Bulimia Nervosa Signs and Symptoms

Bulimia nervosa is an eating disorder that involves a cycle of strict dieting and strong urges to eat in excess, followed by intense efforts to avoid gaining weight.

The signs and symptoms of the disease can vary, but most individuals have normal body weight. The effects of the purging after a binge-eating session often lead to the most prominent signs and symptoms of the condition.

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Cycle of stages

People with bulimia nervosa tend to go through a cycle of stages that characterizes the condition, which includes:

  • Strict dieting
  • Obsession or fear about gaining weight
  • Cravings for prohibited foods and resulting tension and anxiety
  • An episode of binge eating where the individual consumes large quantities of food (approximately 3,000-5,000 calories within one hour.)
  • Purging to avoid weight gain by inducing vomiting, doing intense exercise, or using laxatives or diuretics.
  • Shame or disgust about binge eating and reinforcement of strict diet to control weight.

This cycle can continue indefinitely with affected individuals feeling like they have reduced control over their consumption of food. This often causes them to enforce a stricter diet to manage their body weight, which leads to undernourishment, a greater obsession with food, and an increased likelihood of binge eating as a natural response.

Signs and symptoms

When an individual is affected by bulimia nervosa, several changes can occur in the body that may become evident.

As a result of malnutrition, frequent vomiting, or the use of laxatives and/or diuretics, the concentration of electrolytes including potassium, magnesium, and sodium in the blood can be altered. This can cause consequent effects such as changes in the rhythm of the heart (arrhythmias). Other symptoms linked to the cardiovascular system include decreased muscle mass in the heart, heart failure, hypotension, bradycardia, and anemia.

The gastrointestinal system can also be affected, with many bulimic patients reporting abdominal pain or cramping, bloating, or stomach ulcers. Additionally, irregular bowel motions, constipation, or diarrhea are particularly common in individuals who use laxatives as a purging mechanism.

Most people with bulimia have a normal body weight or are slightly overweight due to their binge eating and purge habits. It is also common for body weight to fluctuate considerably in these individuals. This is because the purging methods are not entirely effective at eliminating the calories of a binge eating session, as the body begins to absorb the food as soon as it is eaten. It is estimated that vomiting removes less than half of the calories and other methods, such as laxatives or diuretics, remove even less at approximately 10% of consumed calories.

Many patients with bulimia nervosa are also affected by psychological symptoms as a result of the condition. They may have an intense fear of gaining weight or issues with anxiety, in addition to feelings of shame and low self-esteem linked to their dietary patterns. Affected individuals are also more likely to become depressed and experience other mental health issues.

Eating disorder signs and symptoms

Signs of frequent vomiting

Not all patients with bulimia nervosa follow binge-eating sessions with vomiting, as these individuals may resort to other methods such as intense exercise or the use of laxatives or diuretics. However, frequent vomiting is a common characteristic of individuals with bulimia and can cause specific signs and symptoms of the condition. These may include:

  • Scarred or callused hands from inducing vomiting with fingers in the throat
  • Swollen or puffy cheeks
  • Discolored teeth from stomach acid in the mouth
  • Sore throat or hoarseness
  • Gum disease
  • Sensitive teeth


Further Reading

Last Updated: Dec 22, 2022

Yolanda Smith

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.


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