If you have come to this page looking for signs of bulimia nervosa, you probably know about this eating disorder already or suspect that you suffer from it. But if you’ve stumbled on this quite accidentally then bulimia is an eating disorder characterized by binge eating followed by compensatory behaviors like purging, use of laxative, starving, etc to avoid weight gain. Coming into the limelight as the eating disorder Princess Diana had, bulimia nervosa is quite prevalent among both men and women.
Most of the time, bulimia is mistaken for its close cousin anorexia nervosa. In both the cases, the patients are trying to keep their weight below a self-imposed threshold which is almost always less than their normal weight. But unlike in anorexia, where the patient restricts food intake severely, bulimia nervosa has the patient exercising no control on eating for a specific period of time followed by compensatory behaviors. Moreover, in contrast to patients with anorexia, patients with bulimia tend to be heavier and more sexually active, and they menstruate more regularly and are fertile.1
As we have already mentioned, bulimia nervosa is an eating disorder and most cases have their roots in body image issues. For the same reason, it is more prevalent among women than men. That is not to say men don’t suffer from body image issues or eating disorders but statistics show that women suffer from them more. In fact, the prevalence is double among women. In the US, 20 million women and 10 million men are estimated to suffer from one eating disorder or the other in their lifetime.2
Coming to bulimia, however, 1.5 percent of American women suffer from it in their lifetime.3 The figure may seem insignificant but the real threat is in the comorbidities like anxiety, mood disorders, and substance abuse disorders that seem to accompany the condition.
All these make it significant that bulimia is detected on time and treated without much delay. Let’s look at what some of the classic symptoms of bulimia nervosa look like.
Symptoms Of Bulimia Nervosa
1. Binge Eating And Compensatory Behaviors
One telltale symptom of bulimia is repeated episodes of binge eating or eating large quantities of food in a short span of time which is followed by attempts to compensate for the bingeing either through vomiting, use of laxatives or diuretics, starving or exercising. Detecting this symptom, however, is not as simple as it may sound. Because bulimics are often discreet in their behavior and look and behave normally.4 They have normal body weight unlike anorexic people and seem capable, positive and on top of things. But in reality, they are suffering inside–from shame, guilt, and body negative images of themselves.
2. Dental Problems
The constant binge eating and purging, which is the mainstay of bulimia, results in a very distinct oral profile of the patients that is characterized by one or more dental problems like enamel erosion, dental caries, dental pain, orthodontic abnormalities, xerostomia, reduced saliva secretion, parotid enlargement and dysphagia, among others.5 Dental erosion–the loss of dental tissues without the working of bacteria–is found in bulimia cases because most bulimics are frequent vomiters.
This also makes dentists and dental hygienists the primary detectors of any eating disorders in their patients. A good degree of understanding of eating disorders among dentists and dental hygienists are essential to detect the disease at the initial stage itself. Unfortunately, a study has found that only 16 percent of dentists and 28 percent of dental hygienists have a good knowledge of oral cues of eating disorders.6
3. Dehydration And Electrolyte Imbalance
Dehydration is a given in the case of frequent vomiting or laxative abuse. In many cases, it is also found to cause electrolyte imbalance in the body. In a study conducted on 168 bulimia patients, 82 of them or 48 percent were found to have one or the other electrolyte abnormality in their body. The most common abnormalities were metabolic alkalosis (27·4 percent), hypochloremia (23·8 percent) and hypokalemia (13·7 percent).7 Electrolytes are essential minerals that play a vital role in maintaining a lot of actions in the body like blood chemistry, muscle action, etc. Electrolyte imbalances like hypokalemia can be life threatening because of the loss of potassium in the body from dehydration. Cardiac arrhythmia is one of the leading causes of death in patients with eating disorders and electrolyte imbalance is a surefire route to get there.8
