Bulimia nervosa is characterised by a cycle of binge/purge behaviours. Bingeing is often accompanied by a sense of loss of control, which is followed by compensatory behaviours designed to prevent weight gain (e.g., vomiting, use of laxatives, fasting or excessive exercising). Self-evaluation is disproportionately influenced by body weight, size and shape [24]. The cycle of binge/purge is maintained by the belief that control over eating, weight and shape will increase a person’s self-worth, but restricting food intake leads to binge eating which then results in compensatory behaviours [882]. Negative mood states (e.g., sadness, frustration, anger, fear, or loneliness) can exacerbate this cycle [882]. However, unlike many people with anorexia nervosa, those with bulimia nervosa often realise that their behaviour is abnormal and attemptto hide or conceal their symptoms. As such, bulimia nervosa can be an isolating disorder [882]. As with anorexia nervosa, the outward symptoms can be difficult to observe, particularly as people with bulimia nervosa may not display the same dramatic loss in weight. They include [879, 882, 887]:
- Fatigue.
- Bloating and constipation.
- Abdominal pain and distension.
- Calloused knuckles.
- Hoarse voice.
- Delayed digestion.
- Hypokalaemia (low potassium).
- Muscle spasms.
- Heart palpitations.
- Nausea.
- Poor kidney function.
- Dental erosion.