It’s not uncommon for people with eating disorders to hide their condition from loved ones. This can be especially true if the person is struggling with bulimia nervosa, which often takes the form of binging and purging. It’s important to know how to identify these signs so that you can get help and support for your loved one (or yourself).
What is Bulimia Nervosa?
Bulimia nervosa is a serious eating disorder and mental illness that is defined by the following, according to the National Eating Disorders Association:
Bulimia Nervosa is 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 disorders association
Since it is a mental illness, it has diagnostic criteria that are detailed in the DSM-5 (the discussion around the issues with the DSM-5 will have to be a whole other discussion). Some of these criteria include episodes of binge eating that occur multiple times.
You may be wondering what is defined as a binge. The DSM-5 defines it as eating an amount of food larger than most people would eat during a time period within 2 hours. There is also a sense of lack of control when a binge is occurring where you would feel that you cannot stop eating.
Another key part of this diagnosis is that after a binge, there is a compensatory behavior to prevent weight gain. This could be self-induced vomiting, using laxatives or diuretics, fasting for a period of time or over-exercising.
The next important part of the puzzle is determining the frequency for these behaviors. If they are occurring once a month for a period of 3 months, then it would be sufficient for a DSM-5 diagnosis. However, I would highly encourage anyone who is doing these behaviors to reach out for help regardless of the frequency.
If you are wondering whether a loved one may have bulimia nervosa, here are 5 signs to look for.
5 signs of Bulimia Nervosa
Sudden and extreme weight fluctuations
While the media portrays eating disorders as only being in thin, white women, that is not at all the case. If someone is having sudden and extreme weight *fluctuations,* then this could be a potential warning sign. However, their weight may not change in a noticeable way at all. Note: Please be careful if you are considering approaching this topic with a loved one. You do not want to perpetuate weight stigma or anything related to that under the guise of being concerned.
Frequent trips to the bathroom after eating, or may be unable to go at all
If you start to notice that a loved one is constantly going to the bathroom after meals/snacks, then this could be a potential warning sign. When someone is suffering from bulimia nervosa, they may be compensating for food they ate by frequently going to the bathroom to either purge by vomiting or from laxative or diuretic misuse.
Signs of obsessive behavior around food
These days diet culture likes to encourage obsessive behavior around food, so it may be difficult to determine what is someone participating in a diet vs. what is disordered. In general, you are looking for when someone cannot join you at the restaurant for dinner without looking up the nutrition information first. They are obsessive about tracking their food/calories/points/etc. and cannot miss a day without it causing them distress. They talk about what meal they are really craving, but will not allow themselves that food because it is ‘bad’ or ‘unhealthy.’ They may become obsessed with collecting recipes or cookbooks.
Extreme mood swings, irritability and depression when not following a strict diet plan
Imagine how it feels when you are hungry and become irritable. Now multiply that by about ten and you may soon understand why your loved one could be experiencing mood swings and irritability if they are suffering from bulimia nervosa. It could be from the restriction from food, which causes hunger and irritability. Then they are also using a ton of mental energy doing the gymnastics in their mind around trying to eat perfectly in order to control the size of their body. Add the over-exercising on top of this and it is a dangerous combination.
Attempts at purging through vomiting or misuse of laxatives/diuretics
The most commonly known aspect of bulimia nervosa is self-induced purging or vomiting. If you discover that a loved one is doing this, I encourage you to approach them with empathy and compassion in order to help them get the help they need and deserve. Vomiting causes damage to the body over time including to teeth enamel and the esophagus. Another common method of purging is when they use laxatives or diuretics to rid their bodies of any ‘water weight’ or stools.
How do you approach a loved one
First, I want to say thank you for caring about your loved one. When you decide to discuss your concerns with them I think it is important to not be accusatory in any way. Your loved one is not choosing to participate in an eating disorder. An eating disorder is a serious mental illness and they need your love and support in order to heal and recover. They do not need someone to shame them or punish them (they are punishing themselves enough already). Be sure to listen to them, give them space and ask them how they would like to be supported.
You may find that they do not respond to the conversation positively. Having an eating disorder can cause them to be defensive and not capable of thinking clearly. Please do not take it personally because they do need your help.
It’s hard for anyone to live with an eating disorder, but it can be especially tough on the people closest to them. If you or someone you care about has disordered thoughts around food that may indicate a problem, don’t hesitate to reach out or schedule a call.
Which signs did you notice most?
What was going on in their lives at the same time as these behaviors started happening?