What are the Primary Characteristics of Bulimia Nervosa?

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Eating disorders are a complex and potentially dangerous mental health condition. There are different kinds of eating disorders that have their own set of symptoms. If you are aware of the warning symptoms and warning signs of an eating disorder, it can make it easier for you to spot it in yourself or others who need help.

What is Bulimia?

Bulimia nervosa is an eating disorder characterized by a cycle of binge eating followed by compensatory behaviors. Compensatory behaviors are actions someone takes to off-set the “consequences” of binge eating to avoid gaining weight. Some compensatory behaviors include: [1]

  • Self-induced vomiting
  • Laxative abuse
  • Fasting
  • Excessive or compulsive exercise

Everyone overeats from time to time. This is different from a binge. A binge is when someone eats an amount of food that is considerably larger than what most people would eat in the same time frame.

For example, a binge might look like eating three bags of potato chips in an hour. During a binge, someone feels a lack of control over their eating.

What are the Signs and Symptoms of Bulimia?

A common misconception of eating disorders is that you can tell if someone has them just by looking at them. That’s not true, which is why it’s important to be aware of the signs and symptoms that someone is struggling with bulimia.

There are emotional, behavioral, and physical warning signs of bulimia. The emotional and behavioral warning signs of bulimia include: [1]

  • Evidence of binge eating, such as large amounts of food go missing or finding lots of empty food wrappers in the trash can
  • Signs of purging, such as going to the bathroom frequently after eating meals, smelling vomit, or finding laxatives
  • Looking uncomfortable eating around others
  • Food rituals, such as eating only certain food groups or not allowing food to touch
  • Skipping meals or only eating small portions
  • Disappears after eating to go to the bathroom
  • Fear of eating in public or with other people
  • Stealing or hoarding food
  • Drinking excessive amounts of water or other non-calorie beverages
  • Excessive use of mouthwash, mints, or gum
  • Wearing baggy clothes as a way to hide your body
  • Extreme concern with body weight or shape
  • Frequently dieting
  • Recurring episodes of binge eating
  • Purges after a binge
  • Extreme mood swings

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Physical symptoms of bulimia include: [1]

  • Bloating due to fluid retention
  • Discolored or stained teeth
  • Unusual swelling of cheeks or jaw due to purging
  • Noticeable changes in weight, can either be weight loss or gain
  • Difficulty concentrating
  • Stomach cramps
  • Constipation
  • Acid reflux
  • Dizziness
  • Fainting
  • Sleeping problems
  • Dry or brittle nails
  • Cuts or calluses across the top of finger joints due to purging
  • Abnormal labs, such as anemia, low thyroid or hormones, low potassium, low blood cell counts, slow heart rate
  • Dental problems, such as enamel erosion or cavities
  • Dry and brittle nails
  • Muscle weakness
  • Yellow skin
  • Cold, mottled hands and feet
  • Menstrual irregularities
  • Impaired immune functioning
  • People with diabetes and bulimia may also misuse their insulin

DSM-5 and Bulimia Nervosa

Someone may have some of the warning signs of bulimia nervosa and not meet the full criteria. The American Psychiatric Association (APA) has a set of criteria that must be fully met in order to be diagnosed with bulimia. These are: [2]

  • Recurrent episodes of binge eating. A true binge is when the following two factors are present:
    • Eating in a discrete period of time, such as within two hours, an amount of food that is definitely larger than most people would eat in the same time frame
    • Feeling out of control over eating during the episode
  • Ongoing compensatory behaviors in order to prevent weight gain from binges
  • Binge eating and compensatory behaviors both occur at least once a week for at least three months
  • Self-esteem is significantly influenced by body shape or weight
  • These symptoms do not co-occur with symptoms of anorexia

If you or your loved one don’t fully meet these criteria, but are struggling with some of the symptoms of bulimia, it’s still important to get help. These behaviors can be dangerous if left untreated.

The symptoms you are struggling with are more important than whether you receive a diagnosis or not. Eating disorder treatment can help you recover from bulimia or other disordered eating patterns.


[1] National Eating Disorders Association. (n.d). Bulimia nervosa.

[2] American Psychiatric Association. (2013). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).

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The opinions and views of our guest contributors are shared to provide a broad perspective of 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 on May 19, 2022. Published on EatingDisorderHope.com
Reviewed & Approved on May 24, 2022, by Jacquelyn Ekern MS, LPC