I’ve previously talked extensively about binge eating disorder and orthorexia, and now we’re covering bulimia in men.

With the other two eating disorders I mentioned, I have some direct experience. I don’t have any consistent direct experience with bulimia aside from some occasional behaviour patterns that may overlap with it.

So a lot of what I cover here is based on publicly available information and the experience of others.

What Is Bulimia?

The full clinical term is bulimia nervosa but for practicality, I’ll be calling it bulimia here.

The term was first described by psychiatrist Gerard Russell in a 1979 edition of Psychological Medicine, and you can still read the original article online.

People with bulimia, also known as being bulimic, go through periods of eating a large volume of food or binge eating, followed by periods of purging or trying to remove that food from their bodies. This can take the form of inducing vomiting, laxatives or long bouts of exercise.

The binge eating behaviour can overlap with the eating pattern you see associated with binge eating disorder. And I have previously talked about whether you can have both bulimia and binge eating disorder at the same time.

And if you are relying on excessive exercise to remove food you ate from your body, this can overlap with one of the compensatory behaviours you might see in orthorexia. The difference is that with orthorexia, the specific focus is that you are trying to get rid of food you deem “impure” or “unhealthy” whereas with bulimia it can be any of the food you previously ate.

While some of the behaviour patterns do overlap between these eating disorders, it’s also 100% important to remember that bulimia is its own eating disorder. It can just sometimes be helpful to be aware of some of these overlaps.

Stats On Bulimia

It’s difficult to get some authoritative stats on bulimia, but I did find a few studies that give me some numbers.

One thing to bear in mind is that bulimia prominence varies hugely depending on the people being studies:

• It is much more prominent in urban areas than in rural ones
• It is more common in developed countries than in developing ones
• It is more common in Western cultures compared to Eastern

A 2005 study estimated that 1-2% of women aged 15-40 have bulimia. And studies have varied about prominence in men, but the range has been between 0.1% and 1.4%.

Studies do seem to agree that it is much more common in women, with one study suggesting it is as high as 9 times more common.

I did try and do some mental gymnastics to get to some firmer numbers, at least for how prominent bulimia is in the UK.

According to the UK eating disorder charity, BEAT, a 2017 study suggested that there are 1.25 million people in the UK with an eating disorder, and bulimia is the second most common one, with 19% prevalence amongst people with eating disorders.

The most common specified eating disorder was binge eating disorder.

If we stick with the number of 1.25 million people in the UK having an eating disorder, and 19% of that population having bulimia, that gives us 237,500 total people in the UK with bulimia.

To take it further if we apply the findings that suggest women can be 9 times more likely than men to have bulimia, that suggest 90% of those 237,500 will be women compared to 10% that will be men.

That would give us 213,750 women and 23,750 men with bulimia.

So that is one very crude estimate and please note that there is zero merit to my method here of combining multiple studies!

But based on the studies, it seems like this might be a decent ballpark estimate.

I mentioned it can also vary with specific populations and another article mentioned that 70% of male athletes in weight-based sports – boxing, wrestling, judo, combat sports, weightlifting, bodybuilding – engaged in dieting and disordered eating patterns that may overlap with bulimia.

Celebrities Who Have Or Have Had Bulimia

There are quite a few faces who have spoken about or are thought to have had bulimia.

Princess Diana is one such person and her bottle with bulimia was depicted quite graphically in season four of the Netflix series, The Crown.

Cricketer Andrew Flintoff opened up about having bulimia and did a documentary for the BBC on it as well.

Lady Gaga spoke about bulimia in 2012.

And other famous faces have included Elton John, Ed Sheeran and Zayn Malik, formerly of One Direction.

In fact, there is a Wikipedia page that lists several famous personalities that have openly acknowledged having bulimia.

My Exposure To Bulimia

With an estimated 19% of eating disorder sufferers having bulimia, it’s not exactly uncommon, even if it’s not all that well understood by a lot of people.

Another issue with bulimia in men is that the eating behaviour can be normalised as just being a normal “man-size” appetite now and then, rather than acknowledging that it could be a potential disorder.

My first exposure to seeing anyone dealing with an eating disorder was actually bulimia in a male on TV. There used to be a TV series on the BBC called Byker Grove, and in that, one of the boys had bulimia.

The details are sketchy for me but I remember seeing him trying to cope with it, and finding it really difficult to speak to his family.

A Google search tells me the character’s name may have been Joe and it was in season 13, in case you’re curious.

