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Therapists explain the common causes of bulimia nervosa

by Sarah Graham
Wednesday 03 December 2014
651 3509

Bulimia nervosa is an eating disorder, characterised by patterns of restrictive eating, binge eating and purging (i.e. by taking laxatives or self-induced vomiting). Broadly speaking, the condition is caused by a fear of gaining weight or getting fat, but there are a number of emotional, hormonal and cultural causes that may contribute to developing bulimia. We asked RSCPP therapists to explain the common causes of this condition.



Difficulty regulating your emotions

Therapist: Registered Counsellor Styliani Stathi
The causes of bulimia are many and complex - there is always a combination of factors contributing to both the onset and maintenance of the disorder. One of the most consistent and significant of these underlying causes is a great difficulty in identifying, acknowledging and 'containing' negative or painful emotions. Bulimia sufferers, for a variety of reasons, have not developed effective emotion regulation and self-soothing skills, and, as a result, the binge-and-purge cycle, characteristic of bulimia, may become the only way you have found to manage your otherwise intolerable emotional experience.
Registered Counsellor Styliani Stathi


Attempting to control your emotions  

You may often push down and attempt to hide feelings of insecurity, mistrust, anger or not feeling valued. In situations like this, it is not uncommon for people affected by bulimia to use their food behaviour to attempt to manage these emotions. For example, you may either over-eat or starve yourself in an attempt to numb the uncomfortable feelings that you have but do not express. Often this may be too much for you to manage and so you may lose control and self-induce vomiting to get all the unwanted feelings out of yourself. In bulimia this becomes a vicious cycle between attempting to control your life by controlling your eating; being unable to exert enough control over a period of time, so binging and vomiting; then feeling even worse and starting the cycle over again. The key to treatment is to break the cycle.


Low self-esteem 

Therapist: Chartered Psychologist Dr. Beverley Marais
If you have low self-esteem and also evaluate yourself negatively in comparison to others, you are more likely to develop an eating disorder such as bulimia. You may also view your self-worth as comprising totally of the way you look - for example, your weight and body shape. You may be unduly influenced by messages provided through the media about how women/men 'should' look. The strict diets you may use in response are not sustainable long-term, and this then induces a binge. A binge then induces feelings of guilt, which would then lead you to purge. Purging is therefore used to relieve some of the feelings of guilt, but is also used as a weight management strategy. This vicious cycle becomes reinforced over time, and may lead you to develop bulimia, and augment further low feelings of self-worth.
Chartered Psychologist Dr. Beverley Marais


Social and cultural pressures

Therapist: Chartered Psychologist Dr. Julie Scheiner
Pressures and conflicts within the family and amongst peers, and stressful life events are thought to make someone more likely to develop bulimia. Many people with bulimia are over-achievers and perfectionists; you may often feel that you can't live up to the expectations of your parents, family or peers.
Chartered Psychologist Dr. Julie Scheiner


Other mental health conditions, or past experiences

Depression, stress, anxiety disorders, Obsessive Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD) and personality disorders may all be contributing factors in developing bulimia. Bulimia can also occur in people who have experienced physical illness, and in people who have been sexually abused. Some people with bulimia have experienced a difficult childhood, with family problems, arguments and criticism. 


Biological factors

According to the NHS, research suggests that genetics may play a part in developing bulimia - if a family member has bulimia, you are four times more likely to be affected by the condition yourself.

The onset of puberty may also be a contributing biological factor, as many people affected by bulimia develop the condition during puberty, when hormonal changes may make you more aware and conscious of changes affecting your body.

Finding support

You can find out more about symptoms and causes of Bulimia Nervosa, including how to find a therapist. If this route is not appropriate for you, your GP can assess you and direct you towards support.

Find a Therapist working with Bulimia Nervosa

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Updated 03 December 2014