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NEDA TOOLKIT for Parents Bulimia Nervosa In general, behaviors and attitudes indicate that weight loss, dieting, and control of food are becoming primary concerns Evidence of binge eating, including 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 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 Appears uncomfortable eating around others Develops food rituals (e.g., eats only a particular food or food group [e.g., condiments], excessive chewing, doesn’t allow foods to touch) Skips meals or takes small portions of food at regular meals Steals or hoards food in strange places Looks bloated from fluid retention Drinks excessive amounts of water Frequently diets Uses excessive amounts of mouthwash, mints, and gum Hides body with baggy clothes Maintains excessive, rigid exercise regimen – despite weather, fatigue, illness, or injury, the need to “burn off ” calories Shows unusual swelling of the cheeks or jaw area Has calluses on the back of the hands and knuckles from self- induced vomiting Teeth are discolored, stained Creates lifestyle schedules or rituals to make time for binge- and-purge sessions Shows extreme concern with body weight and shape Has secret recurring episodes 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); feels lack of control over ability to stop eating Purges after a binge (e.g., self-induced vomiting, abuse of laxatives, diet pills and/or diuretics, excessive exercise, fasting) Body weight is typically within the normal weight range; may be overweight Withdraws from usual friends and activities Page | 10