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The FOUR types of Bulimia Nervosa

One of the most commonly misdiagnosed Eating Disorders I see in my practice is Bulimia Nervosa. In fact, most of the patients and clients I see with Bulimia think they have Binge Eating Disorder, and in turn have been seeking the wrong type of solutions to their disordered eating for years. But Bulimia is so misunderstood because it’s not as simple as binging then making yourself sick. So let’s take 5 minutes today to explore the four types of Bulimia I see in my practice, and some practical tips to help kick-start your recovery!





Vomiting


The most common type of Bulimia we see in the media is the binge-then-purge cycle involving making yourself sick, but in fact, this is the LEAST common type of Bulimia I see in my practice. That’s not to say that if this has been your experience, it in any way is invalid, but simply it’s much rarer in my clinic.

Why is this type of Bulimia presentation so uncommon? My opinion - it’s seen as an Eating Disorder. I know that sounds absolutely bizarre, but the other three forms of Bulimia have become so socially acceptable and normalised, many trick themselves into thinking they don’t have an Eating Disorder.





Over-exercise


The second type of Bulimia is purging via over-exercise. This is an incredibly common form of Bulimia that I see in my clinic, and an Eating Disorder which is very much fueled by toxic fitness culture. Purging by over-exercise can look like the obvious, gym workouts and attending an excessive number of exercise classes after a binge, or the less obvious, for example, obsessing over your daily step count after a binge. The type of exercise we do when purging is against our intuition, excessive, and will inevitably lead to a physical burnout, with the likelihood of us binging again and repeating the cycle. 






Restriction and Dieting


The third type of Bulimia I see is the MOST common, purging via restriction. You guessed it, this type of purging is pushed by diet culture, and almost always results in significant binging. Again, this type of purge pushes us away from our intuition and our hunger cues. It seriously messes with our metabolism and can cause significant weight gain in the long term because of this. Restriction-based purging comes in many forms that are seen as socially acceptable, from restrictive diets such as keto, the carnivore diet and raw veganism, weight loss plans and liquid ‘meal replacement products’ from leading companies I will not name because, well, I’d rather not be sued. 





Diet Pills and Laxatives


The final type of Bulimia I see in practice is diet pills and laxatives. These range from laxative-based products like teas which will have you on the toilet most of the day, not allowing your body to retain essential nutrients, to diet pills which can be fatal.


As you can see, so many forms of purging have become dangerously normalised, with Bulimia now being one of the biggest Eating Disorders here in the U.K.





What should I do if I have Bulimia Nervosa?


So, what can we do if we realise that we may be suffering from Bulimia?


  1. Get support. Whether it be a loved one or a trusted professional like your GP or a registered therapist like myself, please do reach out for support. Eating Disorders can often leave us feeling isolated, and we need a supportive village in our recovery journey! I appreciate that professional support can be expensive, but many health boards here in the U.K. have fantastic services on the NHS, and many have low-cost or even free therapy from third-sector organisations. If you are in school or university, reach out to student support to see if you would be eligible for therapy, with many offering eight or more sessions completely free of charge. And, shameless plug, if you head over to my website, you can find my online courses designed to help you in your first steps towards recovery.

  2. Acknowledge that you may have unprocessed trauma. One of the biggest messages I try to get out, is that eating disorders stem from unprocessed trauma. We all experience trauma, but if our traumas go unsupported, we can manifest disordered eating behaviours as a way of coping, whether that be to disconnect, find a sense of control, or even to punish ourselves. To move forward with our recovery journey, we must also start a trauma-processing journey.

  3. Notice your triggers. Our unprocessed trauma can be triggered by anything in our day-to-day lives, but acknowledging what our triggers are can be incredibly helpful. The best way to do this can actually be to ‘work backwards’; after a binge, try to look back to figure out what the trigger was, remembering a trigger can be one isolated incident or a build-up of incidents.

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