Inside Look

How Bulimia Affects Your Appearance: How Recovery Restores

bulimia recovery Jan 19, 2024

About Eating Disorders - Myth vs. Truth

One MYTH about eating disorders is that they are not serious but instead a lifestyle choice; or about vanity. That is wrong! The association between body dissatisfaction and eating disorders can sometimes lead people to mistakenly believe that eating disorders are prompted by appearance and represent a lifestyle decision to attain body ideals.

The TRUTH is, eating disorders, including, of course bulimia, are serious mental illnesses with the second highest mortality rate in the nation. Approximately 30 million Americans will suffer from an eating disorder in their lifetime. They are not a choice and develop by a combination of factors, which is unique to each individual suffering

  • Genetics
  • Family History
  • Culture
  • Trauma
  • Environment
  • Traits/ Temperament 


Overview of Bulimia Nervosa

Bulimia nervosa, often referred to as bulimia, is a severe and potentially life-threatening eating disorder. Individuals experiencing bulimia may engage in covert binge-eating episodes; consuming large amounts of food while losing control over their eating; followed by purging in an attempt to eliminate the excess calories through unhealthy means.

To combat calorie intake and prevent weight gain, those with bulimia may employ various methods, including regularly inducing vomiting, misusing laxatives, relying on weight-loss supplements, diuretics, or enemas after binge-eating episodes. Alternatively, individuals may resort to other strategies to eliminate calories and stave off weight gain, such as fasting, strict dieting, or engaging in excessive exercise.

For those struggling with bulimia, it's likely that your thoughts are consumed by concerns about your weight and body shape. Harsh self-judgment based on perceived flaws is common. As bulimia is closely tied to self-image, extending beyond mere dietary habits, overcoming it can be challenging. However, effective treatment holds the potential to improve your self-perception, promote healthier eating patterns and address serious complications.


Body Dissatisfaction

While bulimia is not rooted in vanity, we cannot overlook the body dissatisfaction phenomenon that plays a significant role and even the extreme of Body Dysmorphia Disorder (BDD) for some. According to the National Library of Medicine, a total of 6.5% of subjects in the study who suffered from BDD also had a comorbid lifetime struggle with bulimia.

The comorbidity between bulimia and BDD can vary in different studies. One study published in the International Journal of Eating Disorders found that about 27% of individuals with bulimia nervosa had comorbid, body-dysmorphic disorder.

Often body dissatisfaction is a mixture of how one views their physical body and how they feel in their body, compared to how they think that they should look and feel. To try to feel better, they try to look better. Can you relate? However, the overt behaviors of bulimia tend to make many look worse, creating even more distress. In addition, most people struggling with bulimia are average weight or above weightkeeping them locked into the persistent pursuit of weight loss.


Critical Mind

It is very common in our culture to look at our bodies and notice areas that we wish were different. Yet, if you are struggling or have struggled with an eating disorder, you know this behavior and tendency is magnified and literally can ruin your entire day. The critical mind takes off running with rumination and hateful thoughts about oneself. Here are just three traits that those struggling with bulimia and other eating disorder exhibit:

  • Perfectionistic
  • Obsessive
  • Critical

It is important to note that all of our traits can be liabilities or assets! It just depends on how we choose to use and employ them, while being aware and self-reflective.


How to Leverage Body Dissatisfaction and the Critical Mind in Recovery

The saying goes like this:Body image takes the longest to heal in eating disorder recovery.” Have you heard that before? This can be very defeating, yet I argue we can use body dissatisfaction and our critical mind to propel recovery! It was true for me in my recovery and for many I helped in my private coaching practice over the years. Especially with bulimia!


How my Focus on Appearance HELPED my Bulimia Recovery

There were specifically three outward consequences that accompanied my seven-year struggle with bulimia. Here is how I referred to them, along with the medical terminology.

This distressed me very much and worsened by obsession about how I looked. At the same time, it pushed me forward in recovery, because I didn’t want any of those! I was constantly scared that people would wonder what was wrong with me; or even worse figure out I was struggling in secret with bulimia. While in recovery, when urges to binge and purge would emerge, I would remind myself of these physical consequences of my behaviors. I would also think about what must be happening on the inside, too, that I cannot see. This helped me pause, surf the urge, and realize the price is too high to continue those behaviors. For me, I needed a greater fear than gaining weight to actually change.


