What Are the Signs and Symptoms of Bulimia?

by Margaret Nagib

Signs and symptoms of bulimia (bulimia nervosa) center on the preoccupation with weight and body shape.

Guilt and shame are core symptoms of bulimia. Someone who is bulimic, like a person suffering from anorexia and other eating disorders, judges him- or herself harshly for any perceived flaw.

The psalmist writes in Psalm 139:13-16:

“For you created my inmost being;
    you knit me together in my mother’s womb.
14 I praise you because I am fearfully and wonderfully made;
    your works are wonderful,
    I know that full well.
15 My frame was not hidden from you
    when I was made in the secret place,
    when I was woven together in the depths of the earth.
16 Your eyes saw my unformed body;
    all the days ordained for me were written in your book
    before one of them came to be.” NIV

Any person struggling with self-image issues can benefit by reading these verses from God’s Word every day.


While most people are occasionally self-critical without suffering major consequences, men and women with bulimia nervosa develop serious mental and emotional distortions. A person with bulimia symptoms may feel trapped in an addictive relationship with food. It’s common for sufferers to feel as if they are living in a world of secrecy and shame, where every thought or action centers around food.

One moment, eating may seem like the only solution to deal with difficult feelings.

Moments later, food can seem like the source of all problems in life.

Unlike anorexics, who often must work diligently to hide signs of self-starvation, many people with bulimia nervosa are of normal weight or even slightly overweight. As a result, their disordered eating symptoms or obsessive bingeing and dieting behaviors may be minimized or considered normal by those around them.

Worse, stereotypes about dieting and weight can even lead some medical and mental health professionals to overlook or mischaracterize important physical, emotional, social and spiritual signs and symptoms of bulimia nervosa.

Despite a bulimic’s efforts to conceal the symptoms of an eating disorder, certain warning signs of bulimia are typically visible:

·       Depression

·       Anxiety

·       Social isolation

·       Having a distorted, excessively negative body image

·       Preoccupation body shape and weight

A person suffering from bulimia engages in episodes of bingeing and purging (often referred to as binge-purge cycles).

During binges, he or she will eat a large amount of food, most often in private. He may raid the cupboards when home alone, for instance, eating several hundred dollars worth of groceries. Or she may visit several fast-food restaurants during one bingeing episode, secretly eating in her car between stops. Bulimia may compel a person to eat an entire birthday cake at once, rather than just a slice or two.

Signs of Bingeing

·       Eating much more food in a binge episode than in a normal meal or snack

·       Feeling that eating can’t be controlled once a binge begins

·       Hiding or hoarding food

·       Making excuses for missing food, or money taken to pay for binge foods

·       Eating until the point of physical discomfort or pain

After a binge ends, feelings of self-disgust and shame follow. They are accompanied by the compulsion to engage in some method of purging to rid the body of the extra calories by vomiting, abusing laxatives or diuretics, periods of starving, or excessively exercising. As bulimia worsens, some sufferers feel a need to purge after eating only a small snack or a normal-size meal.

Signs of Purging

Many signs of bulimia relate to self-induced vomiting, which is the most prevalent form of purging. They include:

·       Habitually going to the bathroom immediately after eating or during meals

·       Damaged teeth and gums

·       Swollen salivary glands in the cheeks (chipmunk cheeks)

·       Persistent sores in the throat and mouth

·       Sores, scars or calluses on the knuckles or hands caused by self-induced vomiting

·       Scratchy or raspy voice quality

·       Misuse of ipecac syrup to induce vomiting

Persons with bulimia may also purge by misusing laxatives, diuretics, or enemas. A common sign of this is empty boxes hidden or in a person’s trash. Other bulimics purge by exercising for hours on end. They often make excuses to cover up their behavior or explain increasingly longer absences from work, school or family and friends. Some eating disorder treatment experts consider this to be a discrete form of bulimia nervosa, which they refer to as exercise bulimia or exercise addiction.

