Among the best-known eating disorders, bulimia nervosa is known to affect people of all genders, races, and ethnicities. Eating disorders affect roughly 1.5 percent of women and 0.5 percent of men in the United States at some point during their lifetimes, according to NEDA (National Eating Disorder Association). That may seem like a small percentage, but with a national population of over 311 million, it comes out to over 2 million women and roughly a million men. That means there are more people who have experienced signs of bulimia nervosa, anorexia nervosa, binge eating disorder or others than live in the Chicago city limits.
The eating disorder bulimia nervosa alone affects 1 percent of young women and 0.1 percent of young men in the United States. The sheer numbers alone indicate that it’s clearly a major mental health (and physical health) issue in America. Even more troubling, the percentage of people in the LGTBQ community, particular trans people, have a much higher incidence of eating disorders. It’s likely if you’re reading this, you probably know someone who needs bulimia nervosa treatment or treatment for bulimia nervosa side effects.
For these reasons, it’s important to know how to identify the signs of bulimia nervosa in yourself and those close to you. Many people with eating disorders will deny that there is a problem, even to themselves, and attempt to hide the symptoms, so it’s essential to be aware of typical symptoms, behaviors, and health risks associated with them before attempting to help.
How Does It Start?
The first signs and symptoms of bulimia nervosa normally appear in the teenage years and young adulthood, from roughly age 13 through 22, although the first onset can appear as young as 7. In fact, according to some recent studies, the earliest age for anorexia nervosa and bulimia nervosa is becoming lower on average in recent years. While childhood eating disorders are more common for anorexia nervosa than for bulimia nervosa, parents should be aware of the warning signs even in younger children.
As with all mental health disorders, the causes of anorexia nervosa and bulimia nervosa are normally a combination of genetic factors (inherited traits), psychological factors such as depression, anxiety disorders, and trauma, and environmental concerns such as the influence of peer pressure, parental influence, and the media. The onset of bulimia nervosa is also frequently stimulated by body image concerns which may arise from dieting and a (distorted) perception that the person is “fat” or “unattractive.”
Whether occurring in childhood, young adulthood, or later, the causes of bulimia nervosa are usually a combination of genetic and biological factors, psychological factors, and pressure to be “thin” (from parents, friends or spouses, or even from society in general. In many cases, acute signs of bulimia nervosa can be triggered by traumatic events and the consequent PTSD. These events can vary to great extremes, with trigger points possible including:
- Physical or sexual abuse
- An accident, such as a car accident or a slip-and-fall
- Being the victim of a crime (i.e. being mugged or robbed)
- Doing through a divorce or a bad breakup
- Losing a job
- Losing a loved one or pet
- Suffering a public embarrassment
- Long-term health issues like cancer
- War or combat experiences
In the past, the term PTSD was limited to soldiers returning from combat, but as psychological science has matured and become more encompassing, it’s more understood that there are various events which can cause a post-traumatic stress response. Importantly, events that occur during childhood may not manifest as PTSD or related anxiety disorders until many years later.
For example, a child going swimming at a public pool for the first time may feel uncomfortable in their bathing suit. If they are mocked for being overweight (even if it’s just typical “baby fat” for their age), that can be a traumatic event which may lead to dieting and anxiety over their body image in teenage years, which can lead to the dieting / binging purging cycle that defines bulimia nervosa.
Conversely, an adult who had not previously shown overt signs of bulimia nervosa may be traumatized by the death of their parent, and turn to disordered behaviors as an anxiety relief method. In many ways, this repetitive, disordered behavior shares characteristics with OCD, another anxiety disorder which can be triggered by a traumatic event.
Certainly, not every incidence of anorexia nervosa and bulimia nervosa is caused by a traumatic stressor. In some cases, the onset can be a slow burn of combined contributing factors which do not result in a full-blown case until late adolescence or early adulthood.
Behavioral Symptoms and Signs of Bulimia Nervosa
As with any mental health disease, bulimia nervosa treatment is most effective when begun early, before the disease becomes too severe. Luckily, many of the telltale signs are easily recognizable. While normally the more severe physical symptoms will not appear until there is an extended length of time, there are certain behavioral signs that someone has bulimia nervosa.
Hiding the body
While extreme weight loss or lack of body if is not necessarily associated with bulimia nervosa, a sense of distorted body image or dissatisfaction with their body is common in people with both anorexia nervosa and bulimia nervosa. This dissatisfaction can manifest itself by the individual finding ways to hide their body (noting here that being under- or overweight are not necessary components of bulimia nervosa). Typical methods include wearing baggy clothes to hide the body shape, wearing heavy overcoats and similar garments, and avoiding wearing clothes that are tight or expose the skin.
