Why Does Bulimia Cause Face Swelling?


You may have heard of “bulimia face,” “bulimia cheeks,” or “chipmunk cheeks” highlighted as one of the harder-to-conceal red flags associated with bulimia. Many people who binge eat and purge experience this change to their appearance – here’s why.

Identifying Bulimia Nervosa

Bulimia nervosa is an eating disorder characterised by binge eating followed by unhealthy purging behaviours. It often co-occurs with body dysmorphic disorder, a mental health condition where someone feels excessive concern about perceived bodily flaws.

Bulimia nervosa symptoms may appear similar to those associated with anorexia nervosa, but the two conditions’ causes have a lot in common. A person who suffers from binge-and-purge anorexia, for example, may experience the effects of bulimia on the same grounds.

Bulimia Nervosa: The Severity Scale

We call bulimia nervosa “mild” when the person goes through a binging/purging cycle a handful of times a week, ranging up to “extreme” cases, which involve engaging inappropriate compensatory behaviour at least twice a day on average.

Purging Behaviours and Methods

People tend to picture “purging” as vomiting. This is not without reason, as forcing oneself to throw up (e.g., by using a finger, tool or an emetic medication like ipecac syrup) is the most common method of purging.

However, all of the following make up an in-exhaustive list of what are considered purging methods:

  • Self-induced vomiting
  • Excessive exercise
  • Starvation fasting
  • Diuretic abuse
  • Laxative abuse
  • Enema misuse
  • Under/overdosing insulin for diabetes management

There is no safe way to engage with purging. All of the methods above carry the risk of complications, and broadly speaking, purging is not a strategy that effectively or sustainably provides any of the weight or shape effects desired. Purging in various forms can drastically affect metabolism, reinforce pernicious self-image and self-esteem issues, and physically damage the body from head to toe.

Self-Induced Vomiting and Facial Swelling: Why and What to Do

Facial swelling is one of the common tell-tale signs of bulimia nervosa, cropping up silently in people who regularly purge through vomiting. It is one of the physical effects of a severe eating disorder.

What Causes Facial Swelling?

The body has three main salivary glands located throughout the cheeks and mandible. The largest of these, the parotid glands, are located between the cheekbones and ears. 

When the body functions normally, the parotid gland secretes saliva to make it easier to chew and swallow food. However, excessive vomiting sends saliva production into overdrive by introducing stomach acid to the oral environment. Frequent self-induced vomiting can cause these salivary glands to become seriously inflamed – a condition known as sialadenosis.

Reducing Bulimia Face Swelling

Generally speaking, any swollen face symptoms associated with bulimia calm down within a few weeks to a month after ceasing the pattern of binge eating and purging. It is quite rare for swelling of the salivary glands to turn into a long-term consequence – know that full recovery is almost always possible with time and with no surgical procedure necessary.

It is also worth noting that in some cases, the parotid glands become more noticeably inflamed, and swelling occurs for a short period after getting purges under control. It is good to be aware of this in advance when treating bulimia nervosa.

Swollen cheeks can reinforce bulimic behaviours in people who feel dysphoric about their appearance, triggering thoughts of extreme calorie restriction again. It is crucial that those in this position keep their thoughts positive and focused on the long-term recovery of well-being.

Surgical Intervention

Everybody reacts differently, and in very rare cases, it may take surgical intervention to bring the face back to its previous dimensions. However, surgery comes with potential complications of scarring, nerve damage, and facial paralysis – as well as the risk of reinforcing negative self-image. These cases are extremely uncommon, and dealing with them is a highly personal matter. However, treating bulimia through mental health intervention, nutritional and gastronomic education, and positive lifestyle changes are all the first and most effective fronts of action.

Beyond Bulimia Face: Other Effects of Bulimia

Not everyone with bulimia nervosa purges by throwing up, and not every person who engages in self-induced vomiting experiences facial swelling. If you are concerned that a child, friend, or partner in your life may struggle with binging and purging behaviours, it’s important to watch for the warning signs.

Parents in Conflict and the Children Who Live Through the Trauma

Physical Symptoms of Bulimia

The physical effects of bulimia include swollen cheeks, but they don’t stop there. The dehydration, nutritional loss, and physical stress associated with this eating disorder are seen throughout the whole body, including:

  • Rapid weight gain or weight loss
  • Thinning or brittle hair
  • Dental problems, tooth enamel erosion, and pain
  • Cuts on knuckles or fingers caused by triggering vomiting
  • Electrolyte imbalance
  • Dry, dull, or sallow skin
  • Low blood pressure
  • Bad breath
  • Oral canker sores
  • Acid reflux complaints

The Long-Term Physical Effects of Bulimia

Bulimia can have long-term physical side effects centred on individuals’ oral and digestive health if they develop sores in the mouth or tooth decay that is left untreated. Young people in remission or seeking treatment for bulimia are greatly encouraged to schedule a dental appointment in addition to one with a mental health professional as soon as possible to stop any physical damage from progressing.

Finally, while the list of immediate physical signs may appear mild, bulimia can have devastating effects on many physiological systems if untreated. Chronic dehydration, electrolyte imbalances, and malnutrition can develop and result in life-threatening kidney and heart problems. At the same time, bulimia has been linked to lowered bone density and the chronic deteriorative disease osteoporosis – a particular issue for girls and growing teens. Those who purge by self-induced vomiting can face complications, including ruptured oesophagus, early rectal prolapse, IBS, and digestive tract tearing.

Emotional and Behavioural Symptoms of Bulimia

The effects of bulimia pervade much further than the human body: often, the warning signs of bulimia start in the mind. You may notice any of the following signs of an eating disorder manifest long before physical effects do:

  • Storing large quantities of food around personal space
  • Binge eating in secrecy (e.g., late-night kitchen sweeps or eating when parents aren’t at home)
  • Extreme concern or dysphoria over body shape and size
  • Sudden interest in extreme or excessive exercise
  • Mood swings
  • Self-isolation due to concerns about appearance
  • Low self-esteem
  • Depression
  • Anxiety

Many people are socialised to avoid talking about eating disorders, weight gain, and weight loss, something most of us learn very early. If someone you care about is taking unhealthy measures to prevent weight gain, they may struggle to discuss it with you or anyone. If you see signs of an eating disorder but aren’t sure where to start, professional help is available to support you in starting the conversation.

Treatment for Eating Disorders and Body Dysmorphic Disorders

The Wave is a residential mental health treatment centre that focuses solely on the specific needs of adolescents and young people. We know that clients’ habits and health choices during this time of their life have truly profound long-term effects. 

We treat eating disorders with an approach that is holistic, evidence-proven, and sometimes alternative, taking each person’s journey with the responsibility and compassion it deserves. If you would like to learn more about what recovery at The Wave could mean for you or your loved one – we encourage you to reach out today.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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