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NEDA TOOLKIT for Coaches and Trainers Signs of bulimia nervosa • In general, behaviors and attitudes indicating that body weight and shape, weight loss, dieting and control of food are becoming primary concerns • Evidence of binge eating (eating in a discrete period of time an amount of food that is much larger than most individuals would eat under similar circumstances), including the disappearance of large amounts of food in short periods of time or lots of empty wrappers and containers indicating consumption of large amounts of food; feeling a lack of control over the ability to stop eating • Evidence of purging behaviors, including frequent trips to the bathroom after meals, signs and/ or smells of vomiting, presence of wrappers or packages of laxatives or diuretics • Appearing uncomfortable eating around others • Developing food rituals (e.g., eating only a particular food or food group [e.g., condiments], excessive chewing, not allowing foods to touch) • Skipping meals or taking small portions of food at regular meals • Stealing or hoarding food in strange places • Drinking excessive amounts of water • Using excessive amounts of mouthwash, mints and gum • Hiding body with baggy clothes • Maintaining an excessive, rigid exercise regimen despite weather, fatigue, illness, or injury; the need to “burn off ” calories • Unusual swelling of the cheeks or jaw area • Calluses on the back of the hands and knuckles from self-induced vomiting • Discolored, stained teeth • Creating lifestyle schedules or rituals to make time for binge-and-purge sessions • Withdrawing from usual friends and activities • Bloating due to fluid retention • Frequently dieting • Puffy face • Thinning hair • Has secret recurring episodes of binge eating • Body weight is typically within the normal weight range; may be overweight Page  | 16