Bulimia is the most common eating disorder, affecting about 3 percent of the U.S. population. But that estimate is rough, because the people who suffer from the binge-and-purge eating disorder - 90 percent of whom are females between the ages of 14 and 40 - do their best to hide their odd and potentially deadly behavior.
Do you worry that someone you care about has bulimia? Here are 12 warning signs to watch for, from Harvard psychologist Dr. Sharon Chirban, who specializes in the treatment of eating disorders.
Bulimia can cause dramatic fluctuations in body weight. A bulimic might shift from extreme thinness to being overweight or bloated.
Does she "disappear" after meals? Avoid eating around others? Make frequent trips to the bathroom? Those can all be red flags.
What's That Smell?
Bulimics throw up so frequently that they often have chronic bad breath. Typically, it has an acidic or even rotten smell.
Dry, Puffy Skin
Women suffering from bulimia often develop dry, puffy skin. And that's not the only physical change you might notice. Others include yellowish or brownish teeth, mouth or gum sores, and dull or straggly hair.
Some bulimics spend so much time gagging themselves that they develop worn-down fingernails and knuckle calluses.
There's nothing unusual about occasional use of laxatives. But if you start seeing lots of laxative bottles around the house - or lots of discarded laxative bottles in the trash - be suspicious.
Bulimics often rely on laxatives to get rid of unwanted food and the calories they contain. Some take 20 doses at a time, says Dr. Chirban.
Bulimics generally like to have a receptacle handy for their frequent purges. Does she always keep a cup at her bedside? A thermos in the car? Those could be red flags.
All that binging and purging can take a lot out of a person. No wonder chronic fatigue is so common among bulimics.
Bulimics often feel low just after binging - or missing a workout. Excessive self-criticism and self-doubt are common problems, too. Bulimics tend to be perfectionists.
Bulimics are deeply concerned about their weight and appearance - so much so that they often seem, to talk nonstop about food choices, calorie counts, etc.
To conceal their eating binges, bulimics often stash food in secret places - in a car, bedroom, a dresser, the back of a cabinet, etc.
Exercise is great. But someone who simply cannot stand to miss a visit to the gym - working out even when tired or sick or late at night - may be suffering from bulimia. Spending hours at the gym or working out so intensely that injuries arise are also cause for concern.
Bulimics hate for other people to see them eat. They tend to avoid family dinners and dinner dates.