Physical signs include Swollen parotid glands Scars on the back of the hand (from repeatedly inducing vomiting by using fingers to trigger gag reflex) Dental erosion Diagnosis of Bulimia Nervosa Clinical criteria Clinical criteria (1) for diagnosis of bulimia nervosa include the following: Recurrent episodes of binge eating (the uncontrolled consumption of unusually large amounts of food) that are accompanied by feelings of loss of control over eating and that occur, on average, at least once a week for 3 months Recurrent inappropriate compensatory behavior to influence body weight (on average, at least once a week for 3 months) Self-evaluation that is unduly influenced by body shape and weight concerns Diagnosis reference 1.