Bulimia Nervosa – Signs & Symptoms

bulimia signs in two women

Bulimia nervosa is one of the most commonly known and diagnosed eating disorders. Bulimia affects 1.5% of American women, and bulimia signs are characterized by bingeing and purging behaviors and can result in dire health issues if left untreated [1].


Generally defined, “bulimia nervosa is characterized by recurrent episodes of binge eating followed by inappropriate compensatory purging behavior to prevent weight gain [1].”

The 5th Edition of the Diagnostic & Statistical Manual of Mental Illnesses (DSM-5) provides specific criteria that individuals with a bulimia nervosa diagnosis meet.

First of all, binge-eating episodes are characterized by “eating, in a short period of time, an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.” It is also identified by feeling the loss of control over these behaviors as they occur [2].

Following this, the DSM-5 specifies that the individual engages in “recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise [2].”

Bulimia Signs of Behavioral Symptoms

Individuals struggling with bulimia are often seen to show dieting, weight loss, and control over food to be a primary concern in their life and likely talk about it often.

Some of the behavioral signs the sufferer may display include:

  • feel uncomfortable eating around others
  • develop food rituals
  • skip meals
  • disappear after eating
  • fear eating in public
  • hoard foods
  • drink excessive amounts of water
  • use excessive amounts of mouthwash, mints or gum
  • hide their body with baggy clothes
  • have excessive or rigid exercise behaviors

Specific behaviors that indicate purging are “frequent trips to the bathroom after meals, signs, and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics [2].”

Specific binge-eating signs are “disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food [2].”

Bulimia Signs of Physical Symptoms

Friends are Factors in Anorexia TreatmentBulimia, like all eating disorders, impacts all aspects of the physical body. One study details that “the medical complications of bulimia nervosa are related to the mode and frequency of purging, whereas, in anorexia nervosa, they arise as a result of starvation (restricting) and weight loss [1].”

Physical signs that an individual may be struggling with bulimia include:

  • discolored teeth
  • scrapes or calluses on the back of the hands or knuckle from self-
  • induced vomiting
  • swelling in the cheeks or jaw
  • appearing bloated
  • gastrointestinal complaints
  • difficulty concentrating
  • dizziness
  • fainting
  • sleep problems
  • dry or brittle hair, nails, or skin
  • muscle weakness
  • menstrual irregularities

If you are concerned that a loved one is displaying any of these symptoms, it is important that you do not sit on this information. However, how you approach them is important.

Be sure to take a supportive, open, and nonjudgmental approach, not telling them what they are experiencing but simply letting them know you’ve noticed some concerning behaviors and asking them to share what they are going through.

It may be an uncomfortable or challenging conversation, but they will thank you when they are on the road to eating disorder recovery.


[1] Mehler, P. S. (2003). Bulimia nervosa. The New England Journal of Medicine, 349:9, 875-881.

[2] Unknown (2018). Bulimia nervosa. National Eating Disorders Association, retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia.

About Our Sponsor:

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Fairhaven Treatment Center is a leading eating disorder treatment center that provides treatment for adult women and adolescent girls struggling with Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder and Other Specified Feeding or Eating Disorder (OSFED).

Fairhaven specializes in working with eating disorders with co-occurring post-traumatic stress disorder (PTSD), trauma and attachment disorder, and a history of addiction and substance use disorder.

About the Author:

Image of Margot Rittenhouse.Margot Rittenhouse, MS, PLPC, NCC is a therapist who is passionate about providing mental health support to all in need and has worked with clients with substance abuse issues, eating disorders, domestic violence victims, and offenders, and severely mentally ill youth.

As a freelance writer for Eating Disorder Hope and Addiction Hope and a mentor with MentorConnect, Margot is a passionate eating disorder advocate, committed to de-stigmatizing these illnesses while showing support for those struggling through mentoring, writing, and volunteering. Margot has a Master’s of Science in Clinical Mental Health Counseling from Johns Hopkins University.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published November 18, 2019, on EatingDisorderHope.com
Reviewed & Approved on November 18, 2019, by Jacquelyn Ekern MS, LPC

About Baxter Ekern

Baxter is the Vice President of Ekern Enterprises, Inc. He is responsible for the operations of Eating Disorder Hope and ensuring that the website is functioning smoothly.