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What are the symptoms of bulimia nervosa?

At Priory, we understand that bulimia nervosa is a debilitating condition that can have a devastating impact on health, wellbeing, quality of life, and can be extremely difficult to cope with. In addition, those with bulimia often engage in secretive behaviours in order to conceal their unhealthy eating habits, which means that expert help and treatment for bulimia is often not sought in a timely manner.

The signs and symptoms of bulimia can vary from person to person, and can be categorised into psychological, physical and behavioural/social symptoms.

Psychological symptoms of bulimia:

  • Having an overwhelming urge to binge eat. This may or may not be followed by purging behaviour. A period of starvation or a restricted amount of eating may follow an episode of overeating/bingeing
  • Binges are often characterised by eating an excessive amount of food in a short span of time. The binge may only come to an end after you have run out of food or you cannot physically put more food in your body
  • Having an obsession with food, calories and controlling your diet
  • An overwhelming feeling of guilt, shame and self-disgust after binge eating, which then adds to the desire to purge
  • Having an obsession with looking a certain way and striving for a certain body shape. This is more so in anorexia nervosa but individuals with bulimia nervosa may also experience these thoughts
  • Having an excessively distorted, negative body image – this could also be a sign that you are struggling with body dysmorphic disorder (BDD)
  • Fear or embarrassment about eating sugary or fatty foods in front of other people
  • Spending a lot of time thinking about food, and feeling as though this has taken over your life
  • Depression
  • Anxiety
  • Stress
  • Self-harm
  • Panic attacks
  • Anxiety attacks
  • Frustration
  • Mood swings
  • Anger, irritability and impatience – finding that you get angry for no reason and taking this out on those who are closest to you
  • Low self-esteem and a reduction in confidence
  • Exacerbation of any existing mental health problems such as anxiety, depression or obsessive compulsive disorder (OCD)

Physical symptoms of bulimia:

  • Problems with vital internal organs due to lack of essential minerals, vitamins and other nutrients
  • Ruptured stomach or food pipe, which can result in sudden death
  • Bowel problems and abnormal bowel functioning, as a result of laxative abuse
  • Gastric reflux
  • Kidney damage due to recurrent vomiting
  • A painful throat and damaged vocal chords, causing a ‘raspy’, ‘scratchy’ voice
  • Tooth decay, bad breath and scars on the knuckles as a result of induced vomiting
  • Persistent sores and ulcers in the mouth
  • Swollen salivary glands
  • Fainting
  • Choking
  • Dehydration due to vomiting or avoidance of drinking water
  • Headaches
  • Dry skin
  • Heart palpitations
  • Muscle aches and cramps
  • Bloating
  • Chest pain
  • Seizures
  • Irregular periods in women, or a loss of periods
  • Sleep disturbances, including insomnia
  • Tiredness and fatigue

This page was clinically reviewed by Dr Murali Sekar (MBBS, MRCPsych) in October 2022.

Behavioural/social symptoms of bulimia
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What are the long-term effects of bulimia nervosa?
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Self-help tips for dealing with the early signs of bulimia
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