|Bulimia Resource Guide Summary|
|Bulimia Nervosa Resource Guide for Family and Friends|
|Maximizing Health Insurance Benefits to Pay for Bulimia Treatment|
|Mental Health Laws Affecting Bulimia Treatment|
|Find a Bulimia Treatment Center|
|Checklists and Tip Charts|
|Bulimia Nervosa Resources for Schools and Coaches|
|Selected Reference List|
|Bulimia Nervosa: Efficacy of Available Treatments|
|ABOUT THIS RESOURCE|
|Who Produced and Funded this Content|
|FOR THE MEDIA|
"I felt shame and guilt, but I was fortunate that I lived alone at the time. If I was with people, I did everything I could to make it look like going to the bathroom was normal."
Signs and symptoms are a blend of mental, behavioral, and physical signs and symptoms. Some may be obvious only to a medical professional; others may be more easily noticed by friends and family. See the checklist for the most common signs and symptoms. Other less common symptoms may be present as well.
Binge eating and purging may seem like obvious signs that are hard to miss. But, these behaviors can be, and often are, well masked by a person with bulimia nervosa. People with bulimia nervosa may hide the behavior because they feel shame and guilt about it. The disorder may progress for some time before anyone else notices because the weight or outward physical appearance of people with bulimia nervosa may not change in the same way that appearance changes with an eating disorder like anorexia nervosa. Even an individual with a severe case of bulimia nervosa can appear to be of normal weight, or even be overweight. That is why weight is not used as a criterion in the DSM-IV for diagnosing bulimia nervosa.
Signs a healthcare professional may be most likely to noticeCertain healthcare professionals are in a position to observe the first clinical signs of the disorder. Dentists, in particular, may be the first to see signs because tooth, gum, and mouth problems are a common result of frequent purging by vomiting. Stomach acid, vitamin deficiency, and trauma from vomiting can decalcify teeth, erode enamel, cause cavities, and dry out and crack the skin of lips. Dentists may also notice swollen salivary glands in the mouth, a common side effect of frequent vomiting.
Other signs that a dentist or medical doctor may notice include "Russell's sign," named after the researcher who first identified bulimia nervosa. This is a sign in which the backs of the person's finger joints are particularly callused or discolored from using fingers to gag and induce vomiting. Nonprofessionals may notice this, but be unaware that it is a sign of bulimia nervosa. If the disorder is suspected, examination by a doctor using an endoscope to see into the lowest part of the esophagus may reveal slit-like tears from vomiting. Blood tests may also reveal electrolyte imbalances. More specific chemical imbalances that suggest bulimia nervosa are also listed.
Signs and symptoms that family and friends may be most likely to noticePeople with bulimia nervosa may behave strangely around food. They might skip meals, rapidly change food likes and dislikes, avoid social outings that involve consuming food in front of others, or make excuses not to eat. People with bulimia nervosa may drink lots of water and diet soda or cut food into small bites and chew each bite excessively. Doing these things allegedly makes vomiting easier. They may also be excessively impulsive, depressed, or socially isolate themselves by choice from peers, friends, and family.
Purging behavior often is not obvious because the affected person may strive to hide it. Even roommates or spouses of people with bulimia nervosa can be totally unaware of purging behaviors for years because the affected person is extremely effective at hiding the behavior. For example, a person with bulimia nervosa may run water while in the bathroom to obscure the sound of vomiting. An affected person may use mouthwash, gum, and mints frequently, or excuse herself or himself from meals.
The non-purging behavior of excessive exercise can be noticed by friends and family, but if the individual is a bulimic athlete, it is very difficult to draw the line between training and excess exercise. Fasting may be less obvious if the person makes reasonable excuses for not eating in certain situations.
Signs and Symptoms Health Professionals May Observe
Signs and Symptoms that Family and Friends May Observe