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Bulimia also known as Bulilmia Nervosa. Find all resources for help at EDReferral.com.

Bulimia Nervosa Treatment Center

What is Bulimia Nervosa?

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.


  • Frequent episodes of consuming very large amount of food followed by behaviors to prevent weight gain, such as self-induced vomiting.
  • A feeling of being out of control during the binge-eating episodes.
  • Self-esteem overly related to body image.

The chance for recovery increases the earlier bulimia nervosa is detected. Therefore, it is important to be aware of some of the warning signs of bulimia nervosa.

Warning Signs of Bulimia Nervosa

  • Evidence of binge eating, including disappearance of large amounts of food in short periods of time or finding wrappers and containers indicating the consumption of large amounts of food.
  • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/or smells of vomiting, presence of wrappers or packages of laxatives or diuretics.
  • Excessive, rigid exercise regimen--despite weather, fatigue, illness, or injury, the compulsive need to “burn off” calories taken in.
  • Unusual swelling of the cheeks or jaw area.
  • Calluses on the back of the hands and knuckles from self-induced vomiting.
  • Discoloration or staining of the teeth.
  • Creation of lifestyle schedules or rituals to make time for binge-and-purge sessions.
  • Withdrawal from usual friends and activities.
  • In general, behaviors and attitudes indicating that weight loss, dieting, and control of food are becoming primary concerns.
  • Continued exercise despite injury; overuse injuries.

Health Consequences of Bulimia Nervosa

Bulimia nervosa can be extremely harmful to the body.  The recurrent binge-and-purge cycles can damage the entire digestive system and purging behaviors can lead to electrolyte and chemical imbalances in the body that affect the heart and other major organ functions.  Some of the health consequences of bulimia nervosa include:

  • Electrolyte imbalances that can lead to irregular heartbeats and possibly heart failure and death.  Electrolyte imbalance is caused by dehydration and loss of potassium and sodium from the body as a result of purging behaviors.
  • Inflammation and possible rupture of the esophagus from frequent vomiting.
  • Tooth decay and staining from stomach acids released during frequent vomiting.
  • Chronic irregular bowel movements and constipation as a result of laxative abuse.
  • Gastric rupture is an uncommon but possible side effect of binge eating.

About Bulimia Nervosa

  • Bulimia nervosa affects 1-2% of adolescent and young adult women.
  • Approximately 80% of bulimia nervosa patients are female.
  • People struggling with bulimia nervosa usually appear to be of average body weight.
  • Many people struggling with bulimia nervosa recognize that their behaviors are unusual and perhaps dangerous to their health.
  • Bulimia nervosa is frequently associated with symptoms of depression and changes in social adjustment.
  • Risk of death from suicide or medical complications is markedly increased for eating disorders

Defining characteristics of Bulimia Nervosa:
Individuals with bulimia nervosa regularly engage in discrete periods of overeating, which are followed by attempts to compensate for overeating and to avoid weight gain. There is variation in the nature of the overeating but the typical episode of overeating involves the consumption of an amount of food that would be considered excessive in normal circumstances. The bulimic is dominated by a sense of a lack of control over the eating. Binge eating is followed by attempts to undo the consequences of the binge though self-induced vomiting, misuse of laxatives, severe caloric restriction, diuretics, enemas, or excessive exercising, etc. The bulimic's self-evaluation is centered on the individual's perceptions of his/her body image. 

Concerns about weight and shape are characteristic of those with bulimia nervosa. The diagnostic criterion of bulimia nervosa requires that the individual not simultaneously meet criteria for anorexia nervosa. (If an individual simultaneously meets criteria for both anorexia nervosa and bulimia nervosa, only the diagnosis of Anorexia Nervosa, binge-eating/purging type is given.) The formal diagnosis also stipulates minimal frequency and duration cut-offs. The diagnosis requires that individuals must binge eat and engage in inappropriate compensatory behavior at least twice weekly for three months.
There are also two subtypes of bulimia nervosa. The Purging Type describes individuals who regularly compensate for the binge eating with self-induced vomiting, laxative abuse, diuretics, or enemas. The Non-Purging Type is used to describe individuals who compensate through dietary fasting or excessive exercising.

