The hidden signs of bulimia – what to look for, and why it matters

Bulimia nervosa – commonly referred to simply as bulimia – is a serious eating disorder that affects people of all ages, genders, and backgrounds. Yet despite its severity, it often goes undetected.

The outward signs can be subtle, and the inner distress well-hidden. And for many, the cycle of bingeing and purging continues in silence for months – sometimes years¹ – before help is sought.

Bulimia is characterised by repeated episodes of binge eating followed by behaviours designed to prevent weight gain, such as vomiting, excessive exercise, fasting, or misuse of laxatives. Importantly, it’s not about vanity, and it’s not about lack of willpower. It’s a complex mental health condition with deep emotional and psychological roots.

Globally, it’s estimated that bulimia affects around 0.5% of women and 0.1% of men² – with an overall prevalence of 0.3%³ – though these figures likely underrepresent the true scale due to underreporting and stigma⁴. What’s more, research shows that up to 40% of individuals with bulimia never receive a formal diagnosis⁵, increasing their risk of serious complications – from heart issues and digestive problems, to severe mood disturbances and suicidal ideation.

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Early warning signs of bulimia

Bulimia often begins quietly. In the early stages, it can look like a shift in eating habits, an increase in body preoccupation, or sudden emotional changes⁶. Because many of the initial signs can be mistaken for stress or typical dieting behaviours, it’s easy to miss what’s really happening beneath the surface.

Some of the most common early signs of bulimia include:

• Frequent trips to the bathroom after meals

→ Especially if followed by sounds of vomiting or running water, which may be used to mask purging

• Eating in secret or feeling ashamed about food

→ Including hiding food, bingeing alone, or becoming visibly distressed when eating in public.

• Excessive focus on body shape and weight

→ Including weighing oneself multiple times a day, obsessively checking mirrors, or becoming increasingly anxious about appearance

• Sudden changes in eating habits

→ Such as skipping meals, adopting strict food rules, cutting out major food groups, or alternating between extreme restriction and overeating

• Mood swings and low self-esteem

→ Individuals may experience emotional instability, irritability, or become withdrawn, often linked to distorted body image or feelings of guilt around food

It’s important to remember that these behaviours aren’t simply “bad habits” or signs of vanity. As with other eating disorders (such as anorexia nervosa or binge eating disorder), early warning signs may indicate symptoms of a complex and distressing mental health condition – one that requires clinical understanding and support, not judgment.

Signs that bulimia is more deeply rooted

As bulimia progresses, its effects become more pronounced, both psychologically and physically.

The binge–purge cycle can take a significant toll on the body, leading to serious health complications. Emotionally, the person may become consumed by feelings of shame⁷, fear of gaining weight, and a sense of losing control.

Some of the more entrenched signs of bulimia include:

• Noticeable physical symptoms⁸, such as:
  • Swollen cheeks or jaw (due to inflamed salivary glands)
  • Discoloured or eroded teeth (from frequent vomiting)
  • Calluses or scars on knuckles (from self-induced vomiting, known as Russell’s sign⁹)
  • Persistent sore throat or hoarse voice
• Digestive issues, including acid reflux, constipation, or bloating
• Irregular or absent menstrual periods
• Exercising excessively
  • Not for enjoyment or health, but as a form of compensation or punishment¹⁰ after eating
• Using laxatives, diuretics, or diet pills
  • Often in secret and outside of medical guidance, increasing the risk of dehydration and electrolyte imbalances
• Withdrawing from social life
  • Avoiding friends, family meals, or situations where eating might be involved
• Extreme guilt or emotional distress after eating
  • Particularly following a binge eating episode, where the person may feel a sense of panic, disgust, or self-loathing¹¹
• Signs of depression, anxiety, or obsessive behaviour
  • Bulimia often overlaps with other mental health conditions, amplifying distress and making daily life feel unmanageable

These symptoms are not just emotionally painful; they can be life-threatening.

