How Loved Ones Can Spot the Signs of Bulimia Nervosa

Bulimia nervosa, one of the most dangerous mental health diseases of all, is also surprisingly common. It affects roughly 1.5% of American women, meaning it is known to affect about 4 million people in the United States alone. This figure may be lower than the true number of people suffering from bulimia nervosa; men experience it too, and certain populations like BIPOC and LGBT communities often underreport their symptoms.Just like any other mental health disorder, many people are hesitant to talk about it, especially if they’re ashamed or fear being judged for their disorder.

That’s why parents, siblings, and other loved ones should be on the lookout for the signs and symptoms of bulimia nervosa – a person who is struggling with bulimia needs help, but might not know how to ask for it. Some of its symptoms are relatively easy to spot, and some might be confused with other eating disorders, so it’s important for loved ones to be educated about what to look for. Below are some of the behavioral, emotional, and physical signs that a loved one is struggling with bulimia nervosa.

Behavioral Symptoms and Signs of Bulimia Nervosa

People with bulimia nervosa share common, distinctive disordered eating patterns and other behaviors that provide a signal that eating disorder treatment might be necessary. According to the DSM-V, the main diagnostic is a recurring pattern of binge eating episodes (in which they eat a large amount of food in a short period, accompanies by feelings of helplessness to control their eating. These are followed by shame about the binge eating episode and attempts to purge the calories by a variety of means. There are several other major behavioral signs there is a problem to be addressed:

1. Dieting and concern about losing weight

Almost every person with an eating disorder has a negative body image. The DSM-V lists a link between body image and self-worth as another component of diagnosing bulimia nervosa. Signs that a person has a negative body image might include wearing baggy clothes to hide the shape of their body, expressingunhappiness with their weight, or comparing their body to other peoples’ bodies. Contrary to popular belief, people with bulimia nervosa are not always underweight – a common reactive behavior among people with bulimia nervosa is engaging in a series of crash diets. Experimenting with fad diets, going on “juice cleanses” or obsessing over calories are all indicators someone is unhappy with their weight and might be using disordered eating behaviors.

2. Binge eating followed by self-induced vomiting and other purging behaviors

This is the defining characteristic of bulimia nervosa, as laid out in the DSM-V. Consistent, unnecessary dieting often brings on extreme hunger. Binge eating episodes can also be triggered as a coping mechanism for negative emotions or trauma. Afterward, the individual will binge eat in secret, and then purge the calories they took. Most frequently, purging takes the form of forcing themselves to vomit, but it can also manifest in taking pills (i.e. laxatives) frequently, or excessively exercising. A major sign of binge eating episodes is food wrappers or hoarded food in the person’s room.Of course, if the signs of frequent vomiting such as odors, frequent trips to the bathroom after eating, or discolored fingers or teeth appear, it’s time to schedule an appointment with a therapist or other eating disorder treatment specialist.

3. Food rituals and feeling uncomfortable at meals

Most eating disorders include a troubled relationship with and discomfort around food, especially when eating in a group. People with bulimia nervosa will often develop food rituals such as eating their food in a particular order or making sure different foods are not touching on the plate. They may try to avoid eating in groups or only eat a small amount, maintaining their “diet” while. Eating what they consider too much often triggers feelings of guilt or embarrassment, as well, and this leads to binge eating episodes. Binge eating releases serotonin and dopamine, which raise the mood and alleviate negative emotions.

Physical Signs of Bulimia Nervosa

Weight loss is a possibility with bulimia nervosa, but it’s not the norm.Most people with the disorder are at a regular weight or even overweight (medically speaking). This makes an “eyeball” diagnosis impossible – no eating disorder diagnosis should be based entirely on body weight. A few behaviors related to bulimia nervosa can manifest in telltale physical changes, however. Here are some of the physical signs of bulimia nervosa which can be more easily identified.

