A lifetime prevalence of 0.5 percent and 0.9 percent for adults and adolescents, respectively, is estimated among the United States population. Bulimia nervosa may affect up to 1% of young women and, after 10 years of diagnosis, half will recover fully, a third will recover partially, and 10–20% will still have symptoms.Adolescents with bulimia nervosa are more likely to have self-imposed perfectionism and compulsivity issues in eating compared to their peers. This means that the high expectations and unrealistic goals that these individuals set for themselves are internally motivated rather than by social views or expectations. Criteria
Bulimia nervosa can be difficult to detect, compared to anorexia nervosa, because bulimics tend to be of average or slightly above average weight. Many bulimics may also engage in significantly disordered eating and exercise patterns without meeting the full diagnostic criteria for bulimia nervosa. Recently, the Diagnostic and Statistical Manual of Mental Disorders was revised, which resulted in the loosening of criteria regarding the diagnoses of bulimia nervosa and anorexia nervosa. The diagnostic criteria utilized by the DSM-5 includes repetitive episodes of binge eating (a discrete episode of overeating during which the individual feels out of control of consumption) compensated for by excessive or inappropriate measures taken to avoid gaining weight. The diagnosis also requires the episodes of compensatory behaviors and binge eating to happen a minimum of once a week for a consistent time period of 3 months.
This cycle may be repeated several times a week or, in more serious cases, several times a day and may directly cause:

Chronic gastric reflux after eating, secondary to vomiting
Dehydration and hypokalemia due to renal potassium loss in the presence of alkalosis and frequent vomiting
Electrolyte imbalance, which can lead to abnormal heart rhythms, cardiac arrest, and even death
Esophagitis, or inflammation of the esophagus
Mallory-Weiss tears
Boerhaave syndrome, a rupture in the esophageal wall due to vomiting
Oral trauma, in which repetitive insertion of fingers or other objects causes lacerations to the lining of the mouth or throat
Russells sign: calluses on knuckles and back of hands due to repeated trauma from incisors
Perimolysis, or severe dental erosion of tooth enamel
Swollen salivary glands (for example, in the neck, under the jaw line)
Gastroparesis, or delayed gastric emptying
Constipation or diarrhea
Tachycardia or palpitations
Hypotension
Peptic ulcers
Infertility
Constant weight fluctuations are common
Elevated blood sugar, cholesterol, and amylase levels may occur
Hypoglycemia may occur after vomitingThese are some of the many signs that may indicate whether someone has bulimia nervosa:
A fixation on the number of calories consumed
A fixation on and extreme consciousness of ones weight
Low self-esteem and/or self-harming
Suicidal tendencies
An irregular menstrual cycle in women
Regular trips to the bathroom, especially soon after eating
Depression, anxiety disorders and sleep disorders
Frequent occurrences involving consumption of abnormally large portions of food
The use of laxatives, diuretics, and diet pills
Compulsive or excessive exercise
Unhealthy/dry skin, hair, nails, and lips
Fatigue, or exhaustionAs with many psychiatric illnesses, delusions can occur, in conjunction with other signs and symptoms, leaving the person with a false belief that is not ordinarily accepted by others.People with bulimia nervosa may also exercise to a point that excludes other activities.