Covering for the purging cycle
The most prominent factor in diagnosing bulimia nervosa is the repeated purging (usually by self-induced vomiting) following meals and binge-eating episodes. Since this is so well known, steps are often taken to hide evidence of both the binge eating episodes and the subsequent purging. There may be hidden caches of food, or wrappers being surreptitiously hidden in the garbage. Also, lots of wrappers or bottles of diuretics and laxatives may be found, as those purging drugs are another common method of eliminating the food eaten during a binge session. If the person is engaging in self-induced vomiting, he or she may always have breath mints, gum or Listerine on their person to hide the odor.
Self-induced vomiting and other purging behaviors
The classic symptom of bulimia nervosa needing treatment, a major thing to look out for is evidence of vomiting. This can be in the form of frequent bathroom breaks following meals, taking pills (i.e. laxatives) frequently, and frequent dieting. If the odor of vomit is frequently observed, there should be cause for concern. While vomiting is the most common sign, other behaviors may show up as well. One of the more common ones is an insistence on an extreme exercise regimen, continuing to work out in terrible weather, when there are injuries, past the point of physical safety, and so on.
Food avoidance and rituals
People in need of bulimia nervosa treatment normally have a fraught relationship with food, especially in a group setting. They 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 become distressed at eating with other people and prefer to eat alone (often in binge episodes). Most dangerously for long-term health concerns, people with bulimia nervosa are known to frequently engage in fad diets, especially those which eliminate certain food groups (such as carbs, meats, etc).
Physical Signs of Bulimia Nervosa
Although people often associate eating disorders with the individual being severely underweight, this is not a definitive sign of bulimia nervosa. It can happen, of course, but most people with bulimia are at a “normal” weight or even overweight. However, there are some physical signs of bulimia nervosa which can be more easily identified.
Signs related to vomiting
In addition to the behavioral indications of vomiting listed above, there are some physical characteristics which can be observed, if the purging behavior is frequent and repeated. The teeth may become discolored or stained, and cavities are more frequent. The cheeks and jawline may show unusual swelling. If the purging behavior is especially frequent, the fingers and knuckles can develop callouses from repeatedly self-inducing vomiting
Signs related to malnutrition and the binge/purge cycle
While the following are generally signs of advanced bulimia nervosa rather than the early stages (and some can appear in cases of both anorexia nervosa and bulimia nervosa), they have been known to appear even early on. One of the prominent symptoms, often related to fad dieting, is frequent changes in body weight, fluctuating up and down as the individual binges and purges. These behaviors can also bring around gastrointestinal problems such as acid reflux, constipation, or stomach cramps.
The combination of binges (which are often on non-nutritional foods such as chips or candy), food avoidance, purges, and fad diets can result in certain signs of malnutrition. These can include a litany of health effects. One is a sense of always being cold, which can be combined with the tendency to wear baggy or heavy clothing. More noticeable symptoms are common in most restrictive eating disorders resulting in poor nutritional balance.
These include a thinning of the hair on the head and the hair becoming dry and brittle, a condition known as lanugo. In extreme cases, there may be small, fine hairs arising all over the body. The skin can be extremely dry as well and may show signs of yellowing as the result of a severely restricted food intake. Similarly, the fingernails can become dry and brittle (or stained and eroded from the acids contained in vomit).
Common to an unbalanced nutritional intake is the development of blood and immune system complications. For example, cuts and bruises may be extremely slow to heal. In advanced stages, anemia, low blood pressure, and low blood sugar can appear, leading to a sense of being constantly tired and leading to dizziness and fainting episodes. Menstrual irregularities can also occur, i.e. missing periods.
Catching the Signs and Symptoms Early Can Make the Difference
As with all mental health disorders, the behavioral changes and severity of bulimia nervosa tend to be progressive, meaning they will get worse and more prominent unless there is an effective bulimia nervosa treatment plan put into place. That’s why it’s important for parents and loved ones of people with bulimia nervosa to get educated on the various signs and symptoms, from physical changes to behavioral changes, of the disorder. In cases where some of these telltale signs start to show up, a compassionate discussion with the individual is called for – not an accusation or a guilt-trip. An honest, understanding conversation with a loved one can be the start to recovery, and although the discussion may be emotional or difficult, it’s an important first step. Further help can be received from your doctor or a qualified bulimia nervosa treatment center.
Oliver-Pyatt Centers’ admissions professionals are experienced in helping people of all races, genders, and ethnicities get started on the journey to a full recovery, free of disordered behaviors and living a happier, more mindful life. To learn about eating disorder treatment with a psychiatric focus and the highest levels of care outside a hospital setting, call 866.511.4325 today and speak with us.