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There are various symptoms and complications that are related to different eating disorders, all of which vary according to the severity of the eating disorder.

Bulimia Without Anorexia

Bulimia nervosa, which is more commonly referred to as bulimia, involves recurrent bing eating episodes that can be followed by a period of fasting (bulimia with anorexia), self-induced vomiting, excessive use of either laxatives, diuretics or other medications and/or exercise. Bulimia without anorexia, otherwise referred to as purging type, accounts for a majority of bulimia patients. As a result of self-induced vomiting or other forms of purging, bulimic individuals may exhibit various physical signs and symptoms.

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Behavioral Symptoms

• Sudden episodes of eating or purchasing large amounts of food
• Evidence of use of certain medications:
  • Laxatives
  • Diet pills
  • Emetics (drugs that induce vomiting)
  • Diuretics (medications that reduce fluids)
• Using the bathroom right after meals on a regular basis.
  • Bathroom visits may be unusually long
• Eats in private
• Eats a restrictive diet
• Binge episodes are usually on high-fat, high-carbohydrate and high-sugar “junk” foods
• Behavioral problems like shoplifting, binge spending, alcohol or drug use and/or sexual promiscuity
• Decline in work and school attendance
• Short lasting relationships
• Perfectionist behaviors
• Excessive exercising
• Extreme fluid intake

Cognitive and Emotional Symptoms

• Preoccupation with food
• Difficulty performing daily tasks
  • Concentrating
  • Decision making
  • Rigid thinking
• Fear about intimacy in personal relationships
• Anxiety
• Depression
• Anger
• Irritable
• Defiant or stubborn with or without mood swings
• Feelings of worthlessness, inadequacy, loneliness and low self esteem
• Fear of weight gain
• Withdrawal from family and friends after meals

Physical Symptoms

• Broad fluctuations of weight
• Evidence of red eyes
  • Occurs as a result of  broken eye blood vessels during the strain of vomiting
• Dental Effects (result from excessive acid exposure from forced vomiting episodes)
  • Erosion of the tooth enamel
  • Cavities in the teeth
  • Gum diseases
• Hand (Knuckle) Injuries (result from self-induced vomiting)
  • “Russel’s Sign”
    • Cuts
    • Calluses
    • Scars
• Dehydration
• Fainting spells
• Dizziness
• Hand tremors
• Blurred vision
• Dry mouth
• Swollen parotid and/or salivary glands
  • Pouch-like appearance to the corners of the mouth
• Rashes and pimples
• Loss of, or irregular, menstrual periods
• Hypertension
• Edema (swelling)
• Sore and/or irritated throat
• Esophagitis
• Electrolyte imbalance3

Anorexia

Anorexia nervosa, which is more commonly referred to as anorexia, is characterized by dramatic weight loss that results from severe restriction in food intake. Aside from the emotional and behavioral symptoms associated with anorexia, the physical signs and symptoms of this eating disorder often occur as a result of starvation.

Behavioral Symptoms

• Severe dieting
  • Restrictive dieting
  • Binge-eating
  • Purging
• Individuals maintain detailed food diaries and records
  • Food quantity
  • Weight
  • Fat grams
• Excessive exercising along with severely restrictive dieting
• Refusal to eat in front of others
• Refusal to eat certain foods
  • Can profress to restrictions against whole categories of food (e.g., no carbohydrates)
• Ritualistic eating habits
  • Cutting food into small pieces
  • Avoiding certain foods
  • Eats foods in certain orders
  • Excessive chewing
  • Rearranging food on a plate
• Reactivity and hypersensitivity to cold
• Excessive heavy clothing to prevent from being cold and from the thinness being apparent
• Shop for groceries and prepare food for others, but avoids eating
• Food hoarding
• Social withdrawal
• Unrealistic perfectionist behaviors
• Denies feeling hungry

Physical Symptoms

• Dramatic weight loss
• Menstrual irregularities (women)
  • Long periods without menstrual periods
  • Delay in onset of menses in young girls
  • Amenorrhea
• Hair loss from scalp
• Yellow tone to skin.
  • Especially evident on palms of the hands and soles of the feet
  • Occurs as a result of eating too many vitamin A-rich vegetables (e.g., carrots)
• Dry skin covered with fine hair
• Dry and brittle nails
• Sleep problems
• Muscle weakness
• Swollen feet and hands
  • Can be accompanied with cold or mottled hands or feet
• Bloating after eating and digestive problems
• Impaired immune system
• Abnormal laboratory test results
  • Anemia
  • Low thyroid levels
  • Low hormone levels
  • Low potassium
  • Low blood cell count
  • Slowed heart rate
• Gastrointestinal symptoms
  • Stomach cramps
  • Constipation
  • Acid reflux

Cognitive and Emotional Symptoms

• Confused or slowed thinking
• Poor memory or judgment
• Conversations and projects revolving around food and weight loss
• Indecisive
• Inflexible thinking
• Beliefs regarding thinness equating to happiness
• Severe self-control
• Anxiety
• Depressionn
• Angry
• Stubbornness
• Mood swings
• Feelings of inadequacy, worthlessness, ineffectiveness and loneliness
• Low self-esteem
• Incapability to adjust to changes of routines
• Severe fear of weight gain
• Refusal to believe anything is wrong
• Denial for need for help
  • May become sulky, angry or defensive when concern is expressed
  • Denies feeling hungry
• Withdrawal from social activities
  • More isolated
  • Secretive
  • Limited social spontaneity

References

• “Eating Disorder Types and Symptoms” – National Association of Anorexia Nervosa and Associated Disorders
• “Eating Disorders Warning Signs” – Anorexia Nervosa and Related Eating Disorders
• “Warning Signs of Bulimia” – Fairwinds Treatment Center”
• “Teaching Students with Mental Health Disorders Resources for Teachers” – Ministry of Education
• “Anorexia nervosa” – Mayo Clinic

Further Reading

• All Eating Disorder Content
• What is an Eating Disorder?
• What Causes Eating Disorders?
• Eating Disorder Signs
• Eating Disorders Diagnosis

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.