Bulimia is an eating disorder that can become very serious if left untreated, and recognising the signs and symptoms of this condition can be the best way to help either yourself or a loved one seek the required help.

At Augmentive, we aim to provide holistic, tailored mental health support to everyone so they can live their life to the fullest. If you are curious to know more about bulimia and how to identify it, we’re here to support you with the information you need.

Bulimia can be a somewhat mysterious condition since many sufferers are secretive about their actions, so we are here to shine a light on it; its signs and symptoms, why it can be so dangerous, what to look out for in a loved one, and how the condition is treated.

What is bulimia?

You may have heard of bulimia nervosa in the past — commonly known as just bulimia. People who suffer from this condition are usually concerned with body weight or shape, and may eat large amounts of food in secret then try to remove the food from their body in an unhealthy way to avoid processing the calories. This can include, for example, making themselves vomit, taking laxatives (to force a bowel movement), using weight loss supplements, doing an enema after eating, or something else.

The long-term health risks of bulimia are severe, with dehydration leading to potentially major medical problems like kidney failure and heart problems. Early detection and treatment offers the best chance of avoiding more serious issues. Absolutely anyone can suffer from bulimia, but it does tend to be most common among teenagers aged 13 to 17.

"If we peel back the layers, we find that bulimia isn’t just about food and weight. It’s about perception, both internal and external, and a desperate, sometimes silent, scream for validation and acceptance. It’s about finding a way to exist in a world that seems to demand perfection at any cost – even self-harm. It’s important to view bulimia as a functional disorder. The act of purging isn’t simply a self-destructive impulse; it’s a mechanism for managing emotions and, surprisingly, sometimes, a sense of order. The very action that seems so incomprehensible to an outsider is a paradoxical stabilising force for the one suffering."
- James Hitchen, Psychotherapeutic Counsellor

How is bulimia different from other eating disorders?

There are many eating disorders out there, but some of the most common are:

• Anorexia — People with anorexia are typically underweight (although not always) as they restrict or avoid food.
• Avoidant/restrictive food intake disorder (ARFID) — People with ARFID aren’t typically concerned with weight or body image, but restrict food for other reasons (a dislike of certain foods, fear of choking, etc). You can read more about ARFID here.
• Binge eating disorder — People with binge eating disorder tend to binge but don’t purge, and may put on excess weight as a result.
• Bulimia — People with bulimia may maintain their typical weight through a cycle of binge eating then purging.

How common is bulimia?

According to the eating disorder charity, Beat, an estimated 1.25 million people are affected by some sort of eating disorder in the UK, and it is believed bulimia accounts for around 19% of all eating disorders.

What are the signs of bulimia?

Bulimia can trigger a mix of emotional, behavioural and physical signs and symptoms, and understanding what these are enables you to recognise them in yourself or someone you love.

Some of the primary signs of bulimia include:

• Bingeing on food regularly, and overeating until uncomfortably full.
• Purging to negate the bingeing. This includes any attempt to remove previously eaten calories from the body, such as vomiting or taking laxatives.
• Thinking about food most of the time, such as obsessively counting calories and worrying about eating.
• Self-esteem issues and a focus on body image, particularly body weight.

Some other complications of bulimia include:

• Dental issues (frequent vomiting can cause enamel erosion, sensitive teeth and discolouration)
• Stomach issues like acid reflux and constipation
• Fainting or light-headedness
• Irregular menstrual periods
• Muscle weakness and fatigue
• Swollen cheeks or jaw line, sometimes called ‘chipmunk cheeks’

Why does bulimia cause ‘chipmunk cheeks’?

Bulimia is known to cause puffiness around the face and jaw which happens as a result of forced throwing up after eating. We all have two parotid glands located in front of our ears which produce saliva to help us chew and digest food. When someone with bulimia engages in purging, these glands become agitated over time and eventually swell, which causes a puffiness in the face known as sialadenosis.

Although it’s not dangerous, it is noticeable on the face and can affect the person’s self-esteem, further exacerbating body image issues. This swelling can be reversed with medications such as pilocarpine, which increases saliva production. Typically, if someone is suffering from this facial swelling it is likely not the only side effect from their bulimia, and ultimately treatment for the underlying cause will be needed.

"It’s important to note that while “chipmunk cheeks” or facial swelling can be a sign of bulimia, not every person with bulimia will exhibit this symptom, and not all cases of facial swelling are due to bulimia. Bulimia nervosa is a complex eating disorder that has both physical and psychological components, and its symptoms can vary widely among individuals."
- James Hitchen, Psychotherapeutic Counsellor

How is bulimia treated?

Depending on age and the severity of the condition, some people will be recommended a guided self-help program, while others (and those under 18) will require a more tailored treatment plan from a professional.

If you are aged 18+ you may be asked to work through a self-help book, keep a diary to manage your mental health and recognise triggers, and monitor your food intake to plan healthy meals and notice old patterns changing. This will be done with the help of a therapist. Cognitive behavioural therapy (CBT) may also be advised to dive deeper on the issue, and some other things that may help include support groups, medication, nutritional support, and more.

If you're under 18, you may be offered a similar treatment plan to the above, plus family therapy which involves speaking to a therapist together to discuss how your family can support you on your journey back to health.

"From my vantage point, breaking the cycle of bulimia requires far more than just a structured eating plan. It entails reconstruction – of self-image, of emotional management, of finding alternative outlets for relief and control. The side effects of bulimia, if left unchecked, can be devastating. A damaged oesophagus, severe dehydration, and imbalances in essential electrolytes are just some of the physical manifestations. The psychological toll is often more hidden but no less damaging – shattering self-esteem and distorting self-image."
- James Hitchen, Psychotherapeutic Counsellor

How do I know if I have bulimia?

The SCOFF questionnaire can help. Designed by Professor John Morgan at Leeds Partnership NHS Foundation Trust, this list of questions can help identify a potential eating disorder. A score of 2 or more ‘YES’ answers is a positive screen.

• Do you ever make yourself sick because you feel uncomfortably full?
• Do you worry you have lost control over how much you eat?
• Have you recently lost more than one stone in a three month period?
• Do you believe yourself to be fat when others say you are too thin?
• Would you say that food dominates your life?

What do I do if I think someone I love has bulimia?

It’s hard to tell by their appearance whether or not someone has an eating disorder. Someone with bulimia may be binge eating then purging, and as a result maintaining a fairly typical weight.

Swollen cheeks or a swollen jawline could be an indication of a number of things, but if you are worried about someone with signs of bulimia, encouraging them to seek treatment quickly will give them the best chance of recovery.

Outside of the treatment plan recommended to them by a professional, you can also support them by providing a safe space to talk about their feelings, and helping them when doing food-related activities such as shopping at the supermarket or eating meals.

Whether you’re feeling off-kilter or want to shake up your routine, our state-of-the-art mental wellbeing platform gives you quick and seamless access to world-class support on your terms, from private psychiatric assessments and reviews to broader mental health care: join us today.