Bulimia nervosa: Signs and symptoms

By SickKids staff

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Find out how to tell if your child might have bulimia nervosa.

Key points

A person with bulimia nervosa is often at an average or above average weight, but continued bingeing and purging puts them at medical risk.
Behavioural signs of bulimia nervosa include eating food faster than expected or when nobody else is around, disappearing immediately after a meal or becoming more irritable.
Physical signs include puffiness in the face, calloused knuckles and broken blood vessels in the eyes or face from repeated purging and dramatic changes in weight.

Introduction

Signs and symptoms

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

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Last updated: September 12th 2023