How Bulimia Is Diagnosed

Bulimia (also called bulimia nervosa) is an eating disorder involving recurring cycles of binge eating and compensatory (offsetting) behaviors such as:

• Self-induced vomiting
• Excessive exercise
• Misuse of laxatives

It is a serious disorder and can be life-threatening.

Bulimia is typically diagnosed using a combination of physical and psychological exams and lab tests. Learn more.

Professional Screenings

If bulimia does not require emergency treatment, the process of diagnosing bulimia usually begins with a primary healthcare provider.

To start, the healthcare provider will perform a full examination. This might include:

• Taking a medical history, including a mental health history
• Asking about family medical history, including eating disorders, mental health disorders, or substance use disorders
• Reviewing symptoms or concerns
• Asking about current medications being taken
• Measuring height and weight
• Checking vital signs (such as heart rate, blood pressure, and temperature)
• Examining skin and nails
• Listening to the heart and lungs
• Feeling the abdomen
• Asking about diet (what and how much is eaten, binge-eating and purging frequency, compensatory behaviors such as vomiting, use of laxatives or diuretics, fasting, exercise routine, etc.)
• A discussion about substance use
• If indicated, a primary healthcare provider may give a referral to a mental health professional for further screening or treatment

Physical signs healthcare providers may look for as possible indicators of bulimia include:

• Broken blood vessels in the eyes (caused by strain while vomiting)
• A pouch-like look to the cheeks
• Small cuts and calluses on the tops of the finger joints (from inducing vomiting)

Dental professionals may notice these signs of bulimia during a dental exam:

• Cavities
• Gum infections (such as gingivitis)
• Worn or pitted tooth enamel from exposure to the acid in vomit

DSM-5 Criteria

The "Diagnostic and Statistical Manual of Mental Disorders" (DSM–5) published by the American Psychiatric Association uses the following criteria to determine a diagnosis of bulimia:

A. Recurrent episodes of binge eating, as characterized by both:

1. Eating, within any 2-hour period, an amount of food that is definitively larger than what most individuals would eat in a similar period of time under similar circumstances.
2. A feeling that one cannot stop eating or control what or how much one is eating.

B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting or excessive exercise.

C. The binge eating and inappropriate compensatory behaviors occur, on average, at least once a week for 3 months.

D. Self-evaluation is unjustifiably influenced by body shape and weight.

E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

In more basic terms, this means the following cycle of behaviors would occur at least once every week for three or more months:

• Repeated episodes of binge eating: Eating a large amount of food in a fairly short period of time and not feeling any control over what is eaten and how much
• Following binge-eating episodes with purging behaviors: Self-induced vomiting, excessive exercise, severe food restriction or fasting, and/or misuse of laxatives, diuretics, or enemas in an effort to compensate for food intake to prevent weight gain
• Disproportionately negative view of their own weight and shape: Feeling that weight and shape are the most important aspects of themselves, mattering more than any other characteristics

Labs and Tests

Though there are no specific diagnostic tests for bulimia, healthcare professionals may run tests to check the severity of the effects bulimia has had on the body.

Blood Tests

Blood tests that may be run include:

• Complete blood count (CBC): A set of tests evaluating blood cells, including white blood cell count, red blood cell count, platelet count, the concentration of hemoglobin, and hematocrit levels (ratio of red blood cells to total volume of blood)
• Complete metabolic panel: Measures glucose (sugar) level, electrolyte and fluid balance, kidney function, and liver function
• Amylase and lipase measurement: Used to check for problems with the pancreas, such as pancreatitis (inflammation)
• Phosphorus and magnesium measurements
• Thyroid function tests: A set of tests that measures how well the thyroid gland is working
• Electrolyte tests: Measures levels of the body's main minerals (sodium, chloride, potassium, magnesium, bicarbonate)

Urine Tests

Urine analysis can be performed to check:

• Hydration status
• pH level (measurement of the acidity or alkalinity in the urine)
• Ketone level (level of organic compounds found in the liver and made when glucose is in short supply)
• Signs of kidney damage

Other Tests

Other tests and procedures that may be ordered include:

• X-rays and scans: To measure bone density, check for stress fractures/broken bones, and look for pneumonia or heart problems
• Electrocardiogram (ECG): To check for problems with the heart (such as slow heart rate or abnormal heart rhythm)

Self- or At-Home Testing

Usually used as a tool in annual health physicals and sports physicals, the SCOFF questionnaire is an effective way to screen for eating disorders such as bulimia and can be taken at home.

The SCOFF questionnaire asks the following questions:

1. Do you make yourself sick because you feel uncomfortably full?
2. Do you worry that you have lost control over how much you eat?
3. Have you recently lost more than 14 pounds in a three-month period?
4. Do you believe yourself to be fat when others say you are too thin?
5. Would you say that food dominates your life?

One point is given for every “yes” answer. A score of two or more is an indication that a person may have anorexia or bulimia and needs to see a healthcare professional for further steps. Self-screening is not a substitute for consulting with a healthcare provider.

A Word From Verywell

While bulimia is not always easy to spot, getting a proper diagnosis is essential for determining a treatment plan and setting you on the road to recovery.

If you think you may have bulimia or another eating disorder, book an appointment to speak with your healthcare provider.