People with bulimia nervosa are typically within the normal weight range – although their weight may sometimes fluctuate – and the purging behavior is often secretive, which may make it difficult for others to initially recognize a problem. However, the following signs may indicate that a person has bulimia:

• Recurrent episodes of binge eating (consuming excessive amounts of food in a short time period)
  
  
• Extreme efforts to prevent weight gain, especially purging methods (e.g., self-induced vomiting, misusing laxatives [usually mild drugs that induce bowel movement] or diuretics), in addition to fasting or excessive exercising
  
  
• Repeated trips to the bathroom, especially after eating
  
  
• Hiding or storing food in strange places (e.g., under the bed)
  
  
• Unhealthy focus on body shape and weight

Physical symptoms of prolonged bulimia may include:

• Dehydration (e.g., very dry skin)
  
  
• Fatigue or general weakness
  
  
• Dental problems (e.g., gum and tooth decay) from the gastric acids contained in vomit
  
  
• Irregular menstrual periods
  
  
• Swollen cheeks from chronic vomiting
  
  
• Calluses or scars on knuckles from frequent self-induced vomiting (Russell’s sign)
  
  
• Frequent sore throats or swollen lymph glands
  
  
• Signs of trauma to the throat from ongoing use of fingers and/or other objects (e.g., pencils) to induce vomiting
  
  
• Abdominal pain and other stomach problems including bloating, gas and constipation
  
  
• Edema (swelling), caused by laxative and diuretic abuse
  
  
• Painful, swollen veins in the lower portion of the rectum or anus (hemorrhoids)
  
  
• Irregular heartbeat