A person with bulimia nervosa often has an average or above average weight, but the cycle of bingeing and purging puts them at serious medical risk. As a result, it is important to seek medical help as soon as you notice any of the following warning signs of bulimia nervosa.
Bulimia has a range of behavioural and physical signs and symptoms. Click the icons in the image below to find out more.
What are the behavioural signs of bulimia nervosa?
Food being consumed faster than expected
Because of their binge eating habits, people with bulimia nervosa will consume a large amount of food in a short amount of time. You may find that food is disappearing and you continually have to restock the fridge and cupboards. You may also find food wrappers or stashes of food hidden in the garbage or around the house.
Eating when no one is around
Because binge eating is associated with guilt and shame, people with bulimia nervosa will often try to hide their bingeing behaviour. They may eat in the middle of the night or when no one else is home and may skip meals.
Disappearing immediately after a meal
This is often a sign someone is purging or compensating for a binge in some other way. Purging includes vomiting or using laxative or other pills. Warning signs include:
- running water to cover sounds of vomiting following a meal
- using different items to mask the smell of vomit on the breath
- hiding packages of laxatives, diet pills or diuretics
- doing exercises in private or appearing to have just exerted energy after being alone (for example through shortness of breath or sweating)
Becoming more irritable
People with bulimia nervosa may lack concentration and be very irritable (cranky). Because their brains are starved of nutrients, they may not think clearly and, as a result, may react in a way that is out of proportion to the situation. This irritability may result in sudden mood swings or emotional outbursts.
Other behavioural signs of bulimia nervosa include:
- can be of any body weight, shape or size
- skipping meals
- hiding food wrappers around the house
- eating in the middle of the night
- judge themselves based on their body weight
What are the physical signs of bulimia nervosa?
Puffy face
People with bulimia nervosa may develop swollen parotid glands because of their repeated purging. These glands are just in front of the ears and may cause swelling in the face.
Calloused knuckles
A person's knuckles can get calloused if they repeatedly stick their fingers down their throat to induce vomiting.
Dramatic changes in weight
People with bulimia nervosa often have normal or above normal weight. But because of bingeing and purging cycles, their weight may change dramatically over short periods of time.
Broken blood vessels in eyes or face
Repeated retching (attempts at vomiting) in a short space of time can put pressure on the small blood vessels in the face, causing them to burst.
Dizziness
Inappropriate intake of nutrition and fluids, combined with purging, may cause someone with bulimia nervosa to feel dizzy or faint.
Other physical signs of bulimia nervosa include:
- bad breath because of vomiting
- vomiting blood
- digestive problems
- confusion, weakness or fatigue due to changes in electrolytes such as potassium or sodium
- thinning hair
- tooth decay
- potentially dangerous and sometimes fatal changes in heart rate
At SickKids
SickKids has an eating disorder program that treats children and teens who are struggling with symptoms of anorexia nervosa, bulimia nervosa and avoidant restrictive food intake disorder. For more information on our program visit: www.sickkids.ca/adolescentmedicine/eating-disorders-program
Further information
For more information on bulimia nervosa, please see the following pages:
Bulimia nervosa: Medical complications
Bulimia nervosa: Treatment options
Bulimia nervosa: How to help your child at home
Resources
NEDIC – National Eating Disorder Information Centre (Canada)
NEDA – National Eating Disorder Association (United States)
American Academy of Pediatrics – Eating Disorders in Children
BEAT – Beating Eating Disorders (United Kingdom)
Kelty Eating Disorders (Kelty Mental Health Resource Centre, BC Children's Hospital)
Children's Hospital of Eastern Ontario – Eating Disorders