10 Long Term Effects & Complications of Bulimia Nervosa

While most complications of bulimia nervosa resolve with cessation of purging, it can cause various long-term health problems, such as dental erosion, gastroesophageal reflux disease and coronary heart disease. Although these conditions aren't reversible, it is never too late to seek treatment for them or an eating disorder. Medical stabilization and nutritional rehabilitation can help slow progression, manage conditions and improve quality of life regardless of how long someone has suffered from bulimia nervosa.

The Long-term Complications of Bulimia Nervosa

Bulimia nervosa (BN) is an eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors, behaviors used to counteract weight gain from binge eating.¹ Compensatory behaviors fall into two categories:

• Purging behaviors: any compensatory behavior that involves elimination, include self-induced vomiting, laxative misuse, diuretic misuse and enemas
• Non-purging behaviors: any type of compensatory behavior that does not involve purging, which may include food restriction or fasting, excessive exercise or diet pills

Purging behaviors can also cause a variety of different medical complications, including:

• Dental issues
• Heart arrhythmias
• Bradycardia
• Gastrointestinal issues

While most of these issues resolve with nutritional rehabilitation and cessation of purging, some patients with bulimia nervosa can experience long-term effects of their disorder, especially for those whose eating disorder is left untreated or for those who experience either:¹

• Severe BN (8-13 binge/purge episodes per week)
• Extreme BN (14+ binge/purge episodes per week)

What are the Long-term Effects of Bulimia Nervosa?

#1 Dental erosion (perimylosis)

The most common complication of bulimia nervosa is dental erosion, also known as perimylosis.² Self-induced vomiting and repeated exposure to stomach acid can cause dental erosion, leading to brittle and weak teeth. Over time this can increase risk of:

• Chipping and breaking
• Hypersensitivity
• Cavities
• Pain
• Infection
• Discoloration
• Difficulty chewing

Unfortunately, dental erosion is permanent once it develops.²

#2 Gastroesophageal reflux disease

Gastroesophageal reflux disease (GERD) is common in patients with bulimia nervosa.² GERD is a condition characterized by a weakened esophageal sphincter, causing a reflux of stomach contents into the esophagus.

Early identification and treatment can often help reverse the damage caused by GERD. However, individuals who have experienced acid reflux symptoms from self-induced vomiting for several years face a higher risk of developing chronic symptoms, which can significantly reduce their quality of life:

• Persistent heartburn or regurgitation
• Nighttime reflux that disrupts sleep
• Esophagitis
• Scarring of the esophagus
• Chronic cough, hoarseness or globulus sensation

#3 Periodontitis

Chronic irritation from exposure to stomach acid from self-induced vomiting can cause the gums to become inflamed (gingivitis).³ When left untreated, it can develop into more serious periodontal disease, like periodontitis.

Over time the jaw degrades and the gums pull away from the teeth, creating pockets that can fill with plaque and bacteria that can lead to:

• Loose teeth
• Tooth aches
• Tooth loss
• Jaw pain
• Infection

#4 Cathartic colon syndrome

Chronic laxative abuse can lead to severe constipation, also known as cathartic colon syndrome.² With this condition, the colon becomes hypomotile, and in the most extreme cases patients may need to have part or all of their colon removed.⁴

#5 Atherosclerosis

Bulimia nervosa is linked to atherosclerosis, the thickening or hardening of the arteries caused by plaque buildup.⁵ Unfortunately, atherosclerosis cannot be fully reversed, so long-term lifestyle changes and monitoring are needed in order to lower the risk of:

• Blood clots
• Heart attack
• Stroke

#6 Coronary heart disease

Atherosclerosis can also contribute to the development of coronary heart disease (CHD), also called ischemic heart disease or coronary artery disease (CAD).⁵ CAD is a narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart. CAD develops gradually and slowly reduces the amount of blood that can reach the heart. This can cause:

• Chest pain
• Shortness of breath
• Fatigue

CHD is also not completely reversible, requiring long-term management and monitoring to reduce the risk of blood clots, heart attack and sudden cardiac death.

If left untreated, patients may eventually need surgery to fix blocked coronary arteries, such as coronary angioplasty. During this procedure, a blocked coronary artery is opened, and a stent, a mesh-like tube, is inserted to permanently keep the artery open and prevent it from narrowing again.