Definition/Facts: Bulimia Nervosa
A. There are two types of bulimia nervosa:
1. Purging
2. Nonpurging
B. It occurs in 0.5% to 2.0% of adolescents and young adult women.
C. It is usually preceded by dieting behavior.
D. Bulimics are usually of average or above average weight.
E. Self-evaluation is unduly influenced by size and weight.
F. A complex lifestyle develops to accommodate eating disorder behaviors.
G. There are ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem.
H. There are ongoing feelings of isolation, self-deprecating thoughts, depression, and low self-esteem.
I. It typically develops in early to mid-adolescents.
J. There is full recognition of the behavior as abnormal.
K. Statistics indicate it is relatively uncommon in men.

Profile: Bulimia Nervosa
Individuals with Bulimia are usually aware they have an eating disorder. Obsessed with food they often focus on and enjoy discussing diet related issues. The Bulimic may engage in self-starvation between binge-purge episodes thus presenting the same dangers as the anorexic, in addition to the ones presented by the binging and purging. Recurring episodes of rapid food consumption followed by tremendous guilt and often purging, a feeling of lacking control over his or her eating behaviors, regularly engaging in stringent diet plans and exercise, the excessive use of laxatives, diuretics, and/or diet pills and a persistent concern with body image can all be warning signs someone is suffering with Bulimia Nervosa.
It is important to realize that those suffering with Bulimia manifest symptoms in different ways. The Bulimic has binge and purge episodes where as purging can be different things to different people. After binging, some will exercise compulsively, in an attempt to burn off the calories of a binge. Others will self-induce vomiting or take laxatives, or to "fast" for days following a binge. Some take diet pills in an attempt to keep from binging or to use diuretics to try to lose weight. Bulimics will often hide food for later binges and often eat in secret.

Diagnostic Criteria: Bulimia Nervosa
The following definition of Bulimia Nervosa is used to assist mental health professionals in making a clinical diagnosis. The clinical definitions are usually not representative of what a victim feels or experiences in living with the illness. It is important to note that you can still suffer from Bulimia even if one of the below signs/symptoms is not present. If you think you have Bulimia, it is dangerous to read the diagnostic criteria and think if you do not have one of the symptoms, you therefore, must not be Bulimic.
1. Recurrent episodes of binge eating.
A. An episode of binge eating is characterized by both of the following:
1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
2. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
C. The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
D. Self-evaluation is unduly influenced by body shape and weight.
E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.
Purging Type: during the current episode of Bulimia Nervosa, the person has regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas
Nonpurging Type: during the current episode of Bulimia Nervosa, the person has used other inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Both Anorexia and Bulimia
Eating disorders are very complex emotional issues. Though they may seem to be nothing but a dangerously obsessive dietary concern on the surface, for most men and women suffering with an eating disorder there are deeper emotional conflicts to be resolved.
American Psychiatric Association (1998), Eating Disorders.

22 Signs Some One Has Bulimia Nervosa

By Richard Kerr 

The warning signs of bulimia are not easy to spot.

My wife Ali hid her eating disorder from me for 3 years. I know they say love is blind but we spent all day, every day together and I had absolutely no idea she was suffering from an eating disorder.

The point is, people with bulimia are highly skilled in the art of hiding their eating disorder. If you don't know what you are supposed to be looking out for then it can be very easy to miss.

Firstly, lets expel a few myths.

Being under weight isn't usually a sign of bulimia
People with bulimia are not necessarily under weight. In fact most people with bulimia are usually around their normal weight range. So just because someone isn't stick thin, it doesn't mean that they aren't suffering from a serious eating disorder. The truth is for many people bulimia causes weight gain.

"Bulimics - Tend to be normal to slightly overweight. They develop rapid weight fluctuations.  In some cases, a bulimic client may be underweight if they are restricting caloric intake."

