Bulimia is known for the classic symptoms of bingeing and purging, but this eating disorder has several other distinctive symptoms.
Bulimia nervosa, aka bulimia, is an eating disorder where you feel out of control when you eat – like you can’t stop. Then, after overeating, you may feel an intense sense of guilt and an overwhelming urge to make up for the binge.
These episodes of bingeing and purging are a continuous cycle that repeat over and over. It’s not uncommon to feel guilt or shame after each episode.
But you’re not alone. According to a
This number is thought to be even greater among people who have related symptoms but haven’t been diagnosed with bulimia.
Though bingeing and purging are the most well-known symptoms of bulimia, there are other characteristics of the condition as well.
It’s not always easy to tell if someone has an eating disorder, especially bulimia.
People with different body types have eating disorders. While some people with bulimia may be thin, others can be a moderate weight or even overweight.
There are two types of bulimia according to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5). They’re separated by the type of purging behavior.
- Purging bulimia. After binge eating, a person with this type of bulimia will vomit or misuse diuretics, laxatives, or enemas. This is the most common type of bulimia.
- Non-purging bulimia. Instead of purging after binge eating, a person with this type will fast or obsessively exercise.
Like with other eating disorders, bulimia has a variety of symptoms including emotional, behavioral, and physical.
Bulimia can take a toll on the body, causing physical damage to parts of the body involved in eating and digesting food.
Some physical symptoms of bulimia include:
- swollen cheeks or jaw
- cuts or calluses on the knuckles or back of hands
- stained or discolored teeth
- tooth decay
- broken blood vessels in the eyes
- dry skin or dry and brittle nails
- stomach cramps or other gastrointestinal problems, like constipation or acid reflux
- feeling cold all the time
- dizziness and fainting, or syncope
- thinning hair or dry and brittle hair
Emotional and behavioral symptoms
People with bulimia are usually very careful about hiding their symptoms. However, friends and family may notice certain behaviors that indicate there’s something going on.
The emotional and behavioral symptoms of bulimia may include:
- going to the bathroom right after eating
- hiding food wrappers in unexpected places
- seeming uncomfortable eating in front of other people
- hiding packages of laxatives or diuretics
- stealing or hiding food in strange places
- frequently dieting
- excessively using mouthwash, mints, or gum
- obsessively exercising, even in bad weather or when tired or hurt
- acting moody or sad
- overly concerned with bodyweight and shape
- frequently making disparaging remarks about bodyweight and shape
- having extreme shifts in mood
- no longer wanting to hang out with friends or do activities they once enjoyed
Over time, bingeing and purging can do harm to the entire body. It can hurt the digestive system, the heart, and more.
Many of these complications can be severe or life threatening.
- irregular heartbeat (arrhythmia)
- low pulse
- low blood pressure
- heart failure
- nausea and vomiting
- low blood sugar
- stomach pain and bloating
- inflamed or damaged esophagus
- swollen jaws or cheeks
- bowel obstruction, perforation, or infections
- gastroparesis, or slowed digestion
- stomach rupture
- drop in body temperature or hypothermia
- menstrual irregularities (missing or irregular periods)
- insulin resistance (which can lead to type 2 diabetes)
- bone loss (osteopenia or osteoporosis)
- high cholesterol
- reduced resting metabolic rate
- kidney failure
- difficulty falling or staying asleep
- problems concentrating
- numbness or tingling in the hands, feet, or other extremities
- muscle cramps
- sleep apnea
If you think you have symptoms of bulimia or another eating disorder, you can start by reaching out to a healthcare professional. It can be a scary first step, but it can help to talk about it.
Bulimia is often a very private condition, done in secret. You may have feelings of shame, guilt, or embarrassment. This isn’t uncommon — you’re not alone.
Consider talking with family members, friends, or others who you know will be supportive and encouraging.
If you feel comfortable talking with your primary doctor, you can speak to them about your symptoms, thoughts, and feelings. They may refer you to an eating disorder specialist who can do an in-depth evaluation and make a diagnosis.
Talking with others who have lived through similar experiences can also help. The National Eating Disorders Association has forums that can connect you with others.
While you can never force someone to seek help, you can be supportive and encouraging if you believe someone you know has bulimia.
Offer to listen and be compassionate. They may want help but are afraid to ask — or not even know how to start the conversation. They may even think they don’t deserve help.
Before you reach out, here are some tips for how to go about it:
- Start by picking a good time and a private location.
- Point out specific examples to show why you’re concerned, and try not to criticize.
- Let them know you care about them.
- Be prepared — they might deny it or become angry. If this happens, stay calm, patient, and respectful.
- Try to help them find reasons to change, such as their love for someone else or a desire to return to school or work.
- Be patient and continue to support them, even if they’re not yet ready to get help.
Having a conversation with someone you think may have an eating disorder can be hard. It’s OK to be worried and scared to even bring up the subject.
To make the conversation easier for both of you, you can try to avoid:
- commenting on how they look, especially their weight
- shaming them or telling them how they’re harming themselves
- giving medical advice, unless you’re a doctor
- forcing them to go to treatment
- giving ultimatums
The important thing to remember is to make them feel comfortable. Let them know they can always come to you and you’ll always be available.
Bulimia is a common eating disorder. Its classic symptoms involve binge eating (eating large amounts of food) and purging (getting rid of the food).
People with bulimia often feel like they can’t control themselves when eating, then after feel shame or regret. These feelings might drive them to extreme measures to get rid of the food either through vomiting or by using diuretics and laxatives.
Some people may fast or intensely exercise after binge eating.
With the right support and professional care, bulimia can be managed.
Often, treatment programs involve a combo of therapy, medication, and rehabilitation. Individual therapy, family therapy, or support groups may also help.
If you have bulimia, consider talking with a healthcare professional. They can refer you to an eating disorder specialist who can help you make a treatment plan and be there during recovery.
If you think someone you know has bulimia, try our tips above to talk about your concerns, while offering support and encouragement to seek help.