What are the signs and symptoms of bulimia nervosa?

Bulimia nervosa’s signs and symptoms usually consist of a blend of mental and physical characteristics and traits, as well as behaviors. Some may be obvious only to a medical professional; others may be more easily noticed by the affected person’s friends, family, coaches, or teachers (if the individual is in school). See the Checklist: Signs and symptoms family and friends may be likely to notice and Checklist: Signs and symptoms dentists and primary care professionals may be likely to notice. Other less common symptoms may be present as well.

Binge eating and purging may seem like obvious signs that are hard to miss. However, these behaviors can be, and often are, well masked by a person with bulimia nervosa. People with bulimia nervosa may hide the behavior because they feel shame and guilt. The disorder may progress for some time before anyone else notices because the weight or outward physical appearance of people with bulimia nervosa may not change in the same way that appearance changes with an eating disorder like anorexia nervosa. Even an individual with a severe case of bulimia nervosa can appear to be of normal weight or even overweight. That is why weight is not used as a criterion in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for diagnosing bulimia nervosa.