With that in mind, lets cover 22 signs that someone has bulimia nervosa.

The Physical Signs of Bulimia Nervosa

1. Puffy Face
Undeniably one of the most apparent physical signs that can indicate someone is suffering from bulimia is a swollen or “puffy” face. This is usually as a result of swelling of the parotid glands which lie between the ear and jaw line and it occurs as a result of frequent episodes of purging.

2. Scars or red marks on the fingers or knuckles
This is a sign of self induced vomiting and is caused by teeth rubbing against the hands. Although not all people with bulimia need to stimulate their gag reflex in this way to vomit.

3. Tooth Damage
Bulimia causes extensive damage to teeth. This can be difficult to detect at first but eventually teeth will appear to be “graying” or “ragging”, especially at the front.

4. Redness around and in the eyes
Self induced vomiting can cause the blood vessels in and around the eyes to burst leaving scatters of tiny red dots or lines. Many people with Bulimia will wear a lot of makeup in an attempt to conceal some of this.

5. A constantly sore throat and a compromised immune system
Many people with bulimia have frequently sore throats. In addition to this poor nutrition can lead to frequent colds, chapped lips, run down feelings and cold sores.  

6. Rapid weight fluctuations
People with Bulimia often experience very rapid weight fluctuations.

7. Puffy dry skin
Some develop dry, blotchy puffy skin.

8. Short finger nails.
So as to not scratch the roof of their throat whenever they purge.

Behavioral Signs
These are any actions that a person takes or behaviors that they exhibit that could indicate they have bulimia.

9. Frequent visits to the bathroom after eating
Many people with bulimia try to disguise the noise of vomiting by playing load music, running taps or flushing the toilet a few times.  Some may organize their bath or shower time to run "coincidently" after meal times.

10. You may detect a smell of vomit lingering in the bathroom.
However many people with bulimia will be sure to spray the toilet with plenty of fragrance or perfume after purging (another telltale sign).

11. Vomit may be left around the inside of the toilet bowl or spilled around the sides.
Although those with bulimia are normally overly cautious about leaving signs, so this can be difficult to detect

12. You may notice food disappearing in large quantities.
You may also notice the person buys a lot of food in bulk or eats a rather large amount of food without gaining a lot of weight.

13. You might find empty food wrappers hidden around the house.
Not a great clue, however if the person does not eat chocolate or sweets in front of you or others then this could perhaps be an indication of secret bingeing.

14. Look out for unexpected walks or drives at night
As well as staying up after everyone else has gone to bed.  Someone with bulimia may try hard to get others to leave the house or ask leave them alone frequently so that they are able to purge.

15. Social withdrawal.
 A person with bulimia will often turn down social invites, start to distance themselves from family and friends and lose interest in previously engaging hobbies and activities.

16. An increase in irritability and mood swings.
It is very common for people with bulimia to be at war with their feelings and emotions. Combine that with a lack of nutrition and actual changes to their brain chemistry and it's easy to see why someone with bulimia can often experience dramatic and frequent irritability and mood swings.

17. Low self esteem.
While people with bulimia will often try very hard to hide their problem their low self esteem can still be very apparent to others. Someone with bulimia may put her/himself down a lot, comment on their body weight frequently or share worries about not being good enough or not feeling able to cope with life.

18. Laxative tablets being over used.
Laxatives can be used as a form of purging. If you see lots of laxatives around that could be a sign.

19. Hidden cups
If you find cups under the bed or cups around the place. That could be a sign. People with bulimia may use cups to purge into.

20. Fatigue
People with bulimia are regularly tired, listless, sleepy. Especially after a purging episode.

21. Food talk
A side effect of bulimia is food obsession. This includes lots of talk about food. In fact many people with eating disorders have a job that is directly related to food.

22. Over Exercise.
Exercise is good for you, but too much exercise can do serious damage. A person may be suffering from an eating disorder if they regularly spend hours at a time at the gym, or go exercise more than 4 times a week.

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In Partnership with the American Eating Disorder Association- -SINCE 1999