Bulimia: Understanding and Treatment

Bulimia nervosa is characterised by cycles of binge eating followed by compensatory behaviour — most commonly purging through vomiting, but also through laxative use, excessive exercise, or strict fasting. The cycle is typically experienced with significant shame, and it is usually private: people living with bulimia are often indistinguishable from those around them in terms of weight, which means the disorder can persist for years before it is disclosed or treated.

The cycle has a recognisable psychological structure. Restriction or attempts at dietary control create psychological and physiological tension that eventually triggers a binge. The binge provides temporary relief — a quality of numbness, fullness, or comfort — followed by the guilt, shame, and physical discomfort that drive the compensatory behaviour. The compensation temporarily restores a sense of control. And then the cycle begins again.

What drives it

Bulimia is not primarily about food. The food is the medium through which other psychological content is being managed: anxiety, emptiness, self-criticism, an inability to tolerate strong feeling, a relationship with the body marked by hostility or disconnection. The restriction that initiates the cycle is often a response to a feeling of being out of control in some domain — eating becomes the one area that can, in theory, be governed.

Clinically, bulimia is frequently associated with perfectionism, high self-criticism, a history of difficult attachment relationships, and experiences of trauma or loss. Treatment that addresses only the eating behaviour without the psychological substrate rarely produces lasting change.

Treatment at the practice

Dr Jacquet is the only person in Europe to hold a doctorate specifically on male eating disorders, and has 25 years of clinical experience working with the full spectrum of eating disorder presentations. Treatment for bulimia integrates psychotherapy with nutritional support and, where relevant, EMDR for the trauma component. The initial consultation will establish the appropriate treatment frame for your specific presentation.