Symptoms And Behaviour of Bulimia

Let’s have a look at some of the common symptoms and behaviour patterns associated with bulimia next.

There are a few behaviour patterns you may notice which can be indicators of this eating disorder. These include:

• Fixation on the number of calories consumed
• Fixation on body shape, size or weight (or a combination of those)
• Low self-esteem
• Regular trips to the bathroom
• Anxiety, sleep disorder, depression
• Frequent occurrences of binge eating, which isn’t specifically defined but my go-to definition tens to be eating a large volume of food in a short span of time, until feeling uncomfortably full
• Frequent use of laxatives
• Compulsive or excessive exercise
• And as we covered earlier, trying to induce vomiting

Imagine if someone is left to themselves, and they feel a bit stressed, or emotional, or whatever triggers their binge behaviour has happened.

They won’t necessarily feel hungry but will turn to eating and will find themselves eating almost anything and everything in sight. There isn’t really a set limit on the volume of food or time spent in this pattern. I know what this feels like because this is what happens with binge eating disorder too.

What happens with bulimia is that after the binge, the purging behaviour starts. So that is usually one of the things I mentioned already:

• Inducing vomiting
• Use of laxatives
• Intense or excessive exercise

All in an attempt to get that food out of your system.

Impact Of Bulimia

Unsurprisingly, with everything the body goes through, there is quite an impact on the body when someone is battling bulimia.

I want to choose my words carefully as no one eating disorder is better or worse than the other. But something that has a higher short-term or acute health risk that is unique to bulimia is the fact that when you induce vomiting, and if you are vomiting more regularly, churning up stomach acid can do some damage.

While all eating disorders are devastating and can have a huge impact on both mental and physical health, the risk from inducing vomiting is something that is unique to bulimia.

That is my understanding at least. Although if anyone disagrees, I am always happy to learn and be corrected,

Let’s look at some of the short and long-term impacts.

• If you are vomiting up your food, you are going to likely be both malnourished and dehydrated.
• The acid from your stomach can cause damage to your mouth and tooth erosion.
• You can risk inflammation of the oesophagus.
• Excessive exercise can leave you more prone to risk of injury.
• You’re more likely to feel stressed or anxious around food.
• You risk digestive health issues.
• And of course, malnourishment comes with its own set of health risks including dry skin, brittle bones, hormone imbalance, low sex drive, and more.

Another physical trait that is unique to bulimia is swollen cheeks. If someone is vomiting more, they will be increasing their body’s production of saliva. The glands that produce saliva are in the cheeks. When they swell, to keep up with increased production, the cheeks also swell.

Causes Of Bulimia

As with other mental health conditions and eating disorders, there’s no one single specific known cause for bulimia, and a lot of factors can be involved.

A 1998 study suggested there is a genetic element to it.

Some other studies which I tried to read but didn’t really understand enough to draw conclusions from suggest that other hormone imbalances, lack of serotonin, and hormones that affect the regulation of appetite may also play a part.

Your local environment can have an impact. For example, if you have a drive for thinness or are being constantly judged for your body shape or size, the way celebrities are, that can lead to bulimia.

That also applies to athletes, especially in weight-based sports as we already mentioned, because they have to focus on being a specific weight.

It can also be linked to:

• Poor body image
• Stress
• Anxiety
• Boredom
• A feeling of loss of control

The circumstances which cause bulimia and how each episode is triggered is a deeply unique and personal experience.

Treatment And Recovery For Bulimia

Bulimia is a serious medical condition with an impact on both your physical and mental health, and it is important that you get professional, qualified help if it is something you are dealing with.

It’s not always as visible as, for example, anorexia, as many people with bulimia tend to be at an “average” weight.

I was able to find the criteria for a clinical diagnosis of bulimia in the US. This consists of:

• Binge behaviour – defined as a 2-hour eating window where the volume of food consumed is “definitely larger” that what most would eat in a similar time period
• Recurrent compensatory behaviour – vomiting, laxatives, diuretics, fasting, or exercise
• Occurring on average at least once a week for a period of 3 months

So in simple terms, one binge and purge episode per week for 3 months.

There is also a scale:

• Mild – 1-3 episodes per week
• Moderate – 4-7 episodes per week
• Severe – 8-13 episodes per week
• Extreme – 14 or more episodes per week

In terms of treatment, psychotherapy or cognitive behavioural therapy (CBT) is thought to be most effective and has been shown to help in 40-60% of cases. It does seem to work better in adults than in adolescents, however.