Bulimia nervosa is associated with a range of serious complications, from heart rhythm abnormalities¹² and kidney damage¹³ to long-term gastrointestinal issues¹⁴. The risk of suicide is also significantly elevated among those living with eating disorders¹⁵.

When disordered eating becomes life-threatening

As with other eating disorders, bulimia can be hard to spot. Many people continue to function outwardly – working, socialising, maintaining routines – while living in a hidden cycle of bingeing, purging, and shame. But beneath the surface, the toll on both body and mind can be severe.

What may begin as an attempt to control food or weight¹⁶ often becomes a coping mechanism for deeper emotional pain. Over time, this cycle erodes physical health: purging can lead to dangerous electrolyte imbalances, heart irregularities, and damage to the digestive system.

The psychological impact runs equally deep, with isolation, low self-worth, and a sense of being trapped common among those who have been dealing with bulimia for some time.

At this stage, bulimia stops being about food. It becomes a way of managing distress: one that’s incredibly difficult to break alone. And while the risks are serious, this is also a critical moment for intervention.

Real recovery isn’t just about stopping behaviours. Rather, it’s about restoring dignity, building trust, and helping people find new ways to cope, connect, and heal.

What to do if you notice the signs – and why recovery is possible

Recognising the signs of bulimia can be distressing¹⁷. For many, it takes time to acknowledge that certain patterns around food, control, and self-worth may reflect something more serious. But early recognition is one of the most powerful tools in preventing escalation, and in opening the door to recovery.

Because bulimia is often hidden. Individuals may seem outwardly well while privately struggling with cycles of bingeing, purging, and deep emotional distress. Over time, this can lead to significant physical and psychological complications. But with specialist care, change is possible.

If signs of bulimia are present, the following steps can help guide a safe and informed response:

1. Take concerns seriously: changes in eating habits, behaviour, or mood should never be dismissed.
2. Avoid blame or judgment: bulimia is a mental health condition, not a lifestyle choice.
3. Reach out to a mental health professional: early, professional mental health support makes a measurable difference.
4. Prioritise safety: if there are signs of severe physical decline or psychological distress, immediate care may be required.
5. Seek multidisciplinary support: long-term recovery is more effective when supported by a joined-up, collaborative team with a whole-person perspective.

Recovery from bulimia is not about control or willpower – it’s about creating the right environment, with the right support, at the right time. That means working with people who understand the condition, and who offer not just treatment, but dignity and consistency.

In this kind of environment, it is possible to move beyond the cycle of bulimia: towards stability, strength, and a renewed sense of self.

Contact Orchestrate Health today →

References

1. https://bbrfoundation.org/content/binge-eating-disorder-often-untreated-typically-persists-years-infrequent-remissions-study
2. https://www.menshealth.com/uk/mental-strength/a46933537/rise-of-bulimia-boys-men/
3. https://www.nimh.nih.gov/health/statistics/eating-disorders
4. https://jeatdisord.biomedcentral.com/articles/10.1186/s40337-025-01198-x
5. https://www.sydney.edu.au/news-opinion/news/2022/01/21/escalation-of-eating-disorders-during-covid-19-research-finds.html
6. https://www.bbc.co.uk/sport/cricket/54281217
7. https://theconversation.com/middle-age-is-a-time-when-women-are-vulnerable-to-eating-disorders-247753
8. https://my.clevelandclinic.org/health/diseases/9795-bulimia-nervosa
9. https://pubmed.ncbi.nlm.nih.gov/9345215/
10. https://pmc.ncbi.nlm.nih.gov/articles/PMC7877054/
11. https://www.cnn.com/2017/07/18/health/bulimia-brain-stress-food-study
12. https://www.heart.org/en/news/2024/02/26/how-eating-disorders-can-damage-the-heart
13. https://pmc.ncbi.nlm.nih.gov/articles/PMC9942359/
14. https://bulimia.com/bulimia-health-risks/
15. https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(24)00143-3/fulltext
16. https://www.nature.com/articles/s41598-023-41345-5

https://www.cnn.com/2022/03/20/health/how-to-help-someone-with-eating-disorder-wellness