People with the disorder frequently binge and purge in secret. However, a large number of unexplained empty food wrappers and laxative sachets may be a sign of bulimia. Additionally, bulimia nervosa can cause the following behavioral and emotional symptoms:

• frequently trips to the restroom, especially following meals;
• overdone exercise;
• body image anxiety;
• fear of gaining weight;
• drug addiction, anxiety, or depression;
• feeling uncontrollable;
• having shame or remorse about eating; and
• social isolation from friends and family.

Among the additional physical signs of bulimia nervosa are:

• swollen jawline or cheeks;
• digestive issues such as acid reflux and constipation;
• knuckle calluses, scars, or other wounds (from forced throwing up);
• fainting;
• irregular bouts of menstruation;
• muscle sluggishness;
• red eyes; and
• dehydration.

DSM-V criteria state that a person has anorexia bulimia if below are fulfilled:

• repeated binge eating episodes;
• experience a loss of control over your eating during an episode;
• participate in harmful purging habits;
• had at least once a week for three months of binge eating;
• body type or weight significantly affects self-image.

There are no particular laboratory tests available to identify bulimia. A doctor may prescribe tests to determine the impact bulimia has had on your health. These tests may include blood test, urinalysis, kidney function test, electrocardiogram (EKG).

Treatment

Psychotherapy, drugs, nutrition counseling, and medical attention are all used in treatment. These many therapy approaches are intended to:

• maintain weight reduction;
• begin a nutrition rehabilitation program to regain fitness;
• stop purging and other damaging eating behaviors, such as binge eating;
• deal with issues including low self-esteem and faulty thought habits;
• create long-lasting behavioral adjustments.

Identify issues early by being aware of the signs if bulimia runs in the family. Early counseling helps eliminate harmful eating behaviors before they become more challenging to correct.

Additionally, reduce the risk of bulimia nervosa by undergoing therapy for other issues such as depression and anxiety disorders. Lastly, children may also be educated by teachers and parents that the "ideal" body type shown in the media is not necessarily true.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596

Balasundaram P, Santhanam P. Eating Disorders. [Updated 2022 Sep 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK567717/

Cleveland Clinic (2022). Bulimia Nervosa. Retrieved October 22, 2022, from https://my.clevelandclinic.org/health/diseases/9795-bulimia-nervosa

National Institute of Mental Health (2022). Eating Disorders. Retrieved October 23, 2022, from https://www.nimh.nih.gov/health/topics/eating-disorders#part_2272