I did just pull that from the Wikipedia page on bulimia though, and they didn’t include the original study links. So don’t come for me – I am just passing on the information and where I got it from.

Medication is thought to help in some cases as well, either to manage emotional triggers or help regulate hormones but even when using medication, the best results are achieved in combination with therapy.

As with every eating disorder, the cause of it and the support you need in terms of treatment and recovery will be unique and specific to you.

If it’s something you’re dealing with, please do get help. The sooner the better.

I mentioned the three-month criteria. That is only for a clinical diagnosis and only in the US. That doesn’t you have to wait that long to get help. If you have or suspect you have it, get help sooner rather than later.

Start as soon as you feel comfortable.

Recovery from any eating disorder isn’t easy. It will feel bumpy, you may slip up, and at times you may feel like you’re going backwards.

But it is important you take it slow, one step at a time, and forgive yourself for any slip-ups. You’re doing something hard, and it is worth it.

How To Help Someone With Bulimia

Something I haven’t talked about before but am really keen to address is how you can help someone who has bulimia or someone who you think has bulimia.

As I’ve mentioned, it’s not an eating disorder I’ve had to deal with myself before, but I think a lot of this will still overlap with other eating disorders.

In my case, I am quite self-aware and I knew what support resources and professional options were available.

And it’s important to note as well that this is something very specific to each individual, and in terms of the help or support they need it will also be very specific to them.

Some people for example might appreciate someone stopping them in the middle of a binge episode. In my case, that would have made me defensive and put some distance between them and myself.

Having said that, I’ll try to give some guidance that is specific as I can be but still broad and general enough to allow room for interpretation based on the circumstances in front of you.

First of all, it’s important to not assume or claim to know anything about what the person you’re trying to help is going through. You may have seen a snippet of their behaviour, and you may have done some online reading. But you might have no idea how they’re feeling, what is going through their mind, what triggered their episode, or what caused their eating disorder in the first place.

For all you know, even if unintentionally, something you said or did could be a factor. It might not, of course, but it just helps to have that little bit of extra mindfulness.

Next, understand that eating disorders can feel embarrassing. If someone confronted me about my binge eating disorder, my first reaction would be to get defensive. I knew I had it, I knew how I felt at my worst and I was trying to hide it. So I would have definitely ended up running away from that situation as quickly as I could.

Do your research on professional options or reach out to support groups. This might just be doing it to better inform yourself, rather than on behalf of the person you’re trying to help but it can also help you feel better prepared for when you do speak to the eating disorder sufferer.

Try to steer your time with this person away from things that tend to be common issues for those with eating disorders. So avoid topics like weight, body fat, size, and shape if you can. See if they feel relaxed enjoying a “normal” meal out with you. It might be a bit of a minefield but if someone feels comfortable relaxing food rules in your company, that can be a positive sign.

Try to practice body positivity for yourself. This might help inspire this person to feel more comfortable and more accepting of their body, and that is important, especially if body image has played a role in their eating disorder.

I have tended to be good at hiding my own eating disorder issues and I have never felt comfortable talking about them in person. Yes, I know that is weird given that I feel comfortable broadcasting my experience to the whole world on the internet.

But honestly, there is one thing I absolutely would have loved and cherished above anything else when my eating disorders were previously at their worst. And that is just an unprompted hug and for someone to say to me “I know something’s up, I know you’re working through it, and I know you’re not ok. If you want to talk to me about whatever it is, I’m here”.

I never got that hug from anyone, but I did get through the worst of it and I feel more comfortable getting help now if I need to do that. So that’s a positive.

Wrapping Up On Bulimia In Men

As I mentioned, bulimia is both a mental and physical health issue.

Definitely get help as soon as possible if you suspect you have it or if you suspect someone you know has it.

There is no shame in asking for help, and while men may often see it as appearing weak or vulnerable, getting help really isn’t. So try and let that go,

Plus you can get help from fairly anonymous sources now. There are support groups and helplines, and if you want to speak to a therapist, there are even online options that will allow you to have your sessions over text-based chat. So you don’t need to do it in person and it can stay largely anonymous if that is something that’s holding you back.

If you are looking at how to help someone with bulimia, please do tread carefully so they don’t start to get defensive. And it might be worth speaking to support groups for guidance first. But if you do suspect someone is battling bulimia, and you’d like to help them, definitely please do so.

Additional Resources

• BEAT resources on bulimia
• NEDA guidance on bulimia
• NHS guidance on bulimia