Bulimia nervosa is a dangerous eating disorder. It involves bingeing on large amounts of food and purging. Purging can take forms like vomiting, laxative abuse and excessively exercising. Bulimia isn’t just about controlling weight gain. People with bulimia are in emotional turmoil. If you’re worried you or someone you love is struggling with bulimia, learn about bulimia disorder signs and symptoms.

Warning Signs a Loved One Is Bulimic

People with bulimia can be skilled at hiding their eating disorder. Many times bulimics are normal weight or overweight, making it easier to disguise bulimia symptoms. Binge eating episodes usually happen when they’re alone. Sometimes they “purge” by over-exercising or fasting so you may not see signs of vomiting or laxative abuse. While bulimia can be hard to detect, here are some warning signs of bulimia that friends and family can look for:

  • Secretive behaviors around eating
  • Finding evidence of binge eating like lots of food wrappers or cartons in the trash (usually from junk food)
  • Scabs and sores on hands from self-induced vomiting
  • Damaged teeth and gums from acidity of vomit
  • Scratchy voice from trauma to the throat due to excessive vomiting
  • Trips to the bathroom after eating large amounts of food
  • Finding empty boxes of laxatives, diuretics or enemas (or finding full boxes in hiding places)
  • Swollen cheeks
  • Swollen neck glands
  • Fainting spells
  • Obsessive focus on body shape and weight
  • Large amounts of food goes missing
  • Money goes missing (to pay for binge food)
  • Weight may go up and down
  • Frequently uses mints or chewing gum
  • Doesn’t like to eat in front of others

Symptoms of Bulimia Nervosa

If you’re having episodes of bingeing followed by purging behaviors, you’re probably aware that these eating behaviors are unhealthy. These eating behaviors may have started as an experiment of sorts. You wanted to see if they could prevent weight gain. Now you feel like you’d do just about anything to keep the calories out of your system. If you can relate to the following bulimia signs, consider getting professional help.

Bulimia disorder signs and symptoms may include:

  • Episodes of bingeing that may include:
    • Eating a much larger amount of food than normal within two hours
    • Feeling a lack of control over eating behaviors during bingeing episodes
  • Purging in an attempt to prevent weight gain. Types of purging behaviors may include:
    • Self-induced vomiting
    • Laxative abuse
    • Diuretics
    • Enemas
    • Fasting
  • Episodes of bingeing and purging happen at least once a week for three months
  • Self-worth and self-esteem are tied to body image and weight gain
  • Poor body image
  • Avoiding situations where food will be served
  • Feeling self-conscious about eating in front of others
  • Zoning out or feeling detached during binge episodes
  • Not being able to keep certain foods around without bingeing on them
  • Guilt, shame and regret after bingeing or purging
  • Greatly exaggerating and focusing on perceived flaws (body dysmorphia)

Risks and Long-Term Effects of Bulimia

Effects of bulimia can be dangerous and even fatal. Many of the serious complications of bulimia are due to dehydration. Episodes of purging through laxative, diuretics and vomiting causes water loss. This may throw off balances of important electrolytes that help organs function properly. Effects of bulimia’s bingeing and purging behaviors may include:

  • Irregular heartbeat or heart failure from electrolyte imbalances
  • Dehydration from laxatives, diuretics and purging
  • Difficulty having bowel movements naturally due to laxative abuse
  • Swelling of ankles, legs and other body parts
  • Stomach problems like ulcers
  • Tooth decay
  • Tiredness
  • Damage or rupture of esophagus
  • Damage to organs such as the kidneys and pancreas

Often people with eating disorders are so in the thick of it that they don’t care about health risks. Controlling their weight becomes top priority. Their mental health is suffering. It’s hard to think about the long-term consequences of their actions. Hearing about the damage bulimia can do to their body and mind isn’t very motivating. If you feel this way, you should know that this is part of your eating disorder. It’s a red flag that you need eating disorder treatment.

Causes of Bulimia

Usually bulimia occurs because of several risk factors. Some situations that may contribute to developing bulimia include:

Co-Occurring Disorders

People with bulimia often have other mental health problems. According to studies, about half of people with eating disorders struggle with substance abuse. People with bulimia often have problems with alcohol addiction or marijuana abuse. Research finds bulimics may also struggle with:

When you don’t manage mental health disorder symptoms, they can fuel destructive behaviors. Bulimia could be a way you cope with symptoms of anxiety or depression. Bingeing on foods like carbohydrates and sugar may temporarily boost levels of pleasurable chemicals in the brain. That’s why a binge might make you feel better briefly.

Difficult Childhoods

People with eating disorders sometimes carry emotional pain that stems from childhood. Research links developing bulimia with these types of childhood experiences:

You may have started bingeing and purging to numb difficult emotions that come with these challenges. Bulimia can also be a way to feel in control in an unpredictable environment.


There’s a small but growing pool of research on genes and eating disorders. For instance, one study finds people with certain rare gene mutations are at high risk for developing bulimia or anorexia. Another study finds that genes thought to increase your risk of alcohol addiction can also increase your risk for disordered eating.

Cultural Pressures

Studies show social media and the media at large can influence body image. Children and teenagers are especially vulnerable to pressure to have the “perfect body.” That pressure can lead to chronic dieting. Some research shows certain people that diet are at greater risk for developing eating disorders.

Help for Bulimia

Bulimia treatment can help you get to the reasons behind your eating disorder. Time in a residential treatment center can give you space to focus on yourself. You may take part in therapies like:

  • Individual therapy
  • Group therapy
  • Family therapy
  • Cognitive behavioral therapy
  • Dialectical behavior therapy
  • Body image work
  • Shame resilience
  • Alternative approaches
  • Mindful eating
  • Nutrition support

Some people find when they keep the food down, the feelings come up. This is part of the healing process. You’ll be around mental health professionals and peers in recovery to help support you when you feel an urge to purge. They’ll help you stay with uncomfortable emotions so you can learn what they’re all about and how to manage them better.

Krisi Herron

Medically Reviewed by

Krisi Herron, LCDC

Choose a better life. Choose recovery.