4. Mood Disorders, Depression, And Anxiety
Eating disorders, which find a place in the American Diagnostic and Statistical Manual or DSM, are primarily psychiatric disorders that display many other psychiatric problems like depression, OCD, and anxiety as comorbidities.9 Certain study results, however, have shown that anxiety disorders in childhood could make certain people more vulnerable to eating disorders.10 In people with eating disorders, anxiety is often about weight gain because they have an unrealistic idea of what an ideal weight should be. Apart from this, chronic mood swings are also noticed among most people with eating disorders.11
5. Gastrointestinal Issues
In the case of an eating disorder, the stomach is often at the receiving end. In bulimia, you are stuffing the stomach with food at first and later irritating it to a point that all that you have eaten comes out one way or the other. It is no surprize then that many gastrointestinal problems have been reported in the case of eating disorders. One of them is esophagitis from exposure to stomach acid during the purging phase. Esophagitis could develop to esophageal rupture and other complications leading to gastrointestinal blood loss. On the other hand, acute gastric dilation could happen during the binge eating phase. Laxative abuse in bulimia is another reason for gastrointestinal complications in bulimia patients.12 Stomach ulcers are also seen in them. Bingeing and purging also affect the normal bowel movements with constipation or/and diarrhea as common features. Gastric delay and prolonged satiety are other features.13
6. Change In Menstrual Pattern
Bulimia can severely restrict nutrition in the body. In women and young girls, it most often manifests as changes in the menstrual pattern. Depression, anxiety and other psychiatric disorders among bulimics could further aggravate the situation.14
7. Skin Disorders
Russell’s Sign is what a bulimic needs to watch out for. Repeated self-induced vomiting could result in calluses, abrasions or bruises of the dorsum of the hand or thumb, collectively called Russell’s Sign. These damages to the skin occur mostly while trying to induce vomiting. Hemorrhages in the eye and rashes on the face could also happen, though less frequently.15
An eating disorder like bulimia is difficult to detect in the beginning. If you feel your relationship with food is not the best, these signs and symptoms will help you understand if you are suffering from this eating disorder or not.
|↑1||Russell, Gerald. “Bulimia nervosa: an ominous variant of anorexia nervosa.” Psychological medicine 9, no. 3 (1979): 429-448.|
|↑2||Research on males and eating disorders. NEDA.|
|↑3||Eating Disorder Statistics. ANAD.|
|↑4||What is bulimia nervosa?. Bodywhys.|
|↑5||Bretz, Walter A. “Oral profiles of bulimic women: Diagnosis and management. What is the evidence?.” Journal of Evidence Based Dental Practice 2, no. 4 (2002): 267-272.|
|↑6||DeBate, Rita D., Lisa A. Tedesco, and Wendy E. Kerschbaum. “Knowledge of oral and physical manifestations of anorexia and bulimia nervosa among dentists and dental hygienists.” Journal of dental education 69, no. 3 (2005): 346-354.|
|↑7||Mitchell, James E., Richard L. Pyle, Elke D. Eckert, Dorothy Hatsukami, and Richard Lentz. “Electrolyte and other physiological abnormalities in patients with bulimia.” Psychological Medicine 13, no. 2 (1983): 273-278.|
|↑8, ↑12, ↑15||Fairburn, Christopher G., and Kelly D. Brownell, eds. Eating disorders and obesity: A comprehensive handbook. Guilford Press, 2005.|
|↑9||Cooper, Peter J., and Christopher G. Fairburn. “The depressive symptoms of bulimia nervosa.” The British Journal of Psychiatry 148, no. 3 (1986): 268-274.|
|↑10||Kaye, Walter H., Cynthia M. Bulik, Laura Thornton, Nicole Barbarich, Kim Masters, and Price Foundation Collaborative Group. “Comorbidity of anxiety disorders with anorexia and bulimia nervosa.” American Journal of Psychiatry161, no. 12 (2004): 2215-2221.|
|↑11||Bulimia Symptoms. NHS.|
|↑13||Lionetti, Elena, Mario La Rosa, Luciano Cavallo, and Ruggiero Francavilla. “Gastrointestinal aspects of bulimia nervosa.” In New Insights into the Prevention and Treatment of Bulimia Nervosa. InTech, 2011.|
|↑14||Gendall, Kelly A., Cynthia M. Bulik, Peter R. Joyce, Virginia V. McIntosh, and Frances A. Carter. “Menstrual cycle irregularity in bulimia nervosa: Associated factors and changes with treatment.” Journal of psychosomatic research 49, no. 6 (2000): 409-415.|