What Are Some Symptoms of Bulimia Nervosa?

woman who previously had bulimia nervosa

Bulimia nervosa can affect anyone at any point in their life. Even celebrities aren’t spared by this condition. There are, however, many individuals who keep this problem a secret, which hinders them from getting proper treatment.

Thankfully, the issue is openly being discussed by more and more people nowadays. This article will help you understand what bulimia nervosa is, how to spot someone struggling with this condition, and how to get professional help.

What Is Bulimia Nervosa?

Bulimia nervosa is a mental health illness that results in an unhealthy attitude toward eating. Simply referred to as “bulimia,” it’s considered a life-threatening eating disorder. According to the National Association of Anorexia Nervosa and Associated Disorders (ANAD) and the National Eating Disorders Association (NEDA), bulimia is a fatal mental health condition.

People with bulimia nervosa regularly eat too much food. Such binge-eating episodes are then followed by inappropriate behavioral responses such as self-induced vomiting, fasting, misuse of laxatives, too much exercising, and consumption of diuretics. This is why another term for bulimia is “binge and purge.”

Individuals who have this condition may harshly judge themselves, particularly their perceived body weight and shape. Although they’re usually of normal weight, they could also be overweight. This makes the illness hard to notice and diagnose.

Who Is at Risk of Developing Bulimia Nervosa?

Bulimia nervosa commonly develops during late adolescence (teenage years) or early adulthood. There are also children aged five years old and below who are diagnosed with this condition. There are around 1%-4% of individuals who experience bulimia in their lifetime.

Any person can develop this particular eating disorder regardless of age, gender, race, ethnicity, economic status, and physique. However, it typically develops in females more than males. According to ANAD, 15% percent of individuals being treated for bulimia are males. Athletes and performers such as dancers, models, and actors are at greater risk for developing it since their physical appearance is heavily monitored as part of their profession.


The leading cause of bulimia remains unknown. Some research suggests that its manifestation could be due to a combination of genetics, learned behavior, and thought patterns. If the person has an existing mental illness, they’re also at high risk of having the condition later on. 

Bulimia may also develop if the individual is highly influenced by social media or if they live according to social expectations and norms. They might have the tendency to adhere to beauty standards that they achieve by practicing unhealthy eating habits.

Signs and Symptoms of Bulimia Nervosa

Most bulimics are good at hiding whenever they binge-eat or purge. Still, there are some signs at home indicating that a family member possibly has bulimia.

For instance, you may find large quantities of food missing from the pantry or fridge. You might also spot a number of empty food containers that have been left in different parts of the house. Empty packaging of laxatives or diuretics or the smell of vomit could be present in unexpected areas as well.

Apart from those, here are some of the symptoms of someone who has bulimia nervosa as well as the complications they could face:

Physical Symptoms of the Eating Disorder

  • Swelling of the face (swollen parotid glands visible at the cheeks or jawline)
  • Heartburn
  • Indigestion or bloating
  • Irregular menstrual periods
  • Fatigue or exhaustion
  • Dental problems, including bleeding gums
  • Sore throat 
  • Petechiae (pinpoint bruising) found at the back of the throat
  • Thickening of and scratches on the back of the knuckles (Russell’s sign)
  • Sores on either side of the mouth

Behavioral and Emotional Symptoms

  • Eating more than usual
  • Often goes to the bathroom or disappears after meals
  • Hoarding food
  • To prevent gaining weight, the person may vomit or abuse laxatives, diuretics, or other medications
  • Excessive exercising
  • Preoccupied with body image issues
  • Intense fear of weight gain
  • Mood swings or depression
  • Has low self-esteem and a distorted opinion about body image
  • Feels shameful or guilty about eating
  • Sadness or anxiousness
  • Socially withdrawing from family or friends
  • Unaware of the seriousness of their condition

Complications of Bulimia Nervosa

  • Erosion of teeth enamel due to constant exposure to acidic gastric contents
  • Dental cavities
  • Tooth sensitivity either to hotness or coldness
  • Swelling and soreness of the salivary glands due to repeated vomiting
  • Stomach ulcers
  • Tears found along the lining of the stomach and esophagus
  • Insulin resistance, which can cause type 2 diabetes
  • Anemia
  • Constipation
  • Irregular menstrual period, amenorrhea (loss of menstruation), or loss of infertility in females
  • Electrolyte imbalance
  • Severe dehydration
  • Dry skin
  • Irregular heartbeat and abnormal heart rhythms
  • Heart attack (for severe cases)
  • Cardiac death
  • High risk for suicidal behavior

If you’ve noticed that someone you know is exhibiting many of the signs stated above, it’s best to get the help of a professional as soon as possible. Bulimia nervosa is a condition that shouldn’t be taken lightly, so don’t let your friend or loved one suffer any longer.

Bulimia Nervosa vs. Other Eating Disorders

There are other diagnosable eating disorders such as anorexia nervosa and binge-eating disorder. A person with bulimia may secretly indulge in binge-eating because they fear shame or ridicule.

