Look out for these bulimia symptoms if you’re worried about a friend

National surveys estimate that 30 million Americans will have an eating disorder at some point in their lives. According to the National Eating Disorder Association, eating disorders are serious and potentially life-threatening mental and physical illnesses that can affect people of every age, sex, gender, race, ethnicity, and socioeconomic group. Fortunately, they’re also treatable. One of the most well-known eating disorders is bulimia nervosa, which is characterized by a cycle of binge eating followed by self-induced vomiting meant to undo the effects of binge eating.

You might already be familiar with the term bulimia, so it’s possible you have an idea of the most common bulimia symptoms, like purging after a large meal. However, if you have no prior experience with the eating disorder, it’s perfectly understandable that you might not be totally sure what it looks like to have bulimia. That’s why HelloGiggles turned to a group of medical experts to reveal the most common bulimia symptoms and what to do if you suspect a loved one (or yourself) needs support.

What causes bulimia?

Bulimia stems from a combination of genetics and environmental stress, says Dr. Michael Lutter, a Texas-based MD who treats bulimic patients. He tells HelloGiggles that patients with bulimia tend to have impairments in satiety, which is when your body tells your brain to stop eating.

“While most people get signals from their body that they have had enough to eat, people with bulimia usually continue to feel intense hunger even when they have eaten an unusually large amount of food,” he says. “Several studies indicate those with bulimia have deficiency in the satiety hormone GLP-1 (glucagon-like peptide-1). GLP-1 is released by your intestines after a meal and goes back to the reward center of the brain to shut off hunger and the drive to eat. Patients with bulimia release less GLP-1 than [other] people after a meal, and patients with bulimia are more likely to have damaging mutations in the GLP-1 gene than [non-bulimic] people.”

Environmental stress, including traumatic events, alcohol abuse, and the societal pressure to lose weight, not to mention common fat-shaming industries like dancing and modeling, are also contributing factors.

“Bulimia often occurs with other conditions, like depression or anxiety,” says Ashley Wood, an emergency room nurse who’s treated patients with eating disorders. “These individuals often have poor body image and low self-esteem, which usually is the result of perfectionism or a critical home environment. As a result of this, these individuals don’t like themselves and are overly self-critical.”

Major transitions, including moving away to college, starting a new job, or experiencing the death of a loved one, can also trigger it, Wood says. 

“Individuals may develop eating disorders as a way of dealing with the conflicts, pressures, and stresses of their lives,” says Kristen Ulrich, site director at The Renfrew Center of Massachusetts, a treatment clinic for eating disorders. “Eating disorders are often a vehicle to express control when the rest of your life seems out of control.”

The physical symptoms of bulimia

Physical symptoms of bulimia can range from subtle to glaringly specific; that is, if you know what to look out for.

“Physical symptoms will differ depending on the type of purging behaviors folks are using,” says Dr. Rachel Davidson, a Florida-based licensed clinical psychologist.

At the basic level, she says, bulimia often leads to malnutrition, dehydration, and nutrient imbalances. In addition to excessive weight loss, “you may notice weight gain (since they are often purging after the food nutrients have already been absorbed by the body to some extent),” says Dr. Davidson. Dental issues are another sign, including bad breath, dental decay (from stomach acid brought up during vomiting), and cavities. Repetitive acid reflux and constipation could also be potential signs.

According to Ulrich, some of the most subtle signs include: reacting to emotional stress by overeating; feeling guilty about eating; or obsessive exercising. “Women with bulimia often feel out of control in other areas of their lives and may spend money excessively, abuse drugs or alcohol, or engage in chaotic relationships,” she says. 

Another sign? Wood says the binge part of the cycle can be evidenced by large amounts of food disappearing in a short amount of time. “Another way this might be demonstrated is if there is a large number of empty wrappers and/or containers present in someone’s house,” she says. “The other part of the cycle involves purging and is usually signaled by them going to the bathroom frequently after meals or they might smell like vomit. In order to conceal this, the person might excessively use mouthwash, mints or gum.” Being uncomfortable eating in front of other people or in public, and insisting on wearing baggy clothes even in the warmest of temperatures, could also be signs, says Wood. 

Of course, it’s important to consider the aforementioned signs together to determine whether or not bulimia might actually be the cause. 

The psychological symptoms of bulimia

Bulimia can also be revealed in how people respond to themselves and their environment.

“Someone suffering from bulimia can appear withdrawn, have depressed moods or mood swings,” says Ulrich. “They can also appear secretive to loved ones and even leave social situations suddenly after a meal is consumed.”

Individuals with bulimia tend to cycle between bouts of anxiety leading up to a binge or purge, and then depression afterward, says Dr. Davidson. Additionally, “Someone may be more likely to be very self-critical and have a more negative view of themselves and other people. They may struggle to be social, especially in situations that involve food (think: eating in the lunchroom, going to social dinners, family holidays, etc.), which may make them isolate more.”

Substance abuse, of both alcohol and stimulants like cocaine or methamphetamine to suppress appetite, are also common, says Lutter. 

What to do if you suspect a friend has bulimia

Because bulimia is such an isolating disorder, it’s important to show your support as compassionately as possible if you suspect a friend might have it.

“The most important thing you can do is offer them compassion and support,” says Wood. “At first, your loved one might get defensive or angry, but if they do open up, it’s key to listen without any judgment, stress to them that you care about them and want them to get better.” She suggests refraining from scaring or guilt-tripping your friends in an effort to convince them to get help.

“It’s important to understand that your loved one is the only one who can make a decision to move forward with getting treatment,” she says. Also, discussing food, counting calories, and commenting on diets and body image in front of your friend is a big no-no. 

If you suspect you might have bulimia, Davidson says the first thing you can do is to start tracking the number of times you feel you binge on food, as well as times that you have any purging behaviors. “If it is happening more than twice a week, or if you feel that eating in any capacity is causing problems in your life, you need to reach out for help by finding a trained therapist and therapy program,” she says. 

According to our experts, seeking professional treatment is a must, whether that’s by visiting your personal doctor, a therapist, or a clinic like The Renfrew Center to help you understand the root cause of the eating disorder and the necessary steps you need to take to improve your health. 

And while bulimia is a serious disorder that requires professional treatment and support, Wood says, “with the right help, it can be overcome.”

The National Eating Disorders Association provides free referrals, information, and advice via their toll-free hotline at 1-800-931-2237.