Warning Signs of Bulimia: Recognizing Hidden Clues

Eating disorders like bulimia can affect nearly every organ in the body. While it is impossible to tell if someone has an eating disorder simply by looking at them, the warning signs below may indicate whether a friend or loved one might be struggling.

Signs and Symptoms

Published: Nov 03, 2025

Author

Britt Berg, MS

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.

Bulimia impacts nearly every organ in the body

Bulimia nervosa is a serious eating disorder affecting people of all ages, genders and body sizes. The many medical complications related to bulimia can cause both short- and long-term damage to the body. The good news is that with early detection most complications are reversible.

Common bulimia behaviors

Bulimia includes a combination of two primary behaviors:

  1. Binge eating

  2. Purging

The most common ways people purge are:

Watch for signs of binge eating 

You may notice the following if you are close to someone who is binge eating:

  • Binge eating at night when no one else is around

  • Hoarding or storing food

  • Large amounts of food disappearing quickly

  • Empty food wrappers hidden in the house

It can be hard to tell if someone is struggling with binge eating. Binge eating is usually done in isolation and there can be a lot of shame associated with it. 

Watch for signs of purging

Some purging methods can cause excessive urination or frequent bowel movements. These signs may indicate that someone is purging:

  • Using the bathroom immediately after each meal

  • Going to the bathroom frequently (usually related to vomiting or using laxatives or diuretics)

  • Packaging from laxatives, diet pills or diuretics

Other physical changes related to purging include:

  • The development of swelling of the glands in their cheeks (sometimes known as “chipmunk cheeks”)[1].

  • The development of scars on the back of their fingers or knuckles (known as Russell’s sign) related to self-induced vomiting[2].

  • 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[3].

Watch for changes in weight

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.

Watch for physical and medical concerns

People with bulimia are at a significantly higher risk of dying from medical complications. Physical symptoms related to bulimia include:

  • Fatigue or weakness

  • Dizziness/lightheadedness/fainting episodes

  • Dehydration

  • Hair loss

  • Dry skin

  • Brittle nails

  • Chest pain

  • Heart palpitations

  • Abdominal pain or bloating

  • Hematemesis (blood in vomit)

  • GERD/stomach acid reflux

  • Constipation, diarrhea

  • Kidney stones

  • Leg swelling

Watch for mood changes

Bulimia can affect one's emotional state; anxiety or depression are common as well as:

  • Mood swings

  • Low self-esteem

  • 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

Watch for abnormal labs

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[4]. 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. 

If you are looking for any resources or support, ERC also offers free online eating disorder support groups here.

Help is within reach

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:

To learn more about bulimia recovery, please call us at 866-622-5914 or fill out this form.

Sources

  1. 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
  2. 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.
  3. Douglas, L. (2015). Caring for dental patients with eating disorders. BDJ Team 1, Article 15009. https://doi.org/10.1038/bdjteam.2015.9
  4. Mehler, P.S., & Andersen, A.E. (2022). Eating disorders: A comprehensive guide to medical care and complications (4th ed.). Johns Hopkins University Press.