Signs of Bulimia Nervosa

Jennifer Huddy, MS, RD, LD
Registered Dietitian and Nutrition Writer
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Bulimia nervosa is an eating disorder that often goes years before being identified due to the subtle signs and symptoms present early in the disease. A healthcare professional can observe and measure signs through medical exams, blood tests, and other methods. The clinical signs of bulimia can span from dental to digestive to dermatological. 

Top Clinical Signs of Bulimia

Like other eating disorders, people with bulimia tend to hide the disease's hallmark symptoms from friends, family, and medical professionals. When symptoms of recurrent binging and purging, poor body image, and digestive upset are hidden, healthcare providers must look to the clinical signs of bulimia to help these individuals get a proper diagnosis. 

The top clinical signs of bulimia include: 

  • Enamel erosion and cavities
  • Inflammation and swelling of the mouth and parotid glands
  • Calluses on the knuckles
  • Inflammation or bleeding of the digestive tract
  • Amenorrhea or infertility
  • Dehydration and electrolyte abnormalities
  • Extreme weight fluctuations


Dentists are often the first to identify possible cases of bulimia due to the significant dental signs that can be present with this eating disorder. Some of the most common dental signs of bulimia include enamel erosion, cavities, oral mucositis (swelling and irritation of the mouth), and cheilitis (inflammation of the lips). People with bulimia may also present with yellow-stained teeth and gum disease.

The frequent self-induced vomiting that is standard in bulimia is the primary cause of these issues. The stomach acid and digestive enzymes in vomit cause damage to the teeth and mouth. Additionally, brushing one's teeth immediately after vomiting is known to weaken the enamel.

Some people with bulimia use various objects rather than their fingers to induce vomiting. This can lead to cuts in the tissue of the throat and mouth.

The parotid glands are commonly swollen and enlarged in people who have bulimia. Parotid glands are salivary glands located on both sides of the face. The acid and enzyme exposure from recurrent self-induced vomiting are what irritate the parotid glands and cause them to become inflamed. Between 10 and 25% of people with bulimia will exhibit this sign.


Forceful retching and vomiting can lead blood vessels in the face and eyes to burst. Edema (fluid retention and swelling) in the face, hands, and ankles also occurs due to the purging. 

When bulimia has been present for an extended time, calluses can be found on the back of the knuckles. This is also known as Russell’s sign and is caused by a person frequently using their fingers to self-induce vomiting. 


Doctors may observe hyperactive bowel sounds in patients with bulimia who routinely abuse laxatives as a form of purging. Frequent vomiting can lead to esophagitis (inflammation of the esophagus), stomach ulcers, and bleeding in the gastrointestinal tract. 

Gastroparesis, or delayed emptying of stomach contents, is another sign of bulimia. Patients will generally complain of symptoms such as lack of appetite and feeling overly full. 

Patients with undiagnosed bulimia may initially present with these issues due to physical discomfort. It is essential for digestive health doctors to screen for bulimia and other eating disorders when these signs are present. 


Bulimia can lead to irregular periods in females. Sometimes amenorrhea, or complete loss of menstruation, can occur, though this is more common in anorexia nervosa. Menstrual cycle irregularities are sometimes hard to notice if a person is on hormonal contraceptives, as these can cause a person to have more regular periods. Amenorrhea or irregular periods can lead to fertility problems. 

Over-exercise is a compensatory behavior used in bulimia as an alternative or in addition to purging. As a result, myoglobinuria can occur, causing a red tint to appear in the urine. This sign can be identified when a routine urine sample is taken at a doctor’s office. 

Laboratory values

Dehydration is another sign of bulimia and is caused by routine purging. It can be observed through kidney function on lab work or by visual examination and urine samples. In extreme cases, dehydration can lead to electrolyte imbalances and fainting.

Electrolyte abnormalities, particularly low potassium, can indicate bulimia, though not all people with bulimia will initially present with this. 

In addition, eating disorders like bulimia can cause reduced thyroid function. Numerous medical complications, including a slow heart rate, result from hypothyroidism.

Some people with bulimia initially present with normal or only borderline low lab results, so it is important to consider all the other signs when bulimia or any eating disorder is suspected. 


A person’s long-term weight trends can indicate possible eating disorder pathology. Simply looking at the current weight of someone with bulimia, a healthcare provider may simply see a normal or high body weight. Bulimia can also present in an underweight person. 

When looking at the big picture, though, it is common to see significant fluctuations over time in the weight of people with bulimia. The assessment of body weight can be further complicated by edema or fluid retention, causing increases in water weight. 

Nourish Can Help

If you’ve been diagnosed with bulimia, finding the right treatment option for you can feel overwhelming. At Nourish, we match you with outpatient registered dietitians who are experts in eating disorders. We help you every step of the way to recover from bulimia. 

With virtual visits covered by insurance, accessing the care you need couldn’t be easier. Start your recovery with Nourish today. 


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