How Appearance HELPED others in Bulimia Recovery

For this blog, I asked for input from a recovered friend and four of my private-practice clients, who are also now recovered from bulimia. Their ages when they struggled range from 15-40. They all were more than willing to participate in efforts to share the truth and encourage others to seek a path of recovery, plus keep fighting.


My question: In what negative ways did bulimia affect your appearance?


Here is what they said...raw and unedited!


“I felt haggard, it made my eyes lose their sparkle (blood shot). When I look at old photos, I look dull, sad and puffy.”

  •  One of her BEST attributes recovered: Her eyes! 


“My hair loss was terrible.”

  •  One of her BEST attributes recovered: Her hair!


“There were some subtle and some less subtle appearance changes. I experienced a lot of acne while I was actively in bulimia, which was always really frustrating. No matter how good my skin care routine was or how “clean” my beauty products were, I’d have acne. As an adult is was embarrassing, because I felt that my acne should have been better, but because of bulimia, it wasn’t getting better. I had facial swelling like the chipmunk cheeks, which would also really upset me. This was also hard, because it played into some of the negative body image thoughts I had, and coupled with the acne it was upsetting. I remember looking at videos for hours trying to do my makeup perfectly or contour or whatever to try and help it hahaha. I would have intermittent bloodshot eyes from purging, which was also frustrating. I didn’t want people to think that my eyes were bloodshot for any other reasons, but it was also a really hard thing to correct or cover up after I had been purging or was going through a particularly rough period of time. I would also experience bloating in my abdomen from purging or constipation or binging or whatever. This was a really hard thing, because it fed into at the time poor beliefs and at times really affected how I felt about myself and how I dressed. One of the longer lasting things has been some dental issues from years of purging. Luckily this has been better now that I’ve stopped and am not actively wearing down my enamel but definitely did affect how I felt about my smile for a while!”

  • One of her BEST attributes recovered: Her skin! 


“Bulimia affected my appearance in numerous ways.. For one, I think it most definitely affected my teeth.  Looking back on photos many whitening strips later, i can definitely tell a difference in my teeth. My face would almost feel puffy, and my skin was not in the best shape. I didn’t even realize it then that it was probably because of how i was treating my body. I have been fully recovered for quite a few years now, but it was one of the best things i could have done for my body, appearance, and overall health.”

  • One of her BEST attributes recovered: Her smile! 


“I think bulimia definitely Dulled my skin and hair. (Perks of weight gain is definitely a glow lol) My hands are no longer so red and dry and cold. Here's one you might understand too - I could never use fiber mascara like I can now because of the running with the least bit of moisture with fiber lashes lol.”  

  • One of her BEST attributes recovered: Her lashes!


Let’s Get a Little More Technical and Graphic...



    • In certain instances, individuals with bulimia or other conditions linked to purging behaviors may experience the rupture of blood vessels in the eye, known as subconjunctival hemorrhage, due to recurrent episodes of forceful vomiting. The act of purging leads to a sudden increase in eye pressure, resulting in the rupture of blood vessels and givES the white of the eye a vivid red appearance.
    • Self-induced vomiting may lead to periorbital petechiae, characterized by small red dots around the eye. Similar to the rupture of eye blood vessels, purging can also break the capillaries (tiny blood vessels) surrounding the eyes, creating a red speckled appearance.
    • Individuals with bulimia commonly report dry eyes. The use of self-induced vomiting, laxatives, diuretics, and fasting can contribute to dehydration, causing dry and irritated eyes. The dryness may worsen redness.



    • A common indicator of bulimia is the presence of sialadenosis, informally referred to as "chipmunk cheeks." This phenomenon occurs when the parotid gland, one of the three major salivary glands in the human body, undergoes enlargement.
    • Dry, chapped, and small ulcers on the lips or around the mouth are common in periods of extreme vomiting and can even look like cold sores.



    • A distinctive indication of bulimia is the presence of calloused knuckles, commonly known as Russell's sign. This manifestation arises from the repetitive action of inserting fingers into the mouth, leading to irritation and abrasions on the back of the hand.



