lead to the development of bulimia - this is because people are different and not everyone reacts in the same way to the same things.

Everyone has their own eating habits – for example, people with a food intolerance need to avoid eating certain foods to stay healthy. However, people suffering from eating disorders tend to use their eating habits and behaviours to cope with emotional distress, and often have an abnormal or unrealistic fear of food, calories and being fat.

Eating disorders are often associated with an abnormal attitude towards food or body image.

Because of this fear, people with bulimia nervosa tend to restrict their food intake. This results in periods of excessive eating and loss of control (binge eating), after which they make themselves vomit or use laxatives (purging). They purge themselves because they fear that the binging will cause them to gain weight, and usually feel guilty and ashamed of their behaviour. This is why these behaviours are usually done in secret.

Bulimia is often a repetitive vicious circle of binging and purging, triggered by things such as hunger, sadness, stress or emotional anxiety.

If you have Bulimia, it is likely that you have very low self-esteem. You may also think you are overweight, even though you may be at or near a normal weight for your height and build.

This may encourage you to set yourself strict rules about dieting, eating or exercising, which are very hard to maintain. If you fail to keep to these strict rules, you binge on the things that you have denied yourself. After feeling guilty about binging, you purge to get rid of the calories.

For example:

• You may set very strict rules for yourself about dieting, eating or exercising.
• Failing to keep to these then leads to periods of excessive eating and loss of control (binge eating), after which you feel guilty or ashamed.
• You then purge to get rid of the calories, leaving you feeling hungry again, and the cycle continues.

These self-help books may take you through a programme that helps you to:

• Monitor what you are eating – this can help you notice and try to change patterns in your behaviour
• Make realistic meal plans – planning what and when you intend to eat throughout the day can help you regulate your eating, prevent hunger and reduce binge eating.
• Learn about your triggers – this can help you to recognise the signs, intervene and prevent a binge-purge cycle.
• Identify the underlying causes of your disorder – this means you can work on those issues in a healthier way.
• Find other ways of coping with your feelings.

Joining a self-help support group, for people with bulimia, may be suggested to you.

If self-help treatment alone isn't enough or hasn't helped you after four weeks, you may also be offered cognitive behavioural therapy (CBT) or medication.

Children and young people will usually be offered family therapy. This involves you and your family talking to a therapist, exploring how bulimia has affected you and how your family can support you to get better. Children and young people may also be offered CBT, which will be the same as the CBT offered to adults.

Cognitive behavioural therapy (CBT) is sometimes offered by the NHS to those who do not find self-help treatment works for them. Treatment should comprise of up to 20 sessions and last for around four or five months.

CBT involves talking to a therapist, who will help you explore emotions, thoughts and behaviour that could be contributing to your eating disorder, and how you feel about your weight and body shape. 

They will try to help you to adopt regular eating habits and show you how to stick to them. They should also show you ways to manage difficult feelings and situations to stop you from relapsing once your therapy ends.

The other psychological treatment recommended in the NICE guidelines is interpersonal therapy (IPT) which should follow CBT if unsuccessful or if you would instead prefer to follow this line of treatment.

There are many forms of IPT offered by the NHS. In general, they are characterised by having long waiting times, and requiring a significant commitment in terms of the lengthy number of sessions that can be required.

The IPT of choice at The Surrey Hypnotherapy Clinic is Hypnoanalysis Hypnotherapy, because of its speed, which makes it more effective at getting to the root cause of the problem - and also it is more effective in establishing new thoughts, feelings and behaviour around food, eating, body image and Bulimia.

Medication can be offered alongside a programme of self-help or talking therapies. They can help you to reduce the number of times you are bingeing and purging.

Antidepressants should not be offered as the only treatment for bulimia. But you may be offered an antidepressant, such as fluoxetine (Prozac), in combination with therapy or self-help treatment, to help you manage other conditions, such as: 

• anxiety or depression
• social phobia
• obsessive compulsive disorder (OCD)

Antidepressants are very rarely prescribed for children or young people under 18.

It's important to look after your health while recovering from bulimia.

