Signs and Indicators of Bulimia

Naomi Carr
Author: Naomi Carr Medical Reviewer: Dr. Jenni Jacobsen, PhD Last updated:

Bulimia nervosa is a mental health condition characterized by a preoccupation with weight and body image, along with compulsive behaviors relating to food [1]. Recognizing the signs of bulimia can allow for early intervention and prevent worsening symptoms or health complications.

What is bulimia?

Bulimia nervosa is an eating disorder that affects between 0.5% and 1.5% of the population [2]. It is most commonly diagnosed in adolescent females but can be present in people of any age or gender.

People with bulimia tend to have a preoccupation with their weight and engage in unhealthy behaviors around food, such as binge eating, often followed by vomiting, laxative abuse, excessive exercise, or fasting, to compensate for overeating behaviors as an attempt to prevent weight gain [1].

Early warning signs of bulimia

Many people with bulimia engage in secretive behaviors, due to feelings of guilt and shame, so it can be difficult for others to notice the warning signs. Also, unlike certain other eating disorders such as anorexia nervosa, people with bulimia do not tend to be underweight or experience excessive weight loss, which also increases the difficulty in spotting signs of the disorder [1].

Symptoms of bulimia can vary from person to person, and some symptoms may occur within the context of other conditions, so they may not be a clear indicator of bulimia.

Common early warning signs of bulimia can include [3][4]:

Behavioral effects

Some of the behaviorial effects of bulimia include:

  • Changes in mood, such as periods of anxiety or low mood
  • Regular negative comments about body shape or weight
  • Regularly talking or thinking about food
  • Consuming irregual quantities of food
  • Counting calories or grams of fat per food item
  • Disappearing immediately after meals, especially if going to the bathroom
  • Eating in secret
  • Hiding food wrappers, such as in the bedroom or underneath other items in the trash
  • Signs of vomiting, such as smells or residue in the bathroom
  • Eating very fast
  • Extreme exercise

Physical effects

Some of the physical effects of bulimia include:

  • Consistent fatigue
  • Regular stomach pain
  • Sore throat
  • Puffy face
  • Acid reflux
  • Muscle weakness
  • Signs of self-harming
  • Fluctuating body weight
  • Difficulty concentrating
  • Dizziness
  • Russell’s sign, which is the name given to the presence of tooth marks or calluses on the knuckles, indicating self-induced vomiting

The importance of spotting the signs of bulimia early

If you or a loved one is experiencing any bulimic symptoms, it is important to seek professional advice as soon as possible. Spotting the signs early can enable you or your loved one to quickly receive appropriate intervention and professional help.

If the signs are not noticed early, it is likely that the harmful behaviors will continue, and the symptoms of the condition can worsen or become prolonged, which increases the risk of serious physical consequences [5].

For example, prolonged and recurrent self-induced vomiting can lead to several serious physical health issues, such as [2][6]:

  • Dehydration
  • Poor dental health and tooth decay
  • Metabolic alkalosis
  • Damage to gastrointestinal health
  • Tearing of the esophagus
  • Swollen glands
  • Hemorrhages
  • Decrease in electrolytes, which can lead to heart issues

Similarly, prolonged use of laxatives can also contribute to the development of several of these physical health concerns, as well as potentially causing difficulties with bowel movements [5].

Untreated bulimia can result in nutritional deficiencies, as the amounts of food consumed during episodes of recurrent binge eating are often high in fat or sugar, which results in a lack of necessary vitamins and minerals [6].

Left untreated, bulimia can also cause irregular or missed periods in females, imbalanced hormone levels, and issues with conceiving [2][5].

It is common for those with bulimia to also experience other mental health conditions, especially anxiety disorders and depression, along with intense feelings of guilt and shame [1]. As such, it is not only important for people with the condition to receive treatment for bulimia, but also to receive professional help with managing any coexisting conditions.

Research suggests that there is a high prevalence of self-harming behaviors and death by suicide amongst those with bulimia, as well as drug and alcohol abuse [6]. This also highlights the importance of receiving professional help as early as possible, to prevent worsening mental health and the occurrence of harmful or fatal effects.

How to manage bulimia

Many people diagnosed with bulimia can go on to experience a significant reduction in symptoms following effective treatments [2]. Effective ways to manage and treat bulimia include:

  • Therapy: Individual psychotherapy or cognitive behavioral therapy (CBT) with mental health professionals have been found to be useful for the treatment of bulimia and can help to reduce the negative feelings associated with the condition and to develop positive coping strategies to manage emotions and harmful behaviors [7].
  • Family therapy: Many adolescents diagnosed with bulimia have been found to benefit from family therapy, as it can help to promote understanding and awareness of the condition within the home, allowing parents and family members to provide effective support [7].
  • Medication: Doctors may prescribe antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs) such as fluoxetine, to help manage the emotions and behaviors associated with bulimia [2].
  • Guided self-help: Guided self-help books can be effective for many with bulimia, as they can provide advice relating to the monitoring and planning of meals, noticing personal triggers to help prevent episodes of binge eating and purging, and learning coping strategies to manage emotions and behaviors [8].
  • Dentist visits: For those who engage in regular self-induced vomiting, it is advisable to have regular check-ups with a dentist to prevent tooth decay and manage dental hygiene [7].
  • Hydration: As dehydration is a common issue amongst those with bulimia, maintaining a consistent consumption of water can help to prevent certain physical health issues associated with the condition [6][7].
  1. Attia, E., & Walsh, B.T. (Reviewed 2022). Bulimia Nervosa. MSD Manual. Retrieved from
  2. Jain, A., & Yilanli, M. (2022). Bulimia Nervosa.In: StatPearls [Internet] Treasure Island, FL: StatPearls Publishing. Retrieved from
  3. National Health Service. (Reviewed 2020). Symptoms – Bulimia. NHS. Retrieved from
  4. Office on Women’s Health. (Updated 2022). Bulimia Nervosa. OASH Office on Women’s Health. Retrieved from
  5. National Eating Disorders Association. (2022). Bulimia Nervosa. NEDA. Retrieved from
  6. Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P.S. (2021). Medical Complications of Bulimia Nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333–343.
  7. National Health Service. (Reviewed 2020). Treatment – Bulimia. NHS. Retrieved from
  8. Carter, J.C., Olmsted, M.P., Kaplan, A.S., McCabe, R.E., Mills, J.S., & Aimé, A. (2003). Self-Help for Bulimia Nervosa: A Randomized Controlled Trial. The American Journal of Psychiatry, 160(5), 973–978.
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Naomi Carr
Author Naomi Carr Writer

Naomi Carr is a writer with a background in English Literature from Oxford Brookes University.

Published: Feb 23rd 2023, Last edited: Oct 27th 2023

Dr. Jenni Jacobsen, PhD
Medical Reviewer Dr. Jenni Jacobsen, PhD LSW, MSW

Dr. Jenni Jacobsen, PhD is a medical reviewer, licensed social worker, and behavioral health consultant, holding a PhD in clinical psychology.

Content reviewed by a medical professional. Last reviewed: Feb 23rd 2023