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Signs Of Bulimia

What Are The Signs Of Bulimia Nervosa?

The signs of bulimia often go unrecognised. Sufferers can go to great lengths to cover their physical signs of bulimia, however in truth the behavioural signs of bulimia are very hard to conceal. If you suspect a loved one may have bulimia and are looking for information so you can recognise their signs of bulimia - we have just what you need.

The information we have complied on the signs of bulimia has come predominately from ex-sufferers. They have volunteered this 'insider information' because they now realise the best thing that could have happened to them earlier in their life was to be caught, challenged and offered professional help. The vast majority of ex-sufferers agree that the shame of bulimia and the secrecy it demands were pivotal in maintaining their problem.

Getting bulimia out in the open (even through being caught or challenged by someone else) can often be enough to get the ball rolling and direct the sufferer towards professional help.


Signs Of Bulimia - The Toilet


People often associate the purging part of bulimia with vomiting. Although this is the most widespread purging method, you should be careful not to assume it only happens in the toilet. There are plenty of other places a bulimic can purge, as you'll discover in due course.

For the time being however, we'll focus our attention on the toilet. Here's what you should look out for:

  • Is the toilet always spotlessly clean? In reality few people have time or the inclination to meticulously and repetitively clean their toilet. However, if you send a lot of time vomiting with your face in the toilet - you'd probably want it to be clean. Another reason for a bulimic to meticulously clean a toilet is to cover up any evidence. Vomit and bile tend to leave a greasy film even after the toilet has been flushed - so over-cleanliness could well be a sign of bulimia.
  • Is there a greasy residue around the waterline? Is there a greasy film floating on top of the water? Both of these things are the tell tale sign that vomit has been in the toilet recently. This greasy film floats on water so is actually quite difficult to flush away. It has to be removed chemically with cleaning products.
  • Do you notice 'bits' in the toilet? Undigested food often consists of 'floaty bits'. Obviously these rise to the surface once the bulimia sufferer has vomited. Upon flushing the toilet the water turbulence mixes much of the floaty material into the water and it is sent around the u-bend to the sewer. However, small bits can escape the turbulence and return to the surface of the water in the toilet. Look out for small floaty bits.
  • Toilet paper. Using toilet paper as a concealer or helper is important in several bulimic strategies. For example floating toilet paper on top of a greasy film will absorb much of it and when the toilet is flushed the absorbed film is removed along with the toilet paper. Toilet paper can also be used to retain floaty bits by helping to trap them during the flush cycle. Finally, you may well not be surprised to find toilet paper in your toilet. However, the question you should be asking is 'what would a bulimia sufferer be concealing with that?'
  • Time, frequency and distractions in the toilet. How long does the potential bulimia sufferer spend in the toilet? How often do they use the toilet? Do they run the tap or use some other noise as a distraction when they're in the toilet? Vomiting can be a noisy process - be wary of intended distractions.
  • Multiple flushes. If you hear your toilet flushing multiple times when a certain person uses it - you need to ask yourself what specifically they're trying to get ride of. Modern toilets work pretty well for urine and faeces - but they're not designed to get rid of undigested food and bile.
  • Nose blowing. Vomit has a nasty habit of getting into the nose on its way out. So, if you hear habitual nose blowing following a trip to the toilet (pre or post flush) there's a possibility it's to clear the nose of traces of vomit.

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Signs Of Bulimia - Cupboards, Secret Stashes & Bins


When a bulimia sufferer binges they can get through a lot of food. There are two elements here that they have to hide. Where the food comes from (and is stored) and where the packaging goes.

  • Do quantities of food go missing from cupboards or the fridge? If the answer is yes and it's more than a tin of soup or a few biscuits - this is a sign.
  • Receipts. Check for discarded supermarket receipts. They're dated and itemised. Do they show that large volumes of food are being purchased and disappearing?
  • Secret stashes. Bulimia sufferers love to stash food. Under beds, in wardrobes, hidden between clothes... if you can legally check you should do so.
  • Diet pills, laxatives and diuretics. Check for these items which will almost certainly be 'hidden'. The fact that they are concealed implies shame and guilt surrounding their (mis)use.
  • Wrappers. Almost all food comes in packaging of some sort and leaves a disposal problem for the bulimia sufferer. They'll often hoard wrappers in a secret place. It's common for them to meticulously fold wrappers so that they are very small and pack them inside something else. For example you could fit many hundreds of chocolate bar wrappers within a seemingly empty and inoffensive cereal packet... already in your bin...

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Signs Of Bulimia - Going Missing


Bulimia sufferers don't binge and purge in public. This means they have to 'disappear' in order to perform their bulimia rituals.

  • Disappearing following a meal. Just because a bulimia sufferer hasn't binged - doesn't mean they wont have the urge to purge. Be aware of a potential sufferer retreating to their bedroom or the toilet following a meal - particularly if they seem uncomfortable or agitated.
  • Showers. There's nothing wrong with having a shower, but the bulimia sufferers reasons for showering tend to be different to other peoples. Being in the shower gives them private time. They know they wont be disturbed. It's an ideal time (possibly to binge) but definitely to purge. The noise of the running water, coupled with the privacy and the fact that vomit can (at a push) be persuaded down the drain makes showering a golden opportunity. Also check the plug for bits of food or vomit.
  • Excessive time alone or lack of social interaction is another tell tale sign of bulimia. Bulimia is like an addiction - it becomes more important and pressing than anything else. Withdrawal from social life or long periods alone in a bedroom could potentially be a warning sign.

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Physical Signs Of Bulimia


The physical signs of bulimia are numerous and obvious when you know what to look for.

