5 Signs of Bulimia Nervosa

It is not uncommon to be living with an eating disorder for many years without receiving support or recognizing how big of a problem it is to your health and disruption to your life. Eating disorders often occur in secret and thrive in isolation. The less an eating disorder is "exposed” or addressed, the more likely it is to exist under the radar. That is why it is so important to recognize these 5 signs and seek help, or encourage your loved one to get support.

What is Bulimia Nervosa?

Bulimia Nervosa is a serious eating disorder that affects your physical and mental health. The National Eating Disorder Association describes Bulimia Nervosa as:

Bulimia nervosa is a serious, potentially life-threatening eating disorder characterized by a cycle of bingeing and compensatory behaviors such as self-induced vomiting designed to undo or compensate for the effects of binge eating.

National Eating Disorder Association

Since Bulimia Nervosa is considered a mental illness, it’s diagnostic criteria comes from the DSM 5 (Diagnostic Statistical Manual, Fifth Edition). Bulimia Nervosa is characterized by bingeing and purging cycles.

You may have experienced a binge if you eat a larger quantity of food in one sitting (a quantity that is much larger than you would typically eat and leaves you feeling uncomfortably full or sick), and a sense of lack of control while eating.

A key part to bingeing that is a hallmark of Bulimia Nervosa, is that after a binge you use some sort of compensatory behavior. Meaning there is an urge to “get rid of” the food you just consumed by using behaviors such as vomiting, laxatives, exercise, etc.

To receive a diagnosis of Bulimia Nervosa, one must be using those behaviors for a specific duration as outlined in the DSM 5. However, if you or your loved one struggle with this, even on what feels like an infrequent basis, I would strongly urge you to get support rather than let this continue. You are deserving of a better relationship with food and your body.

If you’re wondering if you or your loved one may have Bulimia Nervosa, here are 5 signs to look for:

5 Signs of Bulimia Nervosa

Sudden and extreme weight fluctuations

It is a common misconception that individuals with eating disorders must look frail and very thin. This is not the case for every eating disorder and individual. If you notice a drastic fluctuation in weight, this could be a sign that something is going on. Although, it is also possible for someone’s weight not to change in a noticeable way. Note: please be cautious if you have noticed changes in your loved one’s weight and feel concerned. Body image is a strong component to developing an eating disorder and your loved one may be sensitive to this information.

Frequent trips to the bathroom after eating

Frequent trips to the bathroom right after eating could be a potential warning sign. When someone is suffering from bulimia nervosa they may be using the bathroom after a meal or snack as an opportunity to purge the food they just ate via vomiting, laxatives or diuretics.

Obsessive behaviors and thoughts around food

This can be difficult to identify in today’s world where it is common to negatively talk about yours and others’ appearances or follow a restrictive diet. Food and weight are a normal conversation for many people. If you feel your loved one is struggling with an eating disorder, please know that these conversation topics can be a big trigger for them and cause them to use more eating disorder behaviors. Individuals struggling with an eating disorder may be obsessive around food to the point that it causes a lot of anxiety, fear, and may cause them to isolate or withdraw. The difference between dieting thoughts around food and eating disorder thoughts are that an eating disorder is much more disruptive to your quality of life.

Extreme mood swings, irritability and depression when food feels chaotic

Do you know how it feels to be hungry and cranky? Multiply this by 10 and now you know a glimpse of what it is like to be living with an eating disorder. Bulimia nervosa thrives off of trying to do things perfectly. When food feels chaotic or out of your control, it can cause big mood swings and fear. In addition, the restriction followed by bingeing and purging can be a dangerous combination.

Attempting to purge via vomiting or misuse of laxatives or diuretics

The most common aspect of bulimia nervosa is self-induced purging, or vomiting. If you are struggling with this, or suspect your loved one is struggling with this, please take caution in how you approach them and help them to find the support they need and deserve. Physical effects of purging includes damage to the teeth, specifically the enamel, and the esophagus. Often individuals who purge complain of acid reflux. Other forms of purging may include misuse of laxatives and diuretics. Both can be dangerous and cause irreversible side effects to the GI tract.

How do you approach a loved one?

First I want to say thank you for caring so deeply about your loved one and recognizing the difficult path they are on. Speculating your loved one has an eating disorder is a very hard space to be in because choosing whether or not to say something is a big decision.

It is normal for this conversation to elicit a strong reaction from the individual with the possible eating disorder. Recognize that this defensiveness is not coming from a place of ill-intent, but likely a place of fear, embarrassment, or the eating disorder itself being defensive.

Remaining calm and giving your loved one the opportunity to process next steps with you can be a great first step. Offer to help them find specialized providers and remind them you are a safe person for them to talk to.

