Inside Look

Get Help in 2024: Know the Bulimia Warning Signs

Apr 01, 2024
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 Bulimia nervosa, a multifaceted eating disorder, silently plagues millions worldwide, transcending gender and age boundaries. Rooted in biological, psychological, and social factors, its manifestations often evade detection, concealed by shame and denial. Recognizing the warning signs of bulimia is crucial, not only to mitigate health risks but also to facilitate timely intervention by mental health professionals who can help create treatment plans. 


Bulimia has several interconnected causative factors including biological, psychological, and social influences which cause the disorder to show up in many ways among individuals. Many of the warning signs of bulimia are easily ignored by others and explained away by the individual with the disorder, due to intense fear and shame. Knowing the warning signs of bulimia can help you identify if you or someone you love is suffering.


Knowing the warning signs of bulimia and seeking professional treatment as early as possible is the best way to reach full recovery. By fostering open dialogue and compassion, we aim to destigmatize bulimia and encourage early intervention, offering a safe space and a path to recovery. 


Common Warning Signs of Bulimia

Here are some common signs and symptoms of bulimia and how they might appear in someone’s life.


  • Signs of Bingeing
  • Signs of Purging
  • Signs of Restriction
  • Overall Health Changes
  • Changes in Eating & Bathroom Habits
  • Obsessive Focus on Body & Food 
  • Social Isolation



Bingeing is defined as eating a large quantity of food in a very short time. Individuals may describe the episode as saying they have no control over what or how much they eat. They may consume up to 15,000 calories in less than two hours.

These secret binges may occur more than a dozen times per week for months or even years. However, everyone is different and binge episodes can also look different. Binges do not occur in front of others, which is why social isolation can be a red flag.

Along with the physical discomfort of eating a large amount of food, the individual suffers from the mental anguish of shame, guilt, fear, and body dissatisfaction.


Family and friends may see the warning signs of bingeing in certain ways such as:


Finding food wrappers hidden inside small bags, furniture, or under bed linen.

Late night or very early morning dishwashing 

Missing leftovers, snack foods, or desserts

Insisting on taking out their own trash



People struggling with bulimia are aware of the large quantities of food they have consumed after a binge. They are also incredibly focused on how that food will change their weight and body and often have body image issues. They will use purging behaviors as a compensatory mechanism in order to rid their body of food and calories.

Purging can include self-induced vomiting, laxative abuse, and diuretics. Generally, individuals with bulimia will stick with one form of purging over the others. Excessive exercise with the intent to compensate for food eaten is also considered a form of purging. 

Others may see the warning signs of purging as purchases of medications designed to cause vomiting, bowel movements, and increased urination. The boxes and receipts may be found in hidden areas. Individuals will immediately head to the restroom after eating meals. You may hear sounds of vomiting or notice an increased amount of time in the bathroom. 


Specific signs of vomiting may include:

Chipmunk cheeks occur from swollen salivary glands

Hand injuries appearing as scrapes on the knuckles, also known as "Russell's sign" 

Bad breath, increased dental cavities, discolored teeth, tooth enamel damage

Bloodshot or pink eyes

Raspy voice


Some individuals begin to incorporate multiple workouts, particularly after days of binge eating or social events. The extreme exercise may last for days or months as the illness fluctuates. Unfortunately, many of us do not consider this disordered as society often utilizes exercise as a form of punishment for eating.



Bulimia is a cyclical disorder that includes bingeing, purging, and restriction. As a result of the feelings of guilt, shame, and fear of gaining weight the individual turns to restriction as a means of trying to control their behavior. Limiting food and continued extreme exercise are utilized.

 Others may see the restriction of overall meals and snacks as a “new diet” or extreme discipline. The individual may limit entire food groups, try vegan or vegetarianism, or implement new food challenges like intermittent fasting or detoxing. You may begin to hear the person speak poorly of their body, weight, and self-worth.

Restriction, like all bulimia symptoms, may look different for everyone. It is important to begin the treatment process as quickly as possible. This website provides a terrific treatment directory with location and insurance-specific providers: https://findedhelp.com/ You can also filter by the type of provider you are looking for. 


Overall decrease in health status


Individuals may notice a steady decline in overall health. They may also experience ups and downs in their weight, but not experience large swings either way. 

