What does someone with bulimia look like? Is there a way to “see” if a person has bulimia? Unlike anorexia, those with bulimia may not show drastic weight loss and they are often able to mask their physical symptoms for a long time. Physical symptoms of bulimia are often intrinsically linked to the person’s specific compensatory behaviors to counter their binge eating. This makes specific physical “signs” of bulimia hard to pin down.   

Bulimia is an eating disorder that is characterized by periods of binge eating and followed by compensatory behaviors like purging or exercising excessively. Purging behaviors can include self-induced vomiting, which can sometimes result in tooth decay and overactive, swollen salivary glands – colloquially called “chipmunk cheeks”. Not every person who can be diagnosed with bulimia will have a “telltale” sign or get “bulimia face” as not every person with this eating disorder purges or self-induces vomiting. The negative physical side-effects of bulimia can be life-threatening and often require treatment to help those suffering overcome this condition.  

What is Bulimia Nervosa? 

Bulimia nervosa is an eating disorder (ED) characterized by multiple episodes of binge eating (eating past the point of being full), followed by an unhealthy compensatory behavior. These behaviors can be purging or non-purging and can include, vomiting, taking laxatives, excessive exercise, or any other unhealthy behaviors done to compensate for the bingeing. Bulimia is a serious mental illness that can have devastating effects on mental and physical health.  

Bingeing makes the person feel that they are out of control of their eating and may lead to feelings of intense shame or guilt. To reduce the impact of bingeing, people with bulimia will try to compensate for the excessive caloric intake, which may include behaviors like self-induced vomiting or exercising past a healthy limit. Individuals with bulimia often find themselves thinking about their body weight and shape even when they try not to. Bulimia nervosa is a disorder of both the mind and body. 

The disorder is linked to negative and extremely harsh self-judgment. Self-perceived flaws in appearance and personality are always front of mind, whether the person with bulimia wants to think about these things or not. Trends in body shape and size or facial features like gaunt cheeks and angular bone structure can have profound effects on someone’s mental health and self-esteem, especially if the person feels that they do not match the current trend. Despite many of these “fashionable” features being genetically predetermined, the person may believe, for example, that weight loss will make their cheeks look more gaunt and “desirable”. They might tie thoughts like this to their self-esteem and happiness, making symptoms like “chipmunk cheeks” particularly cruel side effects of purging to control body shape. 

What is “Bulimia Face” or “Chipmunk Cheeks”? 

Bulimia is linked to swelling of the cheeks, which may seem counter-intuitive considering that many people purge to control their body size and shape. Societal norms often dictate that certain facial features are “better” or “more desirable”. Unfortunately, most of our facial features can only be altered with cosmetic illusion or invasive surgeries, like buccal fat pad removal surgery. Using that lens, it is understandable that bulimia-related “chipmunk cheeks” can cause great psychological distress in people who develop them. 

“Bulimia face” or “chipmunk cheeks” are particularly cruel, because this symptom often only develops after a person starts treatment and is recovering from their eating disorder. As the name suggests, the person’s cheeks swell disproportionately to the rest of their face. Like a chipmunk with cheek pouches full of food, the person develops swelling over the joint between the jaw and skull, just in front of the ears. It is not actually the cheeks (buccal pads) that swell, but the salivary glands in that area. These glands are called the parotid glands. In about 50% of those with bulimia who purge by vomiting, the parotid glands will swell after the person stops vomiting regularly.  

Although swelling of salivary glands may be more easily identifiable than other physical side-effects of bulimia, they are not the only side-effect. Specifically looking at the face, other side-effects can include: 

• Tooth decay or erosion. Constant exposure to acidic vomit (3.8pH) when purging along with changes to the saliva due to changes in food intake is thought to be the main cause of tooth erosion in those diagnosed with bulimia with purge by vomiting. Unfortunately, this physical damage cannot be reversed. 
• Damage to the mouth and throat. This is also thought to be related to vomiting. 
• Hoarseness, dry cough, difficulty swallowing can also be a side-effect of vomiting. 
• Dry skin, hair loss and chapped lips. This could be due to dehydration, malnutrition and hormone imbalances. 
• Hair growth (such as on the upper lip or chin). Hormones like estrogen, progesterone and testosterone can become imbalances and change secondary sexual characteristics. 
• Generalized swelling or (edema) might be seen in the face – but will more commonly be seen in places like the ankles. 
• Nosebleeds can be more frequent. 

 What other Effects can Bulimia have on the Body? 

Individuals with bulimia often report that they are unhappy with their body shape or size. Unfortunately, the purging behaviors that people with bulimia perform to compensate for episodes of bingeing can also affect the person’s physical appearance in ways that may exacerbate the negative perception they have of their body. Some of the detrimental physical effects of bulimia include: 

• Skin callouses (or a Russell sign) on the knuckles of their dominant hand. This is caused by the teeth irritating the skin on the back of the hand when the person makes themselves vomit. This is an excellent example of a “telltale” sign not being a good way to self-diagnose others with bulimia, as many people who induce vomiting to purge can do it spontaneously. 
• Lung weakness and increased susceptibility to pulmonary diseases. When retching, internal pressure in the lungs and chest changes drastically and damage can be done to the lungs. Liquids and bacteria may also have increased access to the lungs, because damage can be done to the structure that keeps the esophagus and brachia divided when eating. 
• Upper gastrointestinal complications often occur in those who vomit, while overuse of laxatives can damage the lower part of the gastrointestinal system. 
• Kidney damage can occur due to malnutrition, dehydration, dietary changes and overuse of diuretics. 
• Other effects can be seen here.  

Treatment for “Chipmunk Cheeks” 

It is important to remember that “chipmunk cheeks” or “bulimia face” are a symptom of bulimia. The main treatment that the person needs to seek is that for bulimia nervosa. Within a comprehensive treatment plan for bulimia, medical professionals will treat the swelling of the parotid glands. Treatments for swelling of the parotid salivary glands can include anti-inflammatory drugs, warm compresses, massage, hydration, and good oral health care.  

Many people with bulimia only seek treatment in their 30’s or 50’s, making treatment more complicated and behaviors harder to change. Although eating disorders should be treated as soon as possible, treatment can be started from wherever a person is in their recovery journey. Complete the form below for more information on the treatment program at Koru Spring.