If you are vomiting regularly, the acid in your vomit can damage your teeth over time. In order to minimise this damage you should:

• avoid brushing teeth immediately after vomiting so you don't wear away the enamel
• rinse your mouth with a non-acidic mouthwash
• make sure you see your dentist regularly
• don't drink or eat acidic foods, such as fruit juice, during a binge and after purging
• don't smoke

Vomiting can also lead to risk of dehydration. To avoid this, make sure you drink plenty of fluids to replace what you have vomited.

Hypnosis and Hypnotherapy Treatment Therapy for Bulimia

Most people with Bulimia continue with their binge/purge cycle for reasons, connected to weight control, for example:

• A desire to lose weight, quickly, in preparation for some forthcoming event (e.g. a wedding).
• A desire not to put on any weight at all, maybe as part of an occupational requirement (e.g. ballerina, model, jump jockey).

For some people, in certain occcupations, the binge/purge cycle of Bulinia may be a very expedient and pragmatic way to live thier life. and not necessarily a big problem - for the person, it is a means to an end.

Bulimia becomes a problem when the binge/purge cycle is out of control, it has taken over their life, it is central to their life and it is how they live their life.

The difficult part with Bulimia is usually for the person to first recognise and agree that they have developed a bad habit that is out of control, and for them to appreciate that they do have a problem for which they need help. This realisation usually take place outside of the consulting room, either in an individual moment of recognition or following persuasion by concerned family and friends.

The primary therapeutic goal with Bulimia should be to not only break the break the binge/purge habit but also to encourage a healthy lifestyle and eating habits such that when they have broken the binge/purge cycle of Bulimia the person can at least continue to maintain a healthy weight, and maybe even lose weight as well if weight loss is a valid and underlying driver for their behaviour (i.e. assuming that they are not dangerously under weight).

Bulimia Hypnotherapy - Suggestion Hypnotherapy

Hypnosis and suggestion therapy can be used to administer therapeutic suggestions, whilst in Hypnosis, in the style of "you will feel a sense of pride and pleasure in the way that you eat your food and in the way that you control and limit your portion sizes and, always leave some food on your plate", and "you are pleased that you no longer have a habit which many would love to stop".

Any thoughts that there might be regarding negative body image, or body dysmorphia, can also be addressed and countered using suggestion hypnotherapy.

Bulimia Hypnotherapy - Hypnoanalysis Hypnotherapy

Where the bulimia is genuinely out of control Hypnoanalysis can be used to ascertain the underlying cause of the behaviour and, when combined with Suggestion Hypnotherapy, the bulimia can be stopped in that way. It is generally better to first have Hypnoanalysis Hypnotherapy treatment, to remove any unconscious drivers of the behaviour, before commencing Suggestion Hypnotherapy although the two therapies can be, and often are, intermixed.

NHS Psychological Treatment for Bulimia

Hypnosis and Hypnotherapy treatment can work well as an alternative to NHS psychological treatment of Cognitive Behavioural Therapy CBT), and in combination with a NHS treatment plan. However it should be noted that some people choose not to involve the NHS in their treatment of Bulimia because Bulimia is considered by the NHS to be a serious mental health condition and a person's episode of Bulimia and their treatment is then recorded and noted in their medical history in their NHS medical notes. These notes will stay with them for the rest of their life, and may, longer term, have an affect on things like life insurance and employability.

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Acknowledgements

http://www.nhs.uk/Conditions/Anxiety/Pages/Introduction.aspx

http://evidencebasedpsychotherapy.com/therapist-directory/name/peter-back/

http://www.nhs.uk/conditions/Eating-disorders/Pages/Introduction.aspx

https://www.b-eat.co.uk/

https://www.b-eat.co.uk/assets/000/000/383/Beat_EOSG_survey_results_original.pdf?1427212028

https://www.nice.org.uk/guidance/ng69

https://www.psychiatry.org/psychiatrists/practice/dsm

https://www.nhs.uk/conditions/bulimia/

https://en.wikipedia.org/wiki/Bulimia_nervosa

https://en.wikipedia.org/wiki/List_of_people_with_bulimia_nervosa

The SCOFF Questionnaire

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