Common complaints may include: 

  • Stomach pain
  • Bloating
  • Constipation
  • Irregular periods
  • Fainting
  • Dehydration
  • Headaches
  • Brittle hair
  • Dry skin 
  • Acne
  • Heart palpitations
  • Increase in sports injuries including stress fractures & prolonged healing times
  • Exhaustion
  • Poor sleeping habits
  • Lack of concentration


Eating and bathroom habits

Individuals with bulimia will have unique eating and bathroom habits. They tend to eat quickly and attempt to purge quickly as well. Family and friends may observe very strict limited eating, evidence of binges, and evidence of purging.

You may see different extreme diets come and go. They may be uncomfortable with spontaneous restaurant outings with friends. Those with bulimia may need to scout the location of public bathrooms upon arrival.

They will dismiss themselves from meals quickly and stress their need for privacy when using the bathroom. Their bathroom may smell of vomit and the toilet may show evidence of vomiting or it may be kept incredibly clean to avoid suspicion.  


 Extreme focus on body and food

People struggling with bulimia have a negative relationship with food and their body. They may talk excessively about calories and fat content in foods. Conversations tend to revolve around food. Their social media may also be food and body-focused.

They may engage in consistent negative self-talk related to their appearance. Their conversations about food and bodies tend to be black and white. "Black and white thinking" is a thinking pattern where one thinks in absolutes or extremes.

It is a cognitive distortion common in those struggling with eating disorders. For example, food is either good or bad, there is no in-between. They may believe that all problems in their life are directly related to their “ugly” body. 


Social isolation

Living with bulimia is painful. People with bulimia experience extreme guilt and shame for their bingeing and purging behaviors. They struggle with low self-worth and may believe they don’t deserve food or love because they falsely believe they are at fault for their illness.

They are often too embarrassed to reveal their secret and therefore retreat to isolation. Someone who was once socially engaged may remain in their room. Athletes may quit the sport they love.

In an effort to hide their behaviors, they may unknowingly self-sabotage relationships. Physical pain from hunger, binges, and long-term purging behaviors leave many feeling too exhausted to join family and friends. The mental anguish of persistent negative self-talk perpetuates the idea that their body “isn’t good enough” to enjoy time with others.

At a time when humans need social connection the most, the eating disorder often pushes others away.


Now that I know the bulimia warning signs, what are the next steps?

 If you recognize the behaviors and symptoms discussed above in you or someone you love, please know that bulimia is never the fault of the person struggling. Each of us has unique genetics that may be vulnerable to psychological, social, or cultural influences. We all have unique birth stories and childhood development that may have included serious injuries, illnesses, or trauma that can affect our brain, gut microbiome, immune system, and overall mental health.

Eating disorder researchers and clinicians continue to learn more about the causes of bulimia every day. Once you know the warning signs of bulimia, you can start a conversation with the person you love or with a professional healthcare provider. Only a professional can diagnose an eating disorder.

They can provide a holistic assessment and build a team of dedicated eating disorder specialists customized to meet your physical, mental, and emotional needs. There are a variety of online resources such as our digital course, Conquering Bulimia, blogs that offer information, support groups, and even virtual treatment programs. Nutritional counseling and medical intervention play pivotal roles in addressing both the physical health ramifications and underlying medical conditions associated with bulimia.

By addressing the nutritional and medical aspects in tandem, individuals can embark on a holistic journey toward healing and wellness. Long-term recovery from bulimia is not a solitary pursuit but a collaborative effort encompassing mental health professionals, support networks, and the individual themselves. Through ongoing support and commitment, individuals can transcend the grips of bulimia and reclaim their lives with resilience and determination.

With proper treatment best suited to your individual needs, you have the power to achieve full recovery. Check out the Conquering Bulimia digital course here.


Disclaimer: Please note that while these are common signs of bulimia, we may not have listed all of them. Please consult with your medical provider for accurate physical signs and the most effective treatment for you. 


Author: Merrit Elizabeth

Merrit Elizabeth is an Eating Disorder Recovery Coach certified by The Carolyn Costin Institute. She holds a master’s degree in Health Promotion Management and has years of experience working with women with eating disorders.

Posted on April 1, 2024