Bulimics are aware that they have an eating disorder but may not seek medical help if they feel guilty or embarrassed. They also know that restricting food isn’t their main problem. In contrast, a person who has anorexia nervosa doesn’t recognize their condition. And one thing you might not know about them is that even if they restrict their food intake, they may still binge-eat.

Binge-eating disorder is a disorder limited to binging behavior. It’s defined as eating a large quantity of food in a given time under the same circumstances as other people.

Image from 123RF by belchonock

Diagnosis and Tests

Bulimia nervosa is diagnosed by a medical professional. A doctor will go through the person’s medical history. The patient may also need to undergo a physical examination, including diagnostic tests. Tests that are often required are blood tests, urine tests, and electrocardiograms (ECGs).

The doctor may also conduct an interview with the patient to ask the following:

  • Frequency of episodes of binge-eating and purging
  • Elimination habits either through vomiting, misuse of laxatives or diuretics, fasting, and exercise

Aside from these, the doctor will likely look into the person’s family history of possible eating disorders, substance abuse, and psychological disorders for suicidal inclinations. The person might be asked to undergo a psychological examination. 

The doctor may use the criteria set by the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to determine whether or not the person has bulimia nervosa. They are the answers to the following:

  • Does the individual have repeated binge-eating episodes?
  • During a binge-eating episode, does the person feel they lack self-control? Are they having a hard time controlling what to eat and how much to eat?
  • To prevent weight gain, does the person resort to self-induced vomiting, using laxatives or diuretics, fasting, or excessive exercise?
  • Has the binge-eating behavior happened at least once a week for three months?
  • Does the individual’s body weight or shape strongly influence their self-image?

If there are no noticeable binging or purging behaviors in the specified time frame, the person may be diagnosed with subclinical bulimia nervosa. They should be monitored for they’re still at risk of developing a more serious eating disorder.

The DSM-5 also provides the criteria to determine whether the severity of the patient’s bulimia is mild or extreme. This is the guideline:

  • Mild: 1-3 episodes weekly
  • Moderate: 4-7 episodes weekly
  • Severe: 8-13 episodes weekly
  • Extreme: 14 or more episodes weekly


It’s difficult to say whether bulimia can be prevented because its main cause is still unknown. However, to decrease the risk of developing the condition, parents and educators should help younger individuals understand the concept of self-love. They have to convey the message that the “ideal” body type projected by the media is wrong.


In treating bulimia nervosa, the goal is to break the behavioral pattern of binging and purging. Other objectives are to correct vague thinking patterns and aim for long-term behavioral transformation.

The treatment of bulimia nervosa involves medication (doctors) coupled with psychological counseling (mental health experts) and nutritional counseling (dietitians). The professionals working with the person are there to restore healthy eating habits and improve eating behaviors. 

With the guidance of a registered dietitian, the individual learns healthier ways of consuming food, how to create nutritious meal plans, and how to stick to a controlled program for weight loss. Of course, the treatment for bulimia focuses not only on food intake and nutrition education but also mental wellness. It allows for the improvement of how the patient views themselves as well as their relationship with food.

Common medications for bulimia nervosa include selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs). Fluoxetine (Prozac) is the only antidepressant approved by the U.S. Food and Drug Administration (FDA) for the condition.


Psychological counseling is all about changing the thinking and behavioral processes of an individual, in this case, a person with an eating disorder. Practical techniques are implemented in the treatment of bulimia nervosa. These encourage the person to develop a healthy attitude toward food and weight. They may also help change the way the individual responds to difficult situations.

These three types of psychotherapy are used in dealing with bulimia:

Cognitive Behavioral Therapy (CBT)

The goal of CBT is to address distorted opinions and views about body weight, shape, and overall physical appearance. The therapy also allows a person to undergo behavioral modifications and learn how to come up with alternatives or backup plans they can use should they start reverting to their old ways.

Dialectical Behavioral Therapy (DBT)

DBT helps an individual develop new skill sets related to handling negative triggers or situations. Specific skills one can learn include being mindful, improving relationships through interpersonal interactions, managing emotions, and enduring stress. They’ll be able to discover how to spot triggers for non-useful behavior as well.

Family-Based Treatment (FBT)

This is also known as the Maudsley Method. It entails family-based feeding, which puts the whole family in charge of the nutritional intake of the family member with an eating disorder. FBT could also be used in treating anorexia nervosa.


With proper treatment that’s carried out as early as possible, someone with bulimia has a higher chance of getting better over time. However, relapse may recur if they fail to go for post-therapy checkups. According to statistics, nearly 50% of bulimics may fully recover and 30% may partially recover if given the appropriate treatment.

A Battle Against Binge-Eating and Purging Behaviors

Even if bulimia is a lifelong battle for some individuals, it’s not a hopeless case. It’s important to remember that the moment you notice symptoms of bulimia nervosa among your family or friends, help them get treated right away. As with any illness, the key to managing the condition is immediate intervention before it increases in severity.

Counseling Now is ready to support you or your loved ones in battling this mental health issue. We can work with you in developing a healthy body image and lifestyle. Book an appointment today with Counseling Now to learn more about the wide range of services that our therapists offer.

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