 1. Signs related to vomiting

As mentioned before, parents should watch and listen for signs of vomiting. After frequently purging for an extended period, the teeth will become discolored and develop cavities from the stomach acid. Callouses on the fingers and knuckles also appear with repeated self-induced vomiting. In the long term, swollen glands in the throat are common, as is persistent sore throat and mouth ulcers. Many people with bulimia nervosa are aware that frequent vomiting is apparent, and wish to hide these signs. Frequent use of mints or mouthwash might hide the smell – although be extremely careful of using this as a diagnostic tool. It’s just a hint that there might be a problem.

 2. Rapid changes in body weight

Because people with bulimia nervosa are often on a strict diet, but also binge eat, they often experience sudden fluctuations in their weight. Although they might suddenly lose weight, especially during periods of extreme dieting coming with purging, frequent binge eating episodes can lead to weight gain as well. Rapid weight changes wreak havoc on the body. They can result in diabetes, gastrointestinal problems, heart disease, and decreased brain function if left untreated. Weight fluctuations also affect self-image; rapid weight loss can encourage a person with an eating disorder to continue trying to lose weight and achieve their “ideal” body weight, and weight gain can increase negative feelings about their body.

 3. Malnutrition and nutrient deficiencies

Combining frequent dieting, purging, and eating “empty calories” such as potato chips or snack cakes (which are often but not always the foods eaten during a binge eating episode) can result in malnutrition. Malnutrition can cause several different physical effects, such as a sense of always being cold, persistent headaches, fatigue, and dizziness, and electrolyte imbalances caused by dehydration. Vomiting can also cause dehydration, as can diarrhea and other GI issues caused by disorder eating.Long periods of disordered eating can cause an individual’s hair to become dry and brittle – it may thin out as well. In extreme cases, there may be small, fine hairs growing all over the body, a condition called lanugo (although this is more associated with anorexia nervosa than bulimia nervosa).

Emotional Signs of Bulimia Nervosa

 1. Other forms of mental health disorders are common

Bulimia nervosa can affect a person by itself, but it’s far more likely that one or more other kinds of mental illnesses are present. Depression is the most common form of mental health illness in the United States, and there is a strong link between it and bulimia nervosa. Some evidence suggests that 50% of people with bulimia nervosa are also diagnosed with major depressive disorder. Anxiety disorders like phobias (often regarding certain foods) and social anxiety disorder, with its attendant fear of being judged or looked down upon, are also frequently co-diagnosed. Some studies indicate that the compulsive nature of bulimia nervosa’s binge eating episodes are similar to the compulsive actions associated with OCD. Although some of these disorders are treatable through medication, bulimia nervosa is typically treated with therapy and behavior modification.

 2. Trauma and PTSD

Post-Traumatic Stress Disorder warrants special mention here because it is one of the most potent triggers for disordered eating behaviors in general and bulimia nervosa in particular. PTSD is a reaction to a traumatic event in someone’s life, which can include instances of abuse, violence, loss, or other disturbing experiences. It causes great distress for years afterward, and particularly strong episodes can lead a person to harmful behaviors in order to alleviate the stress. These often include self-harm and substance abuse, both of which release dopamine, just like binge eating does. It’s a common enough factor in mental health recovery that specific treatment methods have been developed focused solely on PTSD. Chief among these is Cognitive Processing Therapy (CPT), a regimented 12-step program designed to help individuals understand how trauma affects thinking and behavior. The therapist conducting CPT sessions will ask the patient to write out their feelings about the traumatic event, then in later sessions introduce healthier coping mechanisms to process and overcome these feelings.

Getting Help for Bulimia Nervosa

There are other signs of bulimia nervosa than those we’ve listed here. You can check out some of them here. However, these behavioral and physical signals are a good start for parents who are concerned about their child’s eating patterns and mental health. If you observe any of these signs, you shouldn’t hesitate to reach out for professional help. It may sound dramatic, but by helping them get treatment, you could save your loved one’s life.


With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.