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Last updated on August 8th, 2025 at 07:33 pm
Bulimia nervosa can also leave visible and painful signs on the face and throat. From swollen cheeks often referred to as “bulimia cheeks” and broken blood vessels to chronic sore throats dental erosion, the physical toll of repeated purging can be both distressing and dangerous
Bulimia nervosa is an eating disorder often characterized by cycles of binge eating followed by purging behaviors such as vomiting, laxative abuse, and/or compulsive exercise.
Understanding how bulimia affects these areas of the body is crucial not just for recognizing warning signs, but for promoting healing and long-term recovery.
This article takes you through some of the signs and clinical impacts of bulimia nervosa from the face to the esophagus.
What is Bulimia Face
Bulimia face is the swelling of the face as a result of self-induced vomiting producing swollen salivary glands.
Contributors to bulimia face include:
- Reduced salivary flow rate resulting from vomiting
- Swelling of the three salivary glands including the parotid gland which is the largest
- The appearance of “chipmunk like” cheeks as a result of the swelling
The appearance of a bulimia face is that of “chipmunk cheeks” or puffy cheeks.
Is Bulimia Face Swelling Reversible
Yes. Bulimia face swelling is temporary as long as the person completely discontinues intentional vomiting.
Salivary glands begin to decrease in size about 8 weeks after someone completely stops vomiting. The sooner a person is able to completely stop purging behavior, the faster the relief from swelling in the face takes place.
The rate in which swelling in the face is reversed varies from person to person. Pharmaceuticals and other treatment remedies can help assist in reducing swelling in the cheeks.
Will Everyone With Bulimia Experience Face Swelling
No.
While up to 80% of those with bulimia nervosa will experience face swelling, many will not.
Face swelling is only one symptom of bulimia nervosa. Bulimia should not be ruled out because someone does not have face swelling if they are showing other symptoms of an eating disorder or purging.
Swelling of the face in bulimia depends on
- Frequency of purging
- Genetics
- Overall level of malnutrition
- How long the person has experienced bulimia
“Bulimia Face” Treatment
When someone stops purging, they might continue to experience swollen glands in the face. Swollen glands that occur in treatment can be just as painful as during active purging. Ultimately, getting rid of swollen glands from purging will require complete cessation from purging.
Even purging one time can quickly elicit symptoms of swollen glands in the mouth.
Treatment for swollen glands after discontinuing purging includes:
- Applying heat to swollen glands
- Sucking on lemon drops to increase salivary flow
- Increasing fluid intake
- NSAIDs or prescription medication to reduce inflammation
- Swishing your mouth with lemon juice (initially this can be painful but will reduce swelling)
- Correcting any malnutrition
- Properly hydrating
- Messaging the face and neck
Bulimia Teeth Signs
One of the most visible and painful consequences of bulimia nervosa is the damage it causes to the teeth. Bulimia often involves repeated self-induced vomiting which causes stomach acids frequently pass through the mouth. This erodes the protective enamel that keeps teeth healthy. Over time, this can lead to a wide range of dental problems that can be both emotionally and physically distressing.
Damage to the teeth in bulimia is the result of:
- Changes in pH of the mouth with continuous vomiting
- Changes in bacteria of the mouth
- Dry mouth
- Decreased salivary flow
- Teeth sensitivity
- The lower ability for saliva to acquire pellicle (a defense against acid erosion)
Gastric acid which has a pH of 2.7 begins to dissolve tooth enamel the more frequently a person purges.
Bulimia and Throat Problems
Frequent vomiting can lead to:
- Acid reflux
- Gerd
- Chronic sore throats
- Barrett’s Esophagus
- Upper GI tract bleeding
- Ulcers
- Partial thickness tears in the esophagus (mallory-weiss tear or Boerhaave syndrome)
Purging through vomiting can cause the upper GI tract to bleed. The stomach becomes irritated by stretching following a binge and then vomiting. This can produce ulcers as well.
While some of these symptoms impacting the GI tract with bulimia are reversible, some such as GERD or Barrett’s esophagus may be lifelong. Symptoms such as Boerhaave syndrome are uncommon but can be deadly.
Bulimia Hands
Damage to the knuckles in bulimia is commonly known as Russell’s sign—a physical symptom that appears as scrapes, calluses, or scarring on the knuckles, particularly the backs of the hands.
Russell’s sign develops from repeatedly using the fingers or hand to induce vomiting. As the knuckles come into contact with the upper teeth during purging, friction and trauma can occur, leading to:
- Redness or abrasions
- Calluses or hardened skin
- Scabbing or scarring
- Swelling or bruising
This damage is most commonly seen on the dominant hand, and over time, it may become more noticeable and harder to heal if the purging continues. If these symptoms are seen on someone’s hand, it is a warning sign of an eating disorder.
Treating Teeth and Face Swelling In Bulimia
The only way to prevent further dental and esophageal damage and reverse some or all of the damage that has already been done is to treat the underlying eating disorder.
This will include working with an eating disorder dietitian, a medical doctor and a therapist to establish a recovery meal plan and stop purging safely. You will need to correct any malnutrition to properly heal from any clinical impacts of eating disorder behaviors.
If you have dental or esophageal damage from purging, visit your dentist regularly and see an ears, nose and throat specialist to determine the extent of the damage caused by any purging.
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