Bulimia: What Are the Signs?

Like addictions to substances, eating disorders can wreak havoc on a person’s life and interpersonal relationships.  Similar to gambling and sex addictions, eating disorders – including anorexia nervosa, bulimia nervosa, and binge eating disorder – are characterized by obsessive behaviors related to food (Read Anorexia: What Are the Signs? and Binge Eating Disorder: What Are the Signs?).  Millions of Americans suffer from diagnosable eating disorders and millions more go undiagnosed and untreated over the course of their lives (Read Obesity: America’s Biggest Problem). Early interventions for these conditions can improve outcomes and decrease the likelihood of serious possible complications including death (Read Eating Disorders: What You Should Know).

What is bulimia?

People who have bulimia will severely overeat (aka, “binging”) and then will feel guilty about having consumed the food; these feelings of guilt propel them to compensate for their binging episode in a number of possible ways.

What are signs that a person is suffering from bulimia?

• Sex: Although anyone may become bulimic, females develop bulimia at a higher rate than do males (Read Eating Disorders: Not Just a Female Problem).
• Age: The greatest proportion of eating disorders occur among the population age 14-25.
• Signs of binging: Food may disappear from the refrigerator quickly or the trash may be filled with a large of number of food containers or wrappers.
• Discolored or decaying teeth: Self-induced vomiting brings stomach acid in contact with the teeth and can lead to staining and decay.
• Food rituals:  Rigid rituals surrounding the preparation or  consumption of food (e.g., always using the same pan and burner or chewing food a specific number of times before swallowing).
• Isolation: Becoming less interested in friends and hobbies, and more interested in weight loss is often a sign.
• Damage to knuckles and hands: Making oneself vomit can produce calluses in these areas.
• Bathroom trips: If you observe that the person has a habit of going to the restroom immediately after meals at restaurants, at home, and at friends’ homes, they are likely doing so to compensate for their food intake by vomiting.
• Calorie restriction: Severe calorie restriction is another mechanism that a person with bulimia may use to compensate after a binge.
• Laxative/diuretic abuse: Frequent presence of laxative or diuretic packaging in the trash may indicate that the person is using these to try to counter their binging episode.
• An obsession with exercise: A patient with bulimia may hit the gym for hours after over-eating to try to shed the excess calories.
• Average body weight: Unlike anorexia, bulimia does not usually cause severe weight loss and may even lead to weight gain in some individuals.
• Negative body image: People with bulimia often have inaccurate and unhealthy perceptions of their body (Read 10 Ways to Improve Your Body Image).

What are possible long-term complications from bulimia?

• Constipation and irregularity (from laxative abuse)
• Esophageal inflammation and rupture (from vomiting)
• Stained or decayed teeth (from vomiting)
• Heart failure/death (from dehydration and low levels of sodium and potassium, which can cause arrhythmias)
• Gastric rupture (uncommon but can occur)