Bulimia Symptoms And Characteristics To Be Concerned About
By: Patricia Oelze
Updated May 14, 2020
Medically Reviewed By: Kristen Hardin
Television and movies often depict eating disorders, such as bulimia, in sensationalized ways. It can become challenging to know the exact symptoms of bulimia. Specifically, what should you watch for and when should you become concerned about yourself or a loved one? Learn more about the diagnosis of bulimia nervosa, its accompanying characteristics, the health risks of bulimia, and when to seek help.
Diagnostic Criteria for Bulimia Nervosa
You may be most familiar with the term bulimia, but the official name for this condition is bulimia nervosa. When mental health care professionals and physicians diagnose eating disorders (and other conditions), they do so with the Diagnostic and Statistical Manual-Fifth Edition (DSM-5). With that guide, they use the following criteria to define bulimia nervosa symptoms:
- Recurrent episodes of binge eating
- Recurrent inappropriate compensatory behavior to prevent weight gain (vomiting, use of laxatives, etc.)
- The binge eating and compensatory behaviors both occur, on average, at least once per week for at least three months
- Body shape and weight is hyper-focused on in an unrealistic manner which determines how often the person engages in these behaviors and to what severity
As noted, these are the very specific criteria that health care professionals use to define and assign the official diagnosis of bulimia nervosa. To be clear, if you read through this list and think that some but not all these matches for you or your loved one, it does not mean there is no reason to get help. It is not uncommon at all for a person to have some symptoms of an eating disorder but not meet the full criteria.
If you or someone you know are showing any of these symptoms, it is still concerning, and help should be sought before the symptoms worsen. In fact, it is better to get help earlier while symptoms are likely to be more manageable.
Typical Signs and Symptoms of Bulimia
The essential symptom of bulimia is binge eating. According to the DSM-5 criteria, a binge is defined as eating a large and excessive amount of food in a short period (two hours or less). Frequently, binges are accompanied by feeling a loss of control over how much food is consumed. People with bulimia often feel unable to stop themselves from eating more and more, even if they feel quite full. It should be noted, that binging behavior typically distinguishes bulimia nervosa from anorexia nervosa as binging is absent from the diagnostic criteria for anorexia.
The symptom that distinguishes bulimia from binge eating disorder is that those with bulimia also engage in purging behaviors while those with binge eating disorder do not. A purge behavior is intended to eliminate or get rid of the food or calories consumed. Most often people purge through vomiting. However, some people will use laxatives and diuretics to clear the food from their system. Other people will fast ahead of the binge or after the binge. Some will use excessive amounts of exercise to eliminate consumed calories.
Characteristics Associated with Bulimia
Aside from the key symptoms of binging and purging, bulimia nervosa is characterized by other features. Many people with bulimia have had some history of trauma or problems in their family. Often, in the face of such challenges, people struggle to cope. Binging and purging behaviors may develop and be used as a way to try and cope with feelings. However, this tends to be maladaptive, in that although it makes people feel better in the short-term, people often feel much worse in the long-term.
Beyond turning to food for comfort, individuals with bulimia often have a complex relationship with food. Sometimes they grew up in homes where parents made negative comments about their appearance or how much they were eating. Sometimes they grew up in homes where parents made most of the decisions related to food and they never learned to regulate their food intake. Sometimes they grew up in homes where food intake was the only thing they could control. Sometimes they grew up in homes with limited access to food and so feel driven to eat, due to fears of scarcity.
Another sign of bulimia is difficulty concentrating because one's thoughts are preoccupied with food. Sometimes people with bulimia will spend hours thinking about food or foods they want to eat. They may plan out a binge and look forward to it. After a binge, they may feel overwhelmed with feelings of guilt and regret. They may fill their mind with thoughts of the purge and turn to it to feel better.
Most people with bulimia also struggle greatly with perfectionism and low self-esteem. Often, they have had a history of feeling badly about themselves. This may include negative views about their abilities and general self-worth. They may engage in negative self-talk and self-deprecating criticism. In many cases, people with Bulimia also have a sense of shame about how they look. They may be very fearful of gaining weight. This shame leads to guilt when they binge and often contributes to their urge to purge.
