These are six common signs of bulimia:
- Evidence of bingeing
- Evidence of purging
- Injuries from vomiting
- Schedule changes
- New topics of conversation
- Social isolation
Let’s explain what all of these warning signs look like. And we’ll discuss one sign people often look for that isn’t common in people with bulimia.
1. Binge Evidence
Bulimia involves binge sessions in which large amounts of food are consumed. During these uncontrollable episodes of food consumption, people often eat very quickly to the point where they are very uncomfortable.
People with bulimia can eat between 5,000 and 15,000 calories in one sitting. (1) These bingeing episodes rarely happen at the family dinner table.
Most people with bulimia feel disgusted by the urge to overeat, and they attempt to hide their habits. But it’s tough to keep this type of eating a secret.
You might notice the following:
- Food stashed in unusual places, like laundry hampers or in desk drawers
- Snack wrappers packed tight in the garbage can
- Late-night dishwashing episodes as the person tries to clean up
- Missing leftovers and communal food
2. Purge Evidence
People with bulimia are afraid of gaining weight. They know bingeing can lead to added calories and weight gain, so they use purging methods to remove the foods they’ve eaten.
Most people with bulimia use one of these three methods to purge:
- Self-induced vomiting
- Laxative abuse
- Diuretic abuse (2)
Less than 10% of women use multiple methods. Most find one purging technique and stick with it. (3)
Someone who uses vomiting will head to the restroom soon after eating a meal. You may notice the smell of vomit on their breath when they return, or they may frequently chew gum in an effort to hide the smell. You may hear wrenching sounds while they are in the bathroom, or you may hear the toilet flush multiple times.
Less than 10% of women use multiple methods of purging.
Someone who uses laxatives or diuretics may have plenty of packages to throw away after a purge, and you may see store receipts for these products around your home. They may occupy the bathroom for long periods of time frequently when they feel the effects of these medications.
3. Injuries From Vomiting
Purging is a compulsive behavior in people with bulimia, and they’ll keep using this method even when injured. Repeated vomiting is incredibly hard on the body and leads to several visible symptoms.
You might notice one of these signs:
- Hand injuries: Self-induced vomiting means sticking fingers deep inside the throat. People who do this regularly develop abrasions on the back of their dominant hand, which can become scar tissue in time. This may look like scratches, scabs, or scars on the back of their hands.
- Eye changes: Vomiting puts pressure on the eyes, leading to tiny breaks in blood vessels. The person’s eyes may regularly look pink or red. They may blame the redness on lack of sleep.
- Dental disease: Repeated exposure to stomach acid can erode teeth. The person may have multiple cavities, or you may notice persistent bad breath. They may pop mints or gum repeatedly in an effort to cover bad breath.
- Voice alterations: Acid can harm the vocal cords and lead to a hoarse or raspy tone. Since the vomiting is continual, the vocal cords don’t have a chance to heal and the hoarseness persists. (3)
4. Unusual Schedule Changes
Bingeing and purging episodes are time-consuming. While people with bulimia tend to eat very quickly and hope to purge just as fast, they need time to complete the process.
Since it’s a compulsive behavior, they may think about bingeing and purging all the time. They may skip out on commitments, even missing classes or work shifts, to engage in these episodes. And hiding the evidence of their bingeing and purging can take a lot of effort and energy.
Some people develop rituals to support their bulimia. They may head to private areas (like bedrooms or the study) early in the evening and spend a few hours eating and purging. They may decline social obligations to keep this appointment, and as the time draws near, they may seem almost excited.
5. New Topics of Conversation
While people with bulimia rarely lose weight due to their habits, they may think about weight loss, body image, and fat content all the time. They may also tie their self-worth to how they look or how much they weigh.
You might notice the following:
- Requests for validation: They may obsess about their appearance, often asking questions like “Does this make me look fat?”
- Meal content questions: They may be unreasonably interested in the ingredients used in meals or snacks. “Does this have whole milk? How many calories are in this salad dressing?”
- Body image comments about others: Body size might be their favorite topic of conversation, often equating larger body sizes with negative associations. “I think she’s fatter than when I saw her last year, and it’s gross.”
- Harmful self-talk: People with bulimia often have a very negative view of themselves, and they often talk about themselves harmfully. They may believe their weight is an obstacle to meaningful relationships and other life goals. “I’m as huge as a whale. No one will ever love me.”
6. Social Isolation
People with eating disorders often feel shame and embarrassment about their behaviors. It’s common for an episode of bingeing and purging to be followed by feelings of guilt, and this often triggers a desire to self-isolate. (4)
In an effort to hide their bingeing and purging, people with bulimia often withdraw from the supportive people in their lives, such as family members and friends. This leads to increased low self-esteem and loneliness.
As they isolate themselves from loved ones, this separation reinforces their feelings of low self-worth. They feel unlovable since they don’t have close relationships and are often alone.
What Not to Look For: Weight Changes
Purging is a remarkably inefficient way to avoid weight gain. Plenty of calories enter your body through your mouth as you chew, and others are absorbed by your body before laxatives remove them. While people with bulimia often want to be thin, they rarely are.
Similarly, many people with bulimia binge and purge infrequently. They may not gain a massive amount of weight despite their eating patterns. Outsiders think they look normal, so they never suspect that anything is amiss.
Someone you love could be bingeing and purging even if you don’t notice any weight issues.
Bingeing and purging are the two hallmark symptoms of bulimia, not weight changes. Someone you love could be suffering from harmful binge and purge behaviors even if you don’t see any weight issues at all. (5)
The lack of weight loss may drive the person further into their harmful behaviors, causing them to take additional measures to purge the calories they consume in a binge. Some people with bulimia who vomit to purge may begin using laxatives or diuretics in addition to vomiting.
What to Do Next to Help Your Loved One
You believe that someone you love has bulimia. What’s your next step?
First, start an open and honest conversation. Explain the signs you’ve seen, and express how concerned you are.
Be as kind and gentle as you can during this talk. It’s very scary to have an eating disorder, and the person will need your help to get better. Remind the person you’re here to help and that you’ll find the right treatment program together.
Professional assistance is available to help your loved one. Bulimia and other eating disorders often co-occur with other mental health issues, such as anxiety or depression.
A comprehensive treatment program will address all co-occurring conditions, ensuring the person has a solid foundation in recovery. The eating disorder can’t be effectively managed if other mental health issues are left untreated.
- Binge Eating. (March 2022). U.S. Department of Health and Human Services.
- The Medical Complications Associated With Purging. (March 2016). International Journal of Eating Disorders.
- A Risk and Maintenance Model for Bulimia Nervosa: From Impulsive Action to Compulsive Behavior. (July 2016). Psychological Review.
- The Role of Perceived Loneliness and Isolation in the Relapse from Recovery in Patients With Anorexia and Bulimia Nervosa. (June 2004). Clinical Social Work Journal.
- Bulimia Nervosa: A Primary Care Review. (2003). The Primary Care Companion to the Journal of Clinical Psychiatry.