Signs and Symptoms

Why Does Bulimia Cause Face Swelling & “Chipmunk Cheeks”?

By Dennis Gibson, MD, FACP, CEDS

Bulimia nervosa is a serious eating disorder that can leave devastating consequences in its wake. While most people with eating disorders put a great deal of effort into keeping their eating disorders secret, when a person with bulimia develops visible swelling on the sides of the face (often dubbed “chipmunk cheeks”), it is harder to keep the eating disorder private.

The development of swollen cheeks with bulimia is a sign that an individual has been living with their eating disorder for quite some time. Additional life-threatening medical complications may also be present and eating disorder treatment should be sought.


What is Bulimia?

The primary behaviors associated with bulimia nervosa include binge eating and purging. Binge eating refers to eating a large amount of food in a short amount of time, often accompanied by strong feelings of guilt or shame. Purging refers to episodes of self-induced vomiting, excessive exercise, laxative abuse and other methods intended as a means of weight loss.

Bulimia can lead to a number of distressing and damaging medical complications. Complications and their severity are highly dependent on the severity of the eating disorder and how long the behaviors have been occurring.


“Chipmunk Cheeks”: A Common Sign of Bulimia

One of the telltale signs of bulimia is the appearance of swollen cheeks – colloquially known as “chipmunk cheeks” – on the sides of the face.  Caused by the enlargement of the parotid glands (one of the salivary glands), the medical term for this phenomenon is sialadenosis. It is estimated between 10-66% of bulimia patients may develop parotid gland enlargement, depending on the number of daily self-induced vomiting episodes.

Individuals living with bulimia often suffer from frequent feelings of anxiety and low self-esteem. They may place a great deal of emphasis on their appearance, become fixated on body weight and may even suffer from body dysmorphic disorder. The binge eating behaviors can trigger calorie restriction or purging behaviors, with vomiting contributing toward the development of sialadenosis. When an individual who is already self-conscious about their appearance develops swollen cheeks, it can be highly emotionally distressing.

In some cases, parotid gland enlargement subsides once the bulimia behaviors have stopped. In other instances, parotid gland enlargement persists for months or years following a full recovery from the eating disorder.  


Causes of Parotid Gland Enlargement

The human body contains three salivary glands, including the parotid gland. Located on each cheek, just below the ear and above the jaw, the parotid gland’s primary job is to produce saliva to aid digestion and other bodily functions.

The exact cause of parotid gland enlargement with bulimia remains unclear. The gland receives both sympathetic innervation (“fight or flight”) and parasympathetic innervation (“rest and digest”) which becomes dysregulated. When this occurs, for whatever reason, the parotid grands hypertrophy, or increases in size, to allow for increased saliva and/or salivary protein production. Whether these nervous system changes are brought about due to repeated bingeing episodes with large quantities of food, vomiting behaviors that increase saliva production, or some other unknown factor, is unclear.  


Treatment for Parotid Gland Enlargement

Here’s the good news for individuals suffering from parotid gland enlargement: when you stop bingeing and purging, the parotid glands shrink back to their normal size over time. However, they do not shrink immediately — so patience is key. Medications and other remedies may help to provide relief. In rare cases, individuals may require a surgical procedure to slim the face further, called a parotidectomy. However, this procedure is not without complications: scarring and nerve damage may occur, as well as facial paralysis.

Cessation of bingeing and purging behaviors is not only emotionally taxing but there are often comorbid electrolyte deficiencies that require urgent or emergent medication intervention. We therefore encourage all individuals to seek medical consultation before abruptly stopping eating disorder behaviors. The goal is always to achieve a full and lasting recovery, but it must be done safely — supervised by trained, experienced eating disorder professionals.

Certain treatments can help including over the counter pain relievers, such as ibuprofen or tylenol along with heating pads. Medications to stimulate saliva production (sialoguges) can also help alleviate any symptoms. In rare instances, a medication called pilocarpine may be required but this has increased side effects that require monitoring.


Get Help for Bulimia & Parotid Gland Enlargement

Living with bulimia is challenging, emotional and painful. And many of the complications that occur with bulimia, like parotid gland enlargement, do not resolve until the individual fully recovers from their eating disorder. Should a patient relapse back into eating disorder behaviors, their symptoms and medical complications will return.

The best treatment for parotid gland enlargement stemming from bulimia is to seek help from an effective, accredited, experienced intensive eating disorder treatment center. Given the expertise of the medical providers at ACUTE, in treating these complications, we will be able to provide excellent education on this condition, and when treatment is warranted, discuss the various modalities available.  

Expertise and experience matter when seeking medical care for a severe eating disorder. The ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health is the only dedicated medical stabilization program in the country with the resources, environment and experience to treat the most medically severe cases of eating disorders. Following treatment, we will help you transition to an inpatient or residential treatment center, if needed, where you can continue making progress towards a full recovery. We are here for you when experience matters most.


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    Written by

    Dennis Gibson, MD, FACP, CEDS

    Dennis Gibson, MD, FACP, CEDS serves as the Medical Director at ACUTE. Dr. Gibson joined ACUTE in 2017 and has since dedicated his clinical efforts to the life-saving medical care of patients with…

    ACUTE Earns Prestigious Center of Excellence Designation from Anthem
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