Long Term Effects & Complications of Bulimia

By Allison Nitsch, MD, FACP, CEDS

Bulimia nervosa (BN) is a serious eating disorder characterized by a cycle of binge eating followed by purging. Binge eating refers to eating a large quantity of food in a short period of time, often followed by feelings of guilt or shame. Purging refers to behaviors people use to prevent weight gain, such as self-induced vomiting, misusing laxatives, exercising excessively and/or misuse of diuretics also known as “water pills”. People with BN may engage in multiple forms of purging and may be in larger bodies.

The dangerous purging behaviors associated with BN can lead to a host of medical complications that affect nearly all vital organs and bodily systems, leading to an increased mortality rate. Thankfully, many of the complications associated with BN are reversible with effective treatment, highlighting the importance of seeking help for bulimia nervosa before medical complications arise.


Long Term Effects of Bulimia

People with severe BN (8-13 binge/purge episodes per week), and extreme BN (14 or more binge/purge episodes per week) may experience both short- and long-term complications related to the eating disorder, depending on the type and frequency of purging. Unfortunately, some medical complications may persist even after stopping chronic purging behaviors. 


Digestive Complications

Purging through vomiting or laxative abuse can cause a wide range of complications in the gastrointestinal tract, contributing to bloody stools, diarrhea, and hemorrhoids. Rectal prolapse may occur, where the rectum (the last part of the large intestine) slides out through the anal opening. Chronic laxative abuse can lead to severe constipation, also known as cathartic colon syndrome; with this condition, the colon essentially stops moving and patients may need to have part or all of their colon removed. Dehydration can be common, as fluids and vital nutrients are lost at abnormally high rates with diarrhea, vomiting and laxative abuse. Additional gastrointestinal issues related to BN include:

  • Gastroesophageal reflux (GERD)
  • Pain with swallowing (odynophagia)
  • Irritation of the esophagus (Esophagitis)esophageal erosions and ulcers
  • Pre-cancer changes in the esophagus (Barrett’s esophagus)
  • Esophageal bleeding (Mallory-Weiss Tears)
  •  Esophageal rupture (Boerhaave’s syndrome)
  • Stomach rupture


Dental Complications

Purging through vomiting causes stomach acid to wear away at the tooth enamel. Teeth may chip or become so thin that they appear translucent. Chewing and eating may become difficult or even painful. Cavity risk increases along with other serious consequences, including:

  • Tooth loss
  • Reduced salivary flow rate
  • Tooth hypersensitivity
  • Gum disease (periodontal disease)
  • Dry mouth (xerostomia)


Throat Complications

Purging through vomiting can cause stomach acid to irritate or tear the esophagus. Chronic acid reflux may appear, along with the following complications:

  • Difficulty swallowing (dysphagia)
  • Sensation of having a lump or something stuck in the throat (globus sensation)
  • Chronic coughing
  • Hoarseness and sore throat
  • Indigestion
  • Esophageal cancer


Cardiac Complications

Bulimia nervosa can result in an electrolyte imbalance, potentially putting a dangerous strain on the heart. This can lead to an irregular heartbeat, a weakened heart muscle and heart failure, as well as low blood pressure, a weak pulse and anemia. Other cardiac complications related to BN include:

  • Increased heart rate (sinus tachycardia) with rest and exertion, low blood pressure (hypotension), and rapid blood pressure drops when standing (orthostasis)
  • Prolonged QTc interval, abnormal heart rhythms (arrhythmias), passing out (syncope) and feeling that the heart “fluttering” (palpitations)
  • Potentially fatal heart rhythms such as Ventricular tachycardia and torsades de pointes
  • Congestive heart failure and sudden cardiac death


Reproductive Complications

The nutritional deficiencies that result from repeated purging and self-induced vomiting can lead to hormonal imbalances. In women, menstrual cycles can become irregular or cycles may stop altogether (amenorrhea). This may result in infertility for women trying to conceive. Furthermore, pregnant women who engage in bingeing and purging behaviors face additional complications for themselves and their unborn child, including an increased risk of:

  • Miscarriage
  • Premature birth
  • Low birth weight
  • Birth defects
  • Stillbirths


Complications with Skin, Hair and Nails

Repeated episodes of bingeing and purging can lead to rough, dry, itchy skin and several other complications that show up in the skin, hair and nails, including:

  • Sudden hair loss (alopecia)
  • Excessive growth of fine hair on the skin (Hypertrichosis lanuginose)
  • Inflammation at the corners of the mouth (Cheilosis)
  • Orange discoloration of the skin (Carotenoderma)
  • Skin abrasions and callus formation on the dorsal aspect of the hand (Russell’s sign)


Complications with Emotional and Mental Health

Most people experiencing complications related to bulimia nervosa will experience one or more distressing symptoms related to their emotional and mental health, including one or more of the following:


Pulmonary Complications

Bulimia nervosa can cause serious damage to the pulmonary system, at times leading to sudden onset respiratory distress. Stomach contents can leak into the lungs during vomiting (aspiration), irritating the lungs (pneumonitis) and potentially cause infection of the lungs (pneumonia). Small breaks in the lung due to the increased pressure caused by vomiting can cause air to leak between the lung and surrounding tissues (pneumomediastinum).


Treating Bulimia and its Complications

If you or someone you know is suffering health effects from bulimia nervosa, know that most complications can resolve with time and effective treatment. Patients experiencing severe medical instability as a result of BN may require medical stabilization in order to become physically, nutritionally, and emotionally stable prior to entering a traditional eating disorder treatment program. Once medically stable, the patient can transition to the appropriate program to continue recovery.

When seeking help for extreme bulimia nervosa, severely underweight patients can turn to inpatient medical settings where trained eating disorder experts are skilled in treating uncomfortable and life-threatening medical complications. In these settings, treatment teams deliver intensive dietary and psychiatric support as they pursue further testing and accurate diagnoses.


Get Help for Bulimia Nervosa

Eating disorders are among the deadliest mental illnesses, affecting people of every size, race, age, sexual orientation, gender identity, ability and background. ACUTE’s hospital-based, inpatient medical stabilization unit treats patients with severe and extreme bulimia nervosa experiencing life-threatening complications. Contact us to learn more about purging cessation and treatment for severe bulimia nervosa today.


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Written by

Allison Nitsch, MD, FACP, CEDS

Dr. Allison Nitsch obtained her Bachelors degree in Chemical Engineering from The University of Texas at Austin. She then matriculated to Texas A&M Health Science Center where she completed her…

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