#7 Gynecological & obstetric problems

Bulimia nervosa can cause menstrual cycles can become irregular (oligomenorrhea).² While eating disorders do not have long-term effects on fertility after recovery, when an eating disorder is active, family planning can be more difficult.⁶

Furthermore, pregnant women with eating disorders who engage in bingeing and purging behaviors face additional maternal and fetal complications, including an increased risk of:^7,8

• Miscarriage
• Premature birth
• Low birth weight
• Peripartum depression (formerly known as postpartum depression)

#8 Mallory-Weiss syndrome

In rare cases, a sudden increase in pressure in the stomach or lower part of the esophagus during vomiting can tear the lining of the upper gastrointestinal tract near where the esophagus meets the stomach, causing bleeding.²

While most cases of Mallory-Weiss syndrome resolve on their own, some patients have persistent or recurring tears that need treatment with an endoscopic injection, heat therapy, hemoclips or band ligation to help close the tear.⁹

#9 Barrett’s esophagus

Because the esophageal mucosa is chronically exposed to stomach contents, there may be a higher risk of developing Barrett’s esophagus, a pre-cancerous condition.² Barrett’s esophagus is a progressive condition, so treatment is necessary to help slow its progression over time.

#10 Esophageal cancer

Barrett’s esophagus puts patients at an increased risk of developing esophageal adenocarcinoma (EAC), a serious and often deadly cancer. While less than 1% of patients with Barrett’s esophagus develop EAC annually, their risk remains significantly higher than that of those without Barrett’s esophagus.^10,11

Recovering from Severe or Extreme Bulimia Nervosa

It’s never too late to get help for bulimia nervosa. Even in severe or extreme cases, medical stabilization and nutritional support can reduce complications and reverse many of the effects of malnutrition. No matter how long you’ve been struggling, recovery is possible. While some effects may be permanent, seeking support still makes a big difference for your health and wellbeing.

Take the first step with a free assessment.

References

1. American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: APA.
2. Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P. S. (2021). Medical complications of bulimia nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333–343. https://www.acute.org/medical-complications-bulimia-nervosa
3. Valeriani, L., Frigerio, F., Piciocchi, C., Piana, G., Montevecchi, M., Donini, L. M., & Mocini, E. (2024). Oro-dental manifestations of eating disorders: a systematic review. Journal of Eating Disorders, 12(1). https://doi.org/10.1186/s40337-024-01050-8
4. Mehler PS, Rylander M. Bulimia nervosa – medical complications. Journal of Eating Disorders 2015;3(1):12. https://doi.org/10.1186/s40337-015-0044-4
5. Tith, R. M., Paradis, G., Potter, B. J., Low, N., Healy-Profitós, J., He, S., & Auger, N. (2019). Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry, 77(1), 44. https://doi.org/10.1001/jamapsychiatry.2019.2914
6. Chaer, R., Nakouzi, N., Itani, L., Tannir, H., Kreidieh, D., Masri, D. E., & Ghoch, M. E. (2020). Fertility and Reproduction after Recovery from Anorexia Nervosa: A Systematic Review and Meta-Analysis of Long-Term Follow-Up Studies. Diseases, 8(4), 46. https://doi.org/10.3390/diseases8040046
7. Morgan, J. F., Lacey, J. H., & Chung, E. (2006). Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: Retrospective Controlled study. Psychosomatic Medicine, 68(3), 487–492. https://doi.org/10.1097/01.psy.0000221265.43407.89
8. Trahan, M., Badeghiesh, A., Baghlaf, H., Picado, J., & Dahan, M. H. (2022). Pregnancy outcomes among women with bulimia nervosa [A217]. Obstetrics and Gynecology, 139(1), 63S. https://doi.org/10.1097/01.aog.0000826144.91955.c7
9. Lecleire, S., Antonietti, M., & Ducrotté, P. (2009). Syndrome de Mallory-Weiss : diagnostic et traitement. La Presse Médicale, 39(6), 640–644. https://doi.org/10.1016/j.lpm.2009.09.019
10. Ebell, M. H. (2025). Predicting the risk of esophageal adenocarcinoma in people with Barrett esophagus. PubMed, 111(3), 279–280. https://pubmed.ncbi.nlm.nih.gov/40106299
11. Hvid-Jensen, F., Pedersen, L., Drewes, A. M., Sørensen, H. T., & Funch-Jensen, P. (2011). Incidence of Adenocarcinoma among Patients with Barrett’s Esophagus. New England Journal of Medicine, 365(15), 1375–1383. https://doi.org/10.1056/nejmoa1103042