  • Teeth. Are teeth decaying due to vomiting? Stomach acid will strip enamel from teeth. Also if the bulimia sufferer is malnourished through starving and/or purging the teeth will not get the elements they need to remain strong. Thus this is another potential cause of decay.
  • Bad breath. Vomit and bile contain noxious chemicals with a distinct 'sick' smell. It only takes a small amount of these chemicals in the throat or mouth to produce bad breath. The other sign to look out for is toothpaste, mouthwash, mints, gum etc being used to conceal 'vomit breath'.
  • Voice. Repeated vomiting takes its toll on the voice, leaving it hoarse. Don't be fooled by excuses like "I'm coming down with a cold".
  • Chipmunk cheeks. This is puffiness and swelling of the cheeks caused by repeated vomiting. This one is very tough to disguise.
  • Hair. Dulling, thinning or even loss of hair are all common signs of malnutrition through bulimia. Use older photographs for reference. Also check hair brushes for excessive hair loss. Check also for hair being tied up (if it's a change of habit). Hair needs to be held out of the way for vomiting.
  • Eyes. Dehydration can make the eyes appear dull and can create grey areas and bags below the eye. Immediately following purging the eyes can be bloodshot, red and watering.
  • Broken capillaries. You need to look quite closely to see these, but if they're repeatedly purging through vomiting - they'll almost certainly be there. Check the forehead in particular for tiny red dots. Beware of bulimia sufferers applying makeup in order to conceal this.
  • Hands. Cuts and callouses on the back of the fingers and knuckles. This is caused by biting down with the top teeth immediately following the gag reflex from purging.
  • Weight. Sufferers of bulimia (alone) tend to be of average weight or occasionally slightly overweight. However, if your suspected bulimia sufferer is clearly underweight - they could well have symptoms of anorexia too. It is not uncommon for this to be the case as one disorder can easily lead to the other.

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Strange Behaviours & Psychological Signs Of Bulimia


  • Drinking. Watch out for excessive drinking of diet coke (and other diet drinks) as well as water - particularly immediately following a meal. Gulping down fluid after a meal before leaving the table makes the purging process so much easier. In extreme cases there will be a drink, purge, drink, purge cycle which will continue until only clear fluid is vomited out.
  • Excessive exercising. There's nothing wrong with being fit, but that normally goes hand in hand with healthy psychology. The bulimia sufferer will be motivated to exercise through guilt (over what they've eaten) and fear of weight gain.
  • Eating unusually large amounts of food (at meal times) but gaining no weight. Look out for pre-prepared excuses such as "fast metabolism" or "this is the first I've eaten all day..."
  • Eating in private. Many people view eating as a social event, however a bulimia sufferer can feel guilt, shame and possibly paranoia when eating in front of others. Look out for excuses or schedules that mean the suspected sufferer eats in private.
  • Swings in eating habits. Notice if the suspected bulimia sufferer alternates between eating well and restricting their intake. Emotionally they're likely to be more upbeat when eating well and down (feeling self conscious) when they're restricting.
  • Showering after a meal. As mentioned before, the shower is an ideal (noisy and private) place to purge following eating.
  • Bite marks on toothbrush. Some bulimia sufferers will poke their toothbrush (rather than their fingers) into their throat to induce vomiting. The gag reflex causes them to bite down onto the shaft of the toothbrush which can leave bite marks or scratches.
  • Carrying toothbrush and toothpaste in handbag. This is the bulimia sufferers expedition kit, so they can clean their teeth and freshen their breath after they've purged when away from home.
  • Self harm. You'll learn elsewhere on the website that bulimia is driven predominantly by negative self image and intense emotional states. These induce a sense of worthlessness, hopelessness, anxiety, frustration and self-loathing. Self harm (cutting, scratching, biting, pinching, punching, burning) can often exist hand in hand with bulimia due to the sufferers self perception. Look out for tell tale marks - but expect the sufferer to have an excuse at the ready.
  • Obsessing over how they look. Constantly looking in the mirror, complaining about how they look and changing clothes multiple times before they're (even remotely) satisfied are all possible pointers towards bulimia. These shouldn't be considered as pivotal signs - but if they're there in addition to others...
  • Depression / anxiety / emotional swings. Bulimia sufferers find themselves in a very dark place emotionally. Their emotions are intense and painful which inevitably leads to cycles of anxiety and depression. A short temper with emotional outbursts and tears could well imply there's a problem.
  • Secrecy and paranoia. Bulimia is a very secretive condition as the sufferer feels so ashamed of what they're doing. The great efforts they make to conceal their behaviours in conjunction with their intensely negative self image can lead them to feel paranoid with respect to being caught or found out.

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Signs Of Bulimia - Disposal Systems

We have already discussed how bulimia sufferers need to get rid of food packaging. However, the truth is that not all vomit ends up in the toilet. It is reasonably common for bulimia sufferers to keep hidden containers to vomit into. These can range from plastic ice cream tubs, biscuit tins right through to carrier bags and bin bags. This is partially for convenience and partially for privacy (so they don't need to pass you on the way to the toilet).

Typical places for these containers are under beds, hidden in wardrobes or secreted between piles of clothes.

If you find a container with vomit inside or even if it's clean but smells of vomit - they're suffering with bulimia for sure.


What To Do Next...

bulimia nervosa help

Perhaps the next thing you should read is our what is bulimia nervosa page, or if you've already read that, our bulimia help page contains some useful information. This will outline how we approach helping our clients to recover. The more you understand how bulimia works - the more likely it is you'll convince your loved one to seek the right help...

We work with clients face to face at our Clinic in Staffordshire although if you don't live near there, we can still help. We offer Nationwide Online Consultations with the very same specialists at very affordable rates. Here are the links:

I'm interested in learning more about Face To Face Consultations in Staffordshire

I'm interested in learning more about Online Consultations (Nationwide)

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