  • An often-observed indication of bulimia involves the erosion of dental enamel, particularly evident in individuals who engage in self-induced vomiting. The lingual surface, the portion of the tooth facing the tongue, on the upper teeth, is the most prominent site for this noticeable erosion.
  • Of all eating disorders, bulimia has the most significant dental consequences. Individuals with bulimia commonly exhibit several dental issues, including: cavities, eroded tooth surfaces, dental pain, elevated levels of bacteria, dry mouth, enlarged glands, and swallowing problems. These symptoms highlight the impact of bulimia on overall oral health.



    • Hair loss - sharing similarities with anorexia, as individuals with bulimia may lack the essential nutrients necessary for hair growth. When the body faces nutritional deficiencies, resources are redirected away from supporting new hair growth. This type of hair loss is gradual, manifesting as a thinning over time, as the pace of new hair growth fails to keep up with hair loss.
    • Telogen effluvium - more dramatic and can be triggered by prolonged emotional or physical stress, a recognized consequence of bulimia. The telogen phase of hair growth, typically a resting phase, is prematurely reached in bulimia. During this phase, the hair follicle rests before shedding hair naturally. In normal growth cycles, this phase lasts about three months, with the active growth phase lasting several years before the rest phase. However, in bulimia, the telogen phase is expedited, leading to premature hair shedding. The result is a noticeable shedding of hair in visible clumps.



    • Bulimia nervosa can contribute to a pale and sallow complexion, primarily attributed to nutrient deficiencies arising from the frequent purging episodes. Additionally, the potential for dehydration, a common consequence of purging behaviors, can lead to dry skin. This combination of nutrient imbalances and inadequate hydration emphasizes the intricate relationship between bulimia nervosa and skin health.
    • In bulimia, individuals often binge and overeat on "forbidden" foods, like cookies, snack cakes, chips, and milk products. This high-fat, milk-rich diet may contribute to acne by clogging pores for some. Post-binge dieting and restricting worsens the issue by depriving cells of essential nutrients for repair.
    • Purging through vomiting exposes the skin to stomach acids, weakening the natural oil barrier. This creates pockets for bacteria entry, leading to the visible consequence of acne.
    • While bulimia may not always cause direct hormonal changes like anorexia, up to half of women with bulimia may experience irregular menstrual cycles, contributing to acne development.
    • Bulimia induces feelings of loss of control, distress, and shame. Efforts to conceal habits generate a chronic stress state, releasing stress hormones and toxins that can clog pores, adding to acne issues.



  • "Bulimia bloat," although not a medical term, is commonly used to describe the distended (swollen) belly often observed in individuals dealing with or recovering from bulimia nervosa (BN). This swelling, similar to general bloating, is typically attributed to an accumulation of excess gas in the digestive tract, stemming from various factors. Individuals struggling with bulimia may also receive a diagnosis of some form of irritable bowel syndrome (IBS), a catch-all term for gastrointestinal issues. In the context of BN, bloating can be not only physically uncomfortable but also poses a psychological risk, particularly for those in eating disorder recovery. The discomfort and the sight of a swollen stomach may evoke negative emotions related to body image, food, and eating.


I want to challenge the misconception that eating disorders, specifically bulimia, are mere lifestyle choices driven by vanity. It's crucial to recognize the gravity of these mental illnesses, understanding that they stem from a combination of factors, like genetics, family history, culture, trauma, environment, and temperament. Bulimia isn't a choice but a severe and potentially life-threatening disorder characterized by secretive binge-eating episodes followed by purging through unhealthy means to manage calorie intake.

While the roots of bulimia aren't in vanity, we can't overlook the role of body dissatisfaction, which can sometimes co-exist as body dysmorphic disorder. The critical mind, often perfectionistic, obsessive, and critical, is a significant player in the experience of those with bulimia. However, again, I argue we can use body dissatisfaction and our critical mind to propel recovery!

If you are in the midst of fighting bulimia, or those of us who have struggled and made it to the other side, I HOPE you know you are not alone! Recovery is possible!


With Love & Light,

Sarah Lee

Sarah Lee is a Certified Eating Disorder Recovery Coach with four professional certifications, including one from the esteemed Carolyn Costin Institute. Since 2016, she has run a private practice currently located in Dallas, TX, assisting clients globally along with mentoring newer recovery coaches.

Posted on January 19th, 2024. 

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Acute: Center For Eating Disorders and MalnutritionEating Disorders.comBulimia.comNature.com - BDJ TeamCureusNational Library of MedicineWebMD