Warning Signs of Bulimia: Recognizing Hidden Clues
By Jillian Moshay
Table of Contents
Early detection of bulimia is important
Bulimia nervosa is a relatively common eating disorder affecting people of all ages, genders and body sizes. Eating disorders like bulimia can affect nearly every organ in the body. Medical complications from bulimia can cause both short- and long-term damage to the body. The good news is that with early detection most medical complications are reversible.
This piece is intended to raise awareness around the warning signs of bulimia, especially for those who are concerned their loved one might be struggling. The symptoms and behaviors we discuss could be triggering, including for those recovering from eating disorders. If you need support, please reach out here.
Common bulimia behaviors
Bulimia includes a combination of two primary behaviors:
- Binge eating
- Eliminating food from the body through purging
It is impossible to tell if someone has an eating disorder simply by looking at them. The warning signs listed below may help you identify if a friend or loved one might be struggling with an eating disorder like bulimia.
Warning signs of binge eating with bulimia
There are few physical signs that will tell you that someone may be struggling with binge eating. Binge eating is usually done in isolation and there can be a lot of shame associated with it. At home, here are some signs to watch for:
- Eating in the middle of the night
- Hoarding or storing food
- Noticing a large amount of food disappearing
- Hiding empty food wrappers in the house
Warning signs of purging with bulimia
There are several different types of purging that people struggle with. The most common ways people purge are:
- Self-induced vomiting
- Laxative use
- Diet pill use
- Diuretic use
There are a few physical signs that may indicate that someone is struggling with purging.
- Some people who engage in self-induced vomiting develop swelling of glands in their cheeks (sometimes known as “chipmunk cheeks”) .
- Other people may develop scars on the back of their fingers or knuckles (known as Russell’s sign) related to self-induced vomiting .
- It is common for people to develop dental changes, including tooth enamel erosion, if they are vomiting frequently. A dental professional may be the first medical professional to express concern about purging .
You may notice a loved one using the bathroom right after they eat or using the bathroom very frequently if they are vomiting or using laxatives or diuretics. These purging methods can cause excessive urination or frequent bowel movements. You may also see packaging from laxatives, diet pills or diuretics around the house if these products are being used to purge.
Changes in weight and appearance with bulimia
People struggling with bulimia often have a distorted body image and a fear of gaining weight. Some people with bulimia may have weight changes (losing or gaining weight) but this does not always happen. It is a myth that people with bulimia are all very thin-bodied. People with bulimia come in all sizes, shapes and weights.
Medical changes to watch for with bulimia
Bulimia, like other eating disorders, is associated with a wide range of physical effects. People with bulimia are at a significantly higher risk of dying from medical complications. Physical symptoms related to bulimia include:
- Fainting episodes
- Weight changes (including weight loss or weight gain)
- Hair loss
- Dry skin
- Brittle nails
- Swollen glands in face and neck
- Dental changes (including irreversible enamel loss)
- Chest pain
- Heart palpitations
- Abdominal pain
- Hematemesis (blood in vomit)
- GERD/stomach acid reflux
- Kidney stones
- Leg swelling
Behavioral warning signs with bulimia
It is very common for people suffering from bulimia to have changes in their mood and overall mental health. Symptoms related to mood changes may include:
- Mood swings
- Low self-esteem
- Anxiety or depression
- Social withdrawal and isolation
- Decline in performance at work, at school, or in sports or other activities
- Fear of gaining weight or worrying about their weight
- Excessive exercise or rigid exercise routine
How serious is bulimia?
Patients who vomit frequently or take laxatives or diuretics can have dangerous changes to the levels of potassium, sodium, chloride, phosphorus and carbon dioxide in the blood. These changes can potentially lead to seizures, heart problems or death . It is very important that people with bulimia and other eating disorders see a primary care medical provider frequently to check their vital signs and labs.
How to help someone with bulimia
If you think your loved one might be struggling with bulimia, it is important to express your concern and offer them support. Eating disorders are complicated, and many people with eating disorders may not be open to receiving help right away. We invite you to reach out to us at 866-622-5914 if you have any questions about what treatment might look like and how you can help your loved one.
Treatment for bulimia
Eating Recovery Center (ERC) offers the right support at the right time with our full continuum of care for bulimia and other eating disorders. Whether an individual needs more intensive treatment with medical monitoring or is suitable for convenient virtual care, we offer nutritional counseling and education, evidence-based therapies and medical management, within the following levels of care:
- Virtual intensive outpatient program (virtual IOP)
- On-site intensive outpatient program (IOP)
- Partial hospitalization program (PHP)
- Residential program
- Inpatient program
When it comes to eating disorders, awareness, education and early intervention are key. If you are looking for any resources or support, ERC also offers free online eating disorder support groups here.
Call us today at 866-622-5914 or reach out to our admissions team with any questions you have by filling out this form.
Read more articles on this topic:
- Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333-343. https://www.ccjm.org/content/88/6/333
- Daluiski, A., Rahbar, B., & Meals, R.A. (1997). Russell's sign. Subtle hand changes in patients with bulimia nervosa. Clinical Orthopedics and Related Research, Oct(343):107-109. PMID: 9345215.
- Douglas, L. (2015). Caring for dental patients with eating disorders. BDJ Team 1, Article 15009. https://doi.org/10.1038/bdjteam.2015.9
- Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press.
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