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Understanding Bulimia

Our ‘Understanding…’ series is a collection of psychoeducation guides for common mental health conditions. Friendly and explanatory, they are comprehensive sources of information for your clients. Concepts are explained in an easily digestible way, with plenty of case examples and accessible diagrams. Understanding Bulimia is designed to help clients with bulimia nervosa to understand more about their condition.

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A psychoeducational guide. Typically containing elements of skills development.


Languages this resource is available in

  • English (GB)
  • English (US)
  • Polish
  • Spanish (International)

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Introduction & Theoretical Background

Many people go through periods where they eat more or less than usual. If these episodes are extreme, distressing, or happen often, they may be a sign of bulimia nervosa. Bulimia is a type of eating disorder where you have episodes of binge-eating (eating large amounts of food in an uncontrolled way) and compensation (doing things to prevent weight gain such as vomiting or using laxatives). At some point in their lives, about 3 in every 100 women and 1 in every 100 men develop bulimia (van Eeden et al., 2021). Fortunately, psychological treatments like cognitive behavioral therapy (CBT) are very effective in overcoming bulimia. This guide will help you to understand:
  • What bulimia is
  • Why bulimia might not get better by itself
  • Treatments for bulimia

Therapist Guidance

Our ‘Understanding…’ series is designed to support your clients:
  • Scaffold knowledge. The guides are perfect during early stages of therapy to help your clients understand how their symptoms fit together and make sense.
  • Reassure and encourage optimism. Many clients find it hugely reassuring to know there is a name for what they are experiencing, and that there are evidence-based psychological models and treatments specifically designed to help.
  • De-mystify the therapy process. To increase your client’s knowledge of the therapy process and the ingredients that it is likely to involve. If you can help your clients to understand why an intervention is important (think exposure!) it can help encourage them to engage.
  • Signposting. If you’re just seeing a client briefly for assessment, or you have a curious client who wants to know more, these resources can be a helpful part of guiding them to the right service.
  • Waiting time not wasted time. When you’ve assessed someone but their treatment can’t begin right away, psychoeducation can help them learn about how therapy can help while they’re waiting.
Each guide includes:
  • Case examples to help your clients relate to the condition, and to normalize their experiences.
  • Jargon-free descriptions of symptoms, and descriptions of how they might affect your thoughts, feelings, and actions.
  • A symptom questionnaire for screening assessment.
  • An accessible cognitive-behavioral account of what keeps the problem going, or what stops it from getting better.
  • A description of evidence-based treatments for that condition, including an overview of the ‘ingredients’ of a good cognitive behavioral approach.

References And Further Reading

  • van Eeden, A. E., van Hoeken, D., & Hoek, H. W. (2021). Incidence, prevalence and mortality of anorexia nervosa and bulimia nervosa. Current Opinion in Psychiatry, 34, 515-524.
  • Waller, G., & Sheffield, A. (2008). Causes of bulimic disorders. Psychiatry, 7, 152-155.
  • Goncalves, S., Machado, B. C., Martins, C., Hoek, H. W., & Machado, P. P. (2016). Retrospective correlates for bulimia nervosa: A matched case-control study. European Eating Disorders Review, 24, 197-205.
  • Slade, E., Keeney, E., Mavranezouli, I., Dias, S., Fou, L., Stockton, S., Saxon, L., Waller, G., Turner, H., Serpell, L., Fairburn, C. G., & Kendall, T. (2018). Treatments for bulimia nervosa: A network meta-analysis. Psychological Medicine, 48, 2629-2636.
  • Bo-Linn, G. W., Santa Ana, C. A., Morawski, S. G., & Fordtran, J. S. (1983). Purging and calorie absorption in bulimic patients and normal women. Annals of Internal Medicine, 99, 14-17.
  • Hay, P. (2013). A systematic review of evidence for psychological treatments in eating disorders. International Journal of Eating Disorders, 46, 462-469.
  • NICE (2017). Eating Disorders: Recognition and Treatment. NICE Clinical Guideline 69. London: National Institute for Health and Care Excellence.
  • Fairburn, C. G., Bailey-Straehler, S., Basden, S., Doll, H. A., Jones, R., Murphy, R., O’Connor, M. E., & Cooper, Z. (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E) and interpersonal psychotherapy in the treatment of eating disorders. Behavior Research and Therapy, 70, 64-71.
  • Polnay, A., James, V. A. W., Hodges, L., Murray, G. D., Munro, C., & Lawrie, S. M. (2014). Group therapy for people with bulimia nervosa: systematic review and meta-analysis. Psychological Medicine, 44, 2241-2254.
  • Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
  • Waller, G., Cordery, H., Corstorphine, E., Hinrichsen, H., Lawson, R., Mountford, V., & Russell, K. (2007). Cognitive behavioral therapy for eating disorders: A comprehensive treatment guide. Cambridge University Press.