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How can I tell if someone has bulimia nervosa?
"I was brushing my teeth, chewing gum, or sucking mints all the time saying 'I had eaten onions or garlic' or 'had a bad taste in my mouth'." Reasons given to friends and family behaviors to cover up noticeable after-effects of vomiting.

The signs and symptoms blend mental, behavioral, and physical signs and symptoms. Some are obvious only to a medical professional; others are noticed more by friends and family members. Here is a list of the more common signs and symptoms—there are others as well. Because purging behavior is usually concealed, it is not listed here as a sign that others would notice.

Signs a Dentist or Doctor May Notice

  • Sore, bleeding gums and mouth
  • Tooth enamel erosion from vomiting
  • Dry, red, cracked lips, especially at the corners
  • Swollen cheeks and jaws
  • Swollen saliva glands
  • Callused or discolored skin at finger joints from forced vomiting
  • Metabolic acidosis or alkalosis
  • High cholesterol

Signs Family and Friends May Notice

  • Appears uncomfortable eating around others
  • Buys large amounts of food that disappear
  • Can't explain missing food
  • Skips meals
  • Takes small portions of food at regular meals
  • Always excuses self from table before others are finished
  • Has odd food habits (e.g., different foods not touching on a plate)
  • Chews each bite of food excessively
  • Eats only a particular food or food group (e.g., condiments)
  • Drinks excessive amounts of liquids
  • Isolates self from interactions with family and friends
  • Uses excessive amounts of mouthwash, mints, and gum
  • Hides body with larger clothes
  • Excessive exercise regimens

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Bulimia nervosa is an eating disorder in which a person engages in binge eating (eating a lot of food in a short time) followed by some type of behavior to prevent weight gain from the food that was eaten. This behavior can take two forms: self-induced vomiting, misuse of enemas, laxatives, diet pills (called purging) and excessive exercise, fasting, or diabetic omission of insulin (called non-purging). Some people with bulimia nervosa may also starve themselves for periods of time before binge eating again. Bulimia nervosa has important mental, emotional, and physical aspects that require consideration during treatment.

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