People with bulimia may also show other mental health concerns. They may have symptoms of Anxiety and depression. They may have a difficult time managing their emotions. They may also be working hard to hide their symptoms and struggles from the people around them. As such, they may display unusual behaviors such as appearing secretive or becoming angry when asked about their eating.
Warning Signs of Bulimia Nervosa
If you have visited this website because you are concerned about someone else, you may not know all the behaviors they are engaging in. As noted, people struggling with symptoms of bulimia will often engage in behaviors that may seem odd but are usually a part of the disorder and their attempts to hide it. Keeping watch for these warning signs can help you know if someone may have bulimia:
- Secretive eating habits, such as hiding eating, and eating at late at night
- Withdrawing from friends and family after meals
- Spending excessive amounts of time, such as hours a day, exercising
- Injuries and scars on knuckles or hands (a sign of using fingers to induce vomiting)
If someone is showing these warning signs, it does not mean that they have bulimia. In fact, people may engage in some of these behaviors for any number of reasons. However, if you suspect they are engaging in binging and purging behaviors, it can be valuable to approach them with your concerns and help connect them to help. Left untreated, bulimia can lead to physical and health consequences.
Health and Medical Risks of Bulimia
People with Bulimia frequently appear as an average weight, which can give them a false sense of their health. Often, people with bulimia are not aware of the toll it can take on their body. The binge and purge behaviors characteristic of bulimia can lead to significant health consequences. For example, often dentists can tell a person is engaging in purging behaviors through vomiting because it wears down their teeth enamel and leads to other dental problems. Other health symptoms include:
- Sore and irritated throat (from vomiting and dehydration)
- Swollen parotid glands (these are the saliva glands, irritated by vomiting)
- Esophagitis (esophagus inflammation, associated with acid reflux and chest pain)
- Hypertension (low blood pressure, usually due to vomiting/laxative use and dehydration)
- Electrolyte imbalance (due to poor nutrition as well as vomiting and laxative use)
- Edema/Bloating (often the result of dehydration and resulting water retention)
- Muscle cramps and weakness (usually due to electrolyte imbalance)
Having one or more of these symptoms can be concerning. You may notice the muscle cramps and bloating yourself, but you may not be aware of the problems that can be happening internally. Nonetheless, if you are struggling with symptoms of bulimia, it is important to seek help before you develop these more severe physical symptoms and complications.
Key Take-Aways and Recommendations
If you searched and found this article, chances are you were already concerned about yourself or someone else. If you have read this far, you may be even more concerned. If you have observed signs of bulimia in yourself or someone else, then you need to seek help.
Bulimia nervosa is a complex disorder with symptoms that can be dangerous to your physical health and well-being. It is also associated with many characteristics that promote and maintain it. When you have symptoms of bulimia, it is unlikely you can stop the behaviors on your own. This is especially true because all sorts of thoughts and feelings underlie those symptoms and they cannot be ignored.
For the best potential success in recovering from bulimia, you should seek out therapy services. A therapist, especially one that has experience working with eating disorders, can help you learn new ways of interacting with food, new coping skills to replace unhealthy ones, and new, healthier ways of evaluating yourself. Often, they will integrate various techniques to provide you with individualized care. That therapy may also address concerns related to self-esteem, anxiety, and depression.
Given the health risks, you may also need a physical evaluation and medical care. People with bulimia also often benefit from working with a dietician or nutritionist to develop healthier eating patterns. If they have been using excessive exercise, they might benefit from working with a physical trainer, who can help them create and use an exercise regimen, that will be reasonable, to promote health.
A final note, people often think of eating disorders, such as bulimia, as being a problem only women have. While bulimia nervosa symptoms are more often seen in women, men can also experience these symptoms and characteristics. Often men are also feeling pressures to look a certain way and may have a difficult relationship with food. If you are a man with these symptoms, you are not alone-seek help.
BetterHelp is an online counseling platform that offers counseling services for mental health disorders including eating disorders. If you have questions about yourself or someone you are worried about, you can reach out to one of the trained counselors on BetterHelp. You may also find that getting in person treatment is important for proper evaluation and diagnosis in the beginning as this disorder is something that a person can absolutely recover from, but is complex and may require specialized care.
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