Symptoms of Bulimia

In a man or woman with signs of bulimia, symptoms of increasing physical damage from the disease may include:

·       Abnormal bowel functioning

·       Bloating

·       Dehydration

·       Fainting

·       Seizure

·       Fatigue

·       Dry skin

·       Irregular heartbeat

·       Menstrual irregularities or loss of menstruation (amenorrhea)

·       Tingling in the hands or feet

·       Muscle cramps

A psychiatrist or other eating disorder treatment provider will look for the following combination of bulimia symptoms to confirm the diagnosis:

·       Obsession with body image, weight, and/or dieting

·       Repeated binge eating episodes over a specified period of time

·       Loss of control during episodes of bingeing

·       Purging behaviors follow a binge to attempt to compensate for extra calories consumed

What are the Effects of Bulimia Nervosa?

Bulimia complications are potentially life-threatening, and the disease requires medical attention from an experienced eating disorder treatment professional. Bulimia treatment centers often see women facing severe effects from advanced bulimia nervosa. These may include:

·       Extreme social isolation

·       Inability to sleep

·       Fractured relationships with family and friends

·       Loss of spiritual connection to one’s faith, religion, or higher power

·       Forced withdrawal from school or college

·       Job loss

·       Bankruptcy, often resulting from excessive spending on binge foods

·       Infertility

·       Internal bleeding

·       Drug and alcohol addiction, especially if these substances are used to self-medicate for uncontrolled emotions or deal with physical complications

·       Suicide

·       Self-injury behavior

·       Heart attack

·       Death

Bulimia nervosa centers on self-image, not just food or weight. Because of the complex feelings a woman develops about her relationship with food, bulimia can be one of the most difficult eating disorders to overcome. The health effects of bulimia are serious. Many people die every year from complications of bulimia.

Types of Bulimia

Before beginning treatment, healthcare professionals must distinguish between the two types of bulimia nervosa. Bulimia is categorized in two ways:

·       Purging-type bulimia involves self-induced vomiting or the misuse of laxatives, diuretics or enemas to rid the body of food eaten during binges before it is digested or metabolized.

·       Non-purging bulimics will make use of other methods to prevent weight gain, such as fasting or over-exercising, which is sometimes called exercise bulimia.

What Causes Bulimia?

As with anorexia and other eating disorders, the causes of bulimia nervosa are impossible to determine in any individual case.

Some women may be genetically predisposed to developing bulimia. Young women with a biological sister or mother with an eating disorder are at higher risk, for example, suggesting a possible genetic link. There is some evidence that serotonin, a naturally occurring brain chemical, may influence eating behaviors because of its connection to the regulation of food intake.

People with symptoms of bulimia may have other psychological and emotional characteristics that contribute to the onset and progression of the disease. They may have low self-worth, for instance, or struggle with perfectionism. They may have trouble controlling impulsive behaviors, managing moods or expressing anger. The families of people with bulimia may tend to have more conflicts, higher rates of alcoholism, along with more criticism and unpredictability. There may be a history of emotional, physical and/or sexual abuse at the center of feelings of worthlessness and self-loathing.

In addition, popular culture cultivates and reinforces a desire for thinness that may contribute to bulimia in both men and women. Success and worth are often equated with being thin, especially for women. Pressure from a peer group at school, work, or social circles can also fuel this desire to be thin, particularly among young girls and teens. For other people, bulimia symptoms may begin later in life, particularly during times of transition, if they experience trauma or stress that overwhelms their ability to cope.

Additionally, bulimia nervosa is also frequently accompanied by other co-occurring disorders or addictions. This may make it challenging for a woman or man to achieve emotional recovery and develop a healthy relationship with food and body. Bulimia nervosa takes a toll on a person’s life very quickly, and so it’s common for sufferers to develop alcoholism or drug addiction, or begin to abuse prescription drugs, in an attempt to cope with their symptoms. Co-occurring mood disorders, anxiety disorders, PTSD, self-injury and personality disorders are also frequently recognized in people with symptoms of bulimia.

Bulimia nervosa is a very serious eating disorder, particularly if it is accompanied by co-occurring disorders. Like other eating disorders, bulimia is a medical disease that can result in irreversible complications, including death. Learn more about why Timberline Knolls is respected nationwide as a bulimia treatment center for women and adolescent girls.

Here’s a helpful beginning to start the healing process:





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