What is bulimia face?

Naomi Carr
Author: Naomi Carr Medical Reviewer: Morgan Blair Last updated:

Bulimia nervosa is an eating disorder, that is often characterized by repeated episodes of binge eating followed by purging behaviors, such as self-induced vomiting. These behaviors and their consequences can cause several effects on a person’s physical health. One physical consequence includes swollen salivary glands, occasionally known as ‘bulimia face’.

Why does bulimia affect your face and cheeks?

Eating disorders are mental health conditions that impact the way an individual feels and behaves in relation to food and body image. Bulimia nervosa is a type of eating disorder that often involves purging behaviors, such as self-induced vomiting, excessive exercising, or abusing laxatives or diuretics [1].

Regularly engaging in self-induced vomiting can cause many physical symptoms. Some of the physical symptoms can be treated and some can become severe or even fatal. One physical effect of self-induced vomiting is sialadenosis, or the swelling of salivary glands [2].

This usually affects the parotid glands. The parotid glands swell up and cause puffy-looking cheeks that can feel tender, although typically do not cause a lot of pain. The appearance of sialadenosis is sometimes known as ‘chipmunk cheeks’ or ‘bulimia face’. It is a condition that affects up to two thirds of those with bulimia, depending on the frequency and duration of self-induced vomiting [3][4].

The exact cause of sialadenosis is not clear but it often begins in the days following the stopping of vomiting. Due to this, it is thought that it may be caused by excess saliva being produced during vomiting, which then causes the glands to grow in size to accommodate for the extra saliva [3][4].  

Similarly, it may be due to stomach acid entering the mouth during vomiting or the excessive consumption of foods high in carbohydrates and sugars, which is common during binge episodes [2][3].

What does bulimia face look like?

The salivary glands are located around the jaw area, with the parotid glands located in front of the ears. When they become swollen, this can cause the appearance of very puffy or large cheeks, hence the use of the term ‘chipmunk cheeks’. This effect can worsen if purging continues [3][5].

Those with bulimia commonly experience concerns and issues related to appearance and body image. The emergence of swollen glands and cheeks can worsen these concerns, potentially causing an increase in purging behaviors in an attempt to lose weight. This creates a problematic cycle thus worsening the effect on the salivary glands.

Early signs

Typically, individuals with bulimia will hide their disordered eating behaviors and may struggle to discuss their condition or ask for help. In many instances, warning signs of the condition will first be noticed by a medical professional or family member.

Some of the early signs of bulimia could be changes in eating habits, attitudes around food and body image, and behaviors, such as [1][2]:

  • Eating in secret
  • Avoiding eating with others
  • Hoarding food for binge episodes
  • Going to the bathroom straight after eating a meal
  • Making negative comments about appearance or body shape

‘Bulimia face’ or ‘chipmunk cheeks’ are a symptom that often develop later in the condition with the cessation of purging or the restarting of previously ceased purging. Therefore, early warning signs typically aren’t shown in the face [3][5].

How to treat bulimia face

Typically, parotid gland swelling will reduce on its own if purging behaviors remain ceased. As such, many individuals do not require treatment for this physical condition alone and will find that the swelling reduces within several weeks [2].

However, for some people, this swelling does not reduce on its own so may require some intervention. It may be helpful in this time to consume sour or tart foods to promote saliva flow, which can aid in the reduction of swelling. Another intervention includes the use of anti-inflammatory medications [4].

In the most severe cases, it may be necessary to undertake a surgical procedure to remove part or all of the swollen area [2][5].

In order to treat swollen glands caused by bulimia and prevent recurring symptoms, the condition itself must be treated effectively. The continuation of purging behaviors will worsen or prolong swelling. Treatment for bulimia typically involves a multidisciplinary team of professionals, including physicians, dieticians, and specialized therapists [1][5].

Are there any complications of bulimia face?

The swelling of the salivary glands caused by bulimia is often reversible, typically leaving no long-term physical impact on the individual. The reversal of ‘bulimia face’ is dependent on effective treatment and management of the condition [3].

However, if bulimia symptoms persist or are untreated, it is possible for the glands to become infected due to blockages or poor hydration, which is known as sialadenitis. This can cause more severe symptoms, including fever, pain, tenderness, increased swelling, and infectious fluid buildup in the glands. This condition requires medical treatment, such as antibiotics and hydration [6][7].

Other physical effects of bulimia

Without effective treatment, bulimia can cause many serious physical health problems. Mostly, these complications can be managed and reduced with professional intervention, but others can cause severe long-term health issues, or even death.

Bulimia nervosa can cause physical health effects such as [1][2]:

  • Rapid weight loss or regular fluctuations in weight
  • Fatigue
  • Poor brain health and cognitive functioning
  • Dental erosion and decay
  • Dehydration
  • Dry and brittle hair or nails
  • Reduced electrolytes
  • Bloating and constipation
  • Stomach pain
  • Abnormal or irregular bowel movements
  • Hormonal abnormalities and fertility issues
  • Complications and issues with heart function
  • Kidney failure
  • Sudden cardiac arrest

If you know someone who struggles with bulimia nervosa, don’t hesitate to support them by encouraging them to seek professional treatment to overcome their disorder.

  1. National Health Service. (Reviewed 2020). Bulimia. NHS. Retrieved from https://www.nhs.uk/mental-health/conditions/bulimia/overview/
  2. Forney, K.J., Buchman-Schmitt, J.M., Keel, P.K., & Frank, G.K.W. (2016). The Medical Complications Associated With Purging. International Journal of Eating Disorders, 49(3), 249-259. Retrieved from https://doi.org/10.1002/eat.22504
  3. Mehler, P.S., & Rylander, M. (2015). Bulimia Nervosa – Medical Complications. Journal of Eating Disorders, 3, 12. Retrieved from https://doi.org/10.1186/s40337-015-0044-4
  4. Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P.S. (2021). Medical Complications of Bulimia Nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333-343. Retrieved from https://doi.org/10.3949/ccjm.88a.20168
  5. Garcia Garcia, B., Dean Ferrer, A., Diaz Jimenez, N., & Alamillos Granados, F. J. (2018). Bilateral Parotid Sialadenosis Associated with Long-Standing Bulimia: A Case Report and Literature Review. Journal of Maxillofacial and Oral Surgery, 17(2), 117–121. Retrieved from https://doi.org/10.1007/s12663-016-0913-7
  6. John Hopkins Medicine. (n.d). Salivary Gland Infection (Sialadenitis). Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/conditions-and-diseases/salivary-gland-infection-sialadenitis
  7. Adhikari, R., & Soni, A. (2022). Submandibular Sialadenitis and Sialadenosis. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562211/
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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: Jun 20th 2023, Last edited: Sep 22nd 2023

Morgan Blair
Medical Reviewer Morgan Blair MA, LPCC

Morgan Blair is a licensed therapist, writer and medical reviewer, holding a master’s degree in clinical mental health counseling from Northwestern University.

Content reviewed by a medical professional. Last reviewed: Jun 20th 2023