Bulimia – Infos at a glance

Bulimia is a mental illness that belongs to the eating disorders. This disorder manifests itself by the sufferers having recurrent bouts of ravenous hunger, in which there is an uncontrolled intake of food. In addition to the “binge eating” episodes, sufferers develop a great fear of gaining weight, which in most cases is triggered by striving for a socially mediated physical ideal image. Therefore, they force vomiting, take laxatives or exercise excessively. Through this blog post, they will get information about the causes, symptoms and treatment of bulimia.


It is believed that bulimia can have different causes, but it cannot be clearly defined why this disorder develops. The interaction of a variety of triggering factors subsequently gives rise to the so-called eating disorders. The main trigger, as with all eating disorders, is a socially transmitted and exaggerated physical ideal image, which conveys that being thin has a strong connection with success and happiness. Although a disturbed relationship to one’s own body and the fear of being fat are considered to be the main causes of vomiting after eating, family conflicts, experienced traumas (e.g. rape, death in the family, etc.) or a certain personality type (anxious, perfectionistic, angry, low self-confidence, self-hatred, etc.) must definitely be taken into account in the therapy of bulimia.

When the disease emerges, several factors often come together. Risk factors include:

  • genetic predisposition
  • biological components
  • lack of self-esteem
  • problematic family influences
  • high performance requirements
  • Western ideal of beauty
  • negative self-image

People with bulimia often have a negative self-image. For those affected, there is a big difference between the subjectively felt desired state and the current actual state. This is especially true for their own body. Self-esteem is strongly dependent on the figure. Bulimics usually strive for a very slim ideal, which they can only achieve through massive restriction in eating – or through vomiting/laxatives/excessive sport.

There is also some evidence for the influence of sociocultural influences: Eating disorders are much more common in the Western world (including among immigrants) than in other cultural groups. It is particularly common in the middle and upper classes, as well as in certain at-risk groups such as high-performance athletes and models.


Symptoms vary depending on the severity of the disorder and the form of bulimia nervosa.

A distinction is made between two types of the disease:

  • “purging type”: Affected persons vomit food after binge eating episodes; in severe forms of the disease, bulimics vomit after every single meal and also have several episodes daily, during which they usually eat large amounts of (high-calorie) food. Some sufferers also vomit after eating even small amounts of food, such as a yogurt. How often and when they vomit depends on how far the disease has progressed.
  • “Non-purging type”: Affected individuals have binge eating episodes but do not vomit afterwards; instead, they follow strict diets, fast, take laxatives, or try to compensate for overeating by exercising to exhaustion (“sports bulimia”).
    Bulimia is not as easy for outsiders to recognize as anorexia, for example. People who suffer from binge eating disorder are usually normal weight or only slightly underweight. Being overweight can also occur. The binge-breaking episodes also usually take place in secret, so no one notices for a long time.

Most of the time, bulimics tightly control their eating behavior. They keep to a diet and skip meals. But then they are overcome by cravings again and again.

Repeated cravings

During a craving attack, bulimics lose all awareness and control over what and how much they eat. They consume large amounts of very high-calorie foods in a short period of time. The loss of control can go so far that bulimics sometimes eat up to 10.000 calories in about one to two hours. This is more than four times what a healthy person needs in an entire day.

The binge eating episodes are often triggered by stress and continue until an uncomfortable feeling of fullness develops. During the eating attacks, sufferers sometimes feel a kind of relaxation, but afterwards there is often a feeling of shame or disgust due to their behavior.


Bulimia is a psychological disorder that must be taken seriously. It is usually very difficult for bulimics to make a realistic assessment of their eating behavior or to accept that their eating behavior is disturbed. Therefore, professional help for bulimia is indispensable. The main goals in the treatment of bulimia are

  • in the short term, to achieve a rapid change in eating behavior in order to restore or maintain physical health.
  • in the long term, to help the person affected to identify the causes of the disturbed eating behavior and to eliminate them or to learn how to deal with the eating behavior.

Normalization of the eating behavior

Mild cases of bulimia can also be treated on an outpatient basis. However, in severe cases, the diet must be controlled to help the sufferer achieve normal eating behavior.

Without vomiting – not too much

At the beginning of treatment, a balanced meal plan is drawn up – preferably together with the patient. The patient must then adhere to the plan. These plans include eating regular meals – at least three a day. The most important thing here is to eat without binge eating or vomiting.

No fear of calories

Patients are shown that they can eat higher-calorie foods, which they avoided outside of binge eating attacks, without fear. Involving bulimia sufferers in food preparation is also essential. Handling food should become a positive, relaxed experience for them.

Normalized eating behavior

The regular and varied diet puts an end to the physical state of deficiency. The end result is that the patient no longer has to go through periods of hunger and the urge to eat large amounts of food is reduced.


Cognitive behavioral therapy is often used to treat bulimia.

Realistic body image: a more realistic attitude towards the patient’s body and weight should be developed. It is important here to challenge society’s ideal conceptions of beauty and thinness.

Looking for triggers: In collaboration with the therapist, bulimic patients explore which situations trigger binge eating. A food diary can also be kept to help with this. Together with the patient, the therapist tries to find alternative ways or behaviors that could be used in these stressful situations.

Confrontation therapy: so-called confrontations can be used to reduce anxiety in bulimia therapy. The therapist encourages patients to expose themselves to situations or eat foods that cause them anxiety and that have triggered binge eating episodes in the past. Therapeutically guided exposure leads to a steady reduction in anxiety and increases the bulimic’s self-confidence and self-esteem.