Bulimia Nervosa Symptoms

Jennifer Huddy, MS, RD, LD
Dietitian and Nutrition Writer
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Bulimia nervosa is a serious eating disorder for which diagnosis is often delayed due to difficulty identifying the signs and symptoms. Symptoms are things that are part of the patient experience. 

Though symptoms can’t always be observed or measured in a doctor’s office, they may be noticed by concerned friends or family members. If you suspect these symptoms in yourself or a loved one, it is imperative to seek help. 

Top Bulimia Symptoms

There is a wide range of symptoms that can indicate bulimia. The top symptoms to be aware of are: 

  • Frequent binge eating followed by purging or other compensatory behaviors
  • Distorted body image and fear of weight gain
  • Dieting or restricting food groups
  • Depression, anxiety, and social isolation
  • Gastrointestinal symptoms, including painful swallowing, upset stomach, constipation, sensitive teeth, and bad breath
  • Weight fluctuations 
  • Skin changes, particularly scabbing on the knuckles

Behavioral Symptoms

Bulimia often goes undiagnosed for many years due to the secretive nature of the eating disorder. People with bulimia rarely disclose binge eating and purging symptoms to a doctor, and the clinical signs of these behaviors can often be missed in a medical exam. Loved ones are often the first to pick up on clues that binging and purging might be occurring. 

Binge Eating

Binge eating is a hallmark of bulimia nervosa, defined as eating large volumes of food over a short period. It often occurs after a period of intense restriction, such as a diet for weight loss that eliminates one or more food groups. It can also happen after a stressful event.  

Family members may notice food disappearing or evidence of food wrappers and packaging. A person with bulimia often wants to eat in private. They will eat very little food around other people and then binge later alone. They might seem uncomfortable when eating around friends and family. 

Purging

Purging and other compensatory behaviors frequently occur after binge eating in people with bulimia. The use of self-induced vomiting, laxatives, and over-exercising are all examples of this. 

Friends and family may notice a person with bulimia frequently visits the bathroom after eating. To hide the smell of vomit, many people with bulimia will often use mouthwash and mints. 

Additionally, the individual may have a very rigid exercise routine, pushing themselves to exercise even when ill or during inclement weather. Extreme fluid intake is also typical in bulimia. 

Dieting behavior

Frequent dieting for weight loss is common in people with bulimia. This stems from an intense fear of weight gain. Loved ones often notice the individual becomes preoccupied with talk of weight, dieting, and food. 

It can be a vicious cycle involving feeling restricted on a diet, binge eating, then feeling concerned about possible weight gain and purging. 

Psychological Symptoms

Bulimia has numerous psychological symptoms that are sometimes identified before the diagnosis of bulimia, making it essential for healthcare providers to screen for eating disorders. For example, an adolescent with undiagnosed bulimia might seek treatment for clinical depression. 

Body image

As with all eating disorders, a negative body image is one of the key psychological symptoms of bulimia. It involves an intense fear of gaining weight and a strong pursuit of thinness. An individual with bulimia is very unhappy with how their body looks and has low self-esteem about their weight, size, and shape. 

People with bulimia tie their self-worth to their physical appearance, particularly weight. Food is viewed as the enemy and cause of their weight concerns, leading to an unhealthy relationship with food. 

Mental health

Depression and anxiety often co-occur with bulimia. Individuals with bulimia can also notice intense mood swings and emotional outbursts. Additionally, self-harm and substance abuse can be mental health symptoms present in bulimia. 

People with bulimia report feeling a lack of self-control. They want to stop binging but can’t, leading to feelings of guilt and shame. Though binging and purging is a disorder, not a choice, people with bulimia feel personal accountability towards these actions. 

Social isolation

For many reasons, people with bulimia tend to self-isolate. This can be due to feeling ashamed about binging and purging behaviors and not wanting loved ones to find out about their eating disorder. It can also result from binge eating in secret and avoiding social situations involving food. 

A person with bulimia may commonly deny any accusations of binging or purging when approached by suspecting family members or friends, which leads to further disconnect and withdrawal. 

Preoccupation with food and weight, along with physical symptoms of bulimia, can lead to difficulty concentrating and poor performance in school and work. These symptoms can fuel feelings of inadequacy and self-loathing. 

Physical Symptoms

In addition to the behavioral and psychological symptoms, physical symptoms are also present in bulimia. 

Oral

Many of the physical symptoms of bulimia stem from frequent self-induced vomiting. People with bulimia often notice they always have a sore throat, likely because of the acid from frequent vomiting, causing the esophagus to become inflamed. 

In addition, the acid from vomiting can irritate the vocal cords. This irritation can result in symptoms including voice changes, coughing, difficulty swallowing, and pain with swallowing. 

The dental signs of bulimia, like enamel erosion, can lead to symptoms like sensitive teeth. Bad breath and tooth discoloration are also common.

Gastrointestinal

Gastrointestinal symptoms are common in bulimia. Acid reflux and stomach pain are some of the most frequent symptoms resulting from repeated, self-induced vomiting. 

Other purging methods, such as laxative abuse, can lead to changes in the appearance of the stool, such as oily, floating stools. Constipation can also occur as a result of thyroid abnormalities. 

Skin

People with bulimia may notice they have dry skin, brittle nails, hair loss, and often feel cold. These are generally the result of thyroid imbalances common in eating disorders. They may also notice swelling in the face and calluses or cuts on the back of their knuckles from frequent vomiting. 

Weight

Weight fluctuations are common in bulimia due to alternating periods of binging and purging. One of the reasons bulimia is challenging to diagnose is that patients often have a normal or elevated weight. 

Why Nourish?

If you’ve identified with the symptoms described above, it is time to seek help. When you have bulimia, an essential component of treatment is nutritional counseling. 

Offering virtual outpatient appointments covered by insurance, the registered dietitians at Nourish are leading experts in eating disorder treatment. They work with your healthcare team to provide the best care possible. Don’t wait to seek treatment – get started today

Sources

https://pubmed.ncbi.nlm.nih.gov/17644865/

https://www.sciencedirect.com/science/article/abs/pii/S1538544217300482?via%3Dihub 

https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia

https://www.aafp.org/pubs/afp/issues/2015/0101/p46.html

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