Bulimia nervosa

Also called Bulimia

Binge eating followed by compensating. Usually hidden behind a completely ordinary body weight.

What it is

Bulimia hides better than any other eating disorder, and the reason is uncomfortable: most people with it are a normal weight, so nobody looks.

The cycle is binge, then compensate. Eating a large amount in a short time with a sense of being out of control, then vomiting, using laxatives, fasting or exercising to undo it. Shame drives the secrecy, secrecy protects the cycle, and the cycle deepens the shame.

It affects people of every gender, though it is diagnosed far more often in women. It commonly begins in the late teens or twenties.

Signs you might notice

Disappearing to the bathroom after meals, reliably.

Large amounts of food going missing. Wrappers hidden.

Damage that shows in the mouth first: eroded tooth enamel, swollen glands at the jaw, a sore throat. Dentists often spot bulimia before doctors do.

Calluses on the knuckles. Weight that fluctuates within a normal range.

Rigid rules about food, and enormous distress when they break.

How it can affect day-to-day life

The physical risk is not obvious from the outside, which is precisely why it is dangerous. Repeated vomiting strips potassium, and low potassium causes heart rhythm problems that can be fatal. Laxative misuse damages the bowel long-term.

Teeth do not recover. The enamel loss is permanent.

Life narrows around the cycle. Meals with other people become impossible to plan, so people withdraw from exactly the settings where somebody might notice.

Supporting someone well

Do not comment on weight, shape or appearance. Not even positively. Any remark confirms that bodies are being watched and judged.

Talk about behaviour and feelings instead of food. "You seem to be having a rough time" opens more than "did you eat".

Do not police bathrooms or count food. Surveillance makes the secrecy more elaborate and destroys the trust you need.

Encourage a dental check-up. It is a lower-stakes door into help than a psychiatric appointment and it addresses a real, immediate harm.

Get help early. Eating disorders treated within the first three years have substantially better outcomes, and waiting to see whether it settles is the wrong instinct.

Where to get help

A GP can refer to a community eating disorder service. In England, people under 19 should be seen quickly under the access standards, so cite them if you are being asked to wait.

Beat run a helpline on 0808 801 0677 and online support groups.

Fainting, chest pain or an irregular heartbeat needs urgent medical assessment. Say that vomiting has been happening, because that is what points a doctor at potassium.