I think I have Bulimia Nervosa, What do I do now?

You’re brave for reading this and for looking for guidance. It can be scary, the unknown of what to do next or what the next steps look like. However, you are deserving of a better life and it is possible to recover.

The first step is building your treatment team. Typically a treatment team consists of a therapist, registered dietitian, and physician. You deserve a team of professionals who are specialized in eating disorders, nothing but the best!

Once you have this team together, the hardest step is making the choice to show up to the appointments and trust in your team. Things sometimes can get worse before they get better, but don’t let this scare you. You are stronger than you think, heck, you’ve made it this far!

If you, or someone you care about, has disordered thoughts around food that may indicate a problem, do not hesitate to reach out or schedule a call.

I Practice Self-Care Yet I Don't Feel Any Different.

I practice self-care, yet I don’t feel any different.

This is a HUGE problem and many times we don’t even realize what is going on until we are so completely empty and drained then we decide to do something about it.

Self-care is beginning to be discussed more and more these days, which is AWESOME! The problem however, is are we doing the self-care actions that are right for us? Let me introduce a new concept to you:

Concept 1: Actively Resting

Actively resting is the idea that whatever restful activity you are doing is actually providing you with energy. I don’t mean that you go for a run and therefore are “actively” resting or that you take a nap then feel like you can do 100 jumping jacks. Imagine this— like a gas tank in a car, you have an emotional tank and this tank slowly gets depleted as you go through the day / week. Whether it is work, taking care of others, having to get the chores done, whatever, you are depleting your emotional tank. The idea of self-care is that you take time throughout the day, everyday, to replenish this emotional tank.

When your emotional tank is on “E.”

When your emotional tank is empty, or pretty-darn close to empty, you may be receiving poor sleep. You could be showing signs of this by being irritable, having intense cravings or an appetite that feels like it is never ending. Maybe you don’t feel hunger and instead feel nauseous or lethargic or sick. You could be emotional with moods up and down all day long. It doesn’t sound good at all for that emotional tank to be empty. So we need to replenish it!

This brings me back to the concept of Actively Resting.

Are the forms of self-care you are working on implementing throughout the day actually re-energize you? Do they replenish your emotional tank or are you just sitting in the bath tub turning wrinkly and thinking… “what am I doing right now? I’d rather be watching Greys Anatomy.”

Yeesh. If this is how you’re feeling, then I would like you to decrease the baths and increase the Greys Anatomy watching.

All jokes aside, ask yourself this- when I am performing self-care or going on my weekend getaway, am I actively resting?

What is the opposite of actively resting? Well draining activities is probably the opposite, but let’s talk about Numbing. There are Numbing activities we do that we may think are self-care or restful, but they are not.

Concept 2: Numbing Activities

Numbing activities can be similar to our go-to, destress after work or a long day, activities. Keep in mind, what is numbing for one person can be active rest for another person. A numbing activity is something you do as a distraction from something, but it does not re-energize you. A common example of a numbing activity is playing on your phone- scrolling through social media, playing a game, etc. These activities suck time and provide little to no enjoyment. Sometimes numbing activities can even continue to drain us as we participate in them.

Can you think of your numbing activities?

Let’s Practice.

Consider making a list of all the activities you do for yourself on a daily basis. Example: buy a coffee, take a nap, take a shower, put on makeup (or not put on makeup), cook a meal, play with your fur baby or children, call a friend/family member. Make this list and don’t be afraid of its length.

Next, separate out what is numbing and what is energizing / active rest. Consider on a daily basis, are you participating in more numbing activities than active rest activities? If so, how can you mix this up?

What does this have to do with food?

Right, let’s connect these two things because after all, we are a group practice of registered dietitians!

Remember earlier when I mentioned the emotional tank? Well, you have a physical tank too. The physical tank is solely for food and beverages. When you are attune to what fills your emotional tank and recognize when this tank is depleted, you are less likely to participate in emotional eating or bored eating. Rather, you are more apt to take care of your body as a whole, mentally and physically.

When clients ask how to decrease their emotional eating, I usually ask them to consider two things:

1. Are you nourishing your body consistently throughout the day? Meals and Snacks.

2. Are you drained and exhausted? If so, what does your self-care look like (numbing or active rest)?

Looking for more?

If you feel like we are just scraping the tip of the iceberg, reach out to us! We do a lot more than just focus on your intake at Bamboo Nutrition. We work with you as a whole person and help you see how food connects to mental health and physical health. We would love to get to know you and help you feel like your optimal self!

Our registered dietitians specialize in various aspects of nutrition and health. To learn more about our team, click here. 

Bamboo Nutrition is located in Columbia, MO and sees clients in-person and virtually.