Bulimia nervosa is an eating disorder that can cause behaviors such as binge eating and self-induced vomiting, as well as psychological symptoms relating to poor self-esteem and body image. Untreated, bulimia can lead to severe medical complications, some of which may be cause permanent harm or fatalities, so professional treatment is often required.
Early physical effects of bulimia
Bulimia can cause physical changes and effects within a short period of time. These physical changes result from binge eating episodes, poor nutritional intake, self-induced vomiting, use of laxatives, and other purging or compensatory behaviors. Often, these effects are reversible if treated, but without proper medical intervention they may cause permanent or long-term health complications [1].
Early and potentially short-term physical effects of bulimia may differ depending on purging activity but can include [2][3]:
- Weight fluctuations
- Dry hair, skin, and nails
- Feeling cold
- Feeling dizzy or faint
- Tooth discoloration, sensitivity, and erosion
- Sore throat
- Cuts or callouses on knuckles
- Dry mouth
- Headaches
- Stomach issues such as pain, acid reflux, and constipation
- Red eyes, known as subconjunctival hemorrhages
Physical effects of long-term bulimia
If bulimia continues for a long time or is not treated, it can cause worsening symptoms and severe physical health complications. With appropriate treatment, many of these complications can be effectively managed, but some physical effects can cause permanent or long-term issues or even fatalities [1][4].
Dental
Regularly engaging in self-induced vomiting for prolonged periods of time is likely to cause severe and irreversible dental damage, including tooth decay, periodontal disease, and gingivitis. This damage is often caused by stomach acid entering the mouth but can also be caused by excessive consumption of sweet or acidic foods during binge episodes [4][5].
Throat
Similarly, self-induced vomiting can cause damage to the esophagus, such as tears, bleeding, and inflammation, and issues with esophageal muscle activity, including spasms, tension, and inability to swallow. Some research also indicates that frequent vomiting can increase the risk of esophageal cancer [4][5].
Gastrointestinal
Various gastrointestinal issues can occur within the context of bulimia, such as bloating and acid reflux caused by binge eating, as well as complications caused by purging behaviors. Self-induced vomiting and excessive use of laxatives can potentially cause severe damage to the stomach, including tears, bleeding, obstructions, and rectal prolapse [1][4].
Dehydration
Purging behaviors, including vomiting, laxative use, and diuretic use, can cause severe dehydration and loss of electrolytes. Low levels of electrolytes, such as potassium, sodium, and magnesium, can lead to severe medical complications, such as coma, seizures, or issues with the heart such as sudden cardiac arrest, which is one of the main causes of fatality in those with bulimia [1].
Swollen glands
One of the salivary glands, the parotid gland, commonly becomes enlarged in those who engage in regular self-induced vomiting, causing excessive swelling of the face. This typically occurs in the days following a cease of vomiting and can cause a lot of pain. Generally, this swelling reduces after purging behaviors have stopped for some time, but in worst cases, surgery may be required to remove or treat the swelling [1][5].
Heart
Cardiac issues, such as arrythmias, low blood pressure, increased heart rate, cardiac arrest, and heart failure can occur because of purging behaviors, poor nutritional intake, and severe dehydration and electrolyte imbalance [5].
Kidneys
Similarly, kidney damage and failure can occur due to dehydration and low electrolyte levels caused by laxative or diuretic abuse and self-induced vomiting [4].
Hormones
As bulimia can cause hormonal deficiencies, some females experience reduced estrogen levels, resulting in a loss of menstrual bleeding. This occurs less often within the context of bulimia than anorexia, in which amenorrhea is common. Females with bulimia tend to experience irregularities in their cycles more often than a complete loss of bleeding [6][7].
As such, infertility is less common in females with bulimia than anorexia, but bulimia can occasionally cause issues with fertility and pregnancy complications in some, particularly if the individual previously experienced symptoms of anorexia [6].
Bones
As hormonal deficiencies impact bone density, bulimia can cause issues with bone health and strength, but again, this is more commonly seen in those with bulimia who have a history of anorexia. Dehydration and laxative abuse can also impact bone health, potentially causing a softening and weakening of the bones [1][7].
What to do if you notice these symptoms in someone
If you notice these physical effects occurring to someone you know, it may be that they have an eating disorder such as bulimia. If it is appropriate, you should encourage them to seek professional help, which is the best way to treat the condition and physical complications that have occurred [4].
Often, asking for help can be a distressing and challenging decision for people with an eating disorder, so you could offer to go with them to the doctor or seek professional advice for yourself on how to help them manage this and receive treatment for their condition [2].
Treatment options for bulimia
It is advised to seek professional intervention to treat bulimia, as this provides the best possible chance of recovery. As bulimia and other eating disorders are complex conditions, treatment often involves input from several professionals, such as a mental health professional, dietician, therapist, and physician. This collaborative multidisciplinary approach helps to effectively manage all mental and physical symptoms of the condition [8].
Physical effects that have occurred due to bulimia will be treated with medical intervention. A dietician can help to improve nutritional intake and provide education around healthy eating habits. A therapist will help individuals explore underlying causes of the condition and any emotional distress that occurs in the context of the condition or the treatment process [1][2].
If it is deemed appropriate by a medical professional, medications can be prescribed during the treatment process to help reduce emotional distress and harmful behaviors. For example, antidepressant medications such as fluoxetine have been found to be helpful for some in the treatment of bulimia [1][8].
- Nitsch, A., Dlugosz, H., Gibson, D., & Mehler, P.S. (2021). Medical Complications of Bulimia Nervosa. Cleveland Clinic Journal of Medicine, 88(6), 333–343. Retrieved from https://doi.org/10.3949/ccjm.88a.20168
- National Health Service. (Reviewed 2020). Bulimia. NHS. Retrieved from https://www.nhs.uk/mental-health/conditions/bulimia/overview/
- National Eating Disorders Association. (2022). Bulimia Nervosa. NEDA. Retrieved from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/bulimia
- Forney, K.J., Buchman-Schmitt, J.M., Keel, P.K., & Frank, G.K. (2016). The Medical Complications Associated with Purging. The International Journal of Eating Disorders, 49(3), 249–259. Retrieved from https://doi.org/10.1002/eat.22504
- Mehler, P.S., Rylander, M. (2015). Bulimia Nervosa – Medical Complications. Journal of Eating Disorders, 3, 12. Retrieved from https://doi.org/10.1186/s40337-015-0044-4
- Crow, S.J., Thuras, P., Keel, P.K., & Mitchell, J.E. (2002). Long-Term Menstrual and Reproductive Function in Patients with Bulimia Nervosa. The American Journal of Psychiatry, 159(6), 1048–1050. Retrieved from https://doi.org/10.1176/appi.ajp.159.6.1048
- Warren, M.P. (2011). Endocrine Manifestations of Eating Disorders. The Journal of Clinical Endocrinology & Metabolism, 96(2), 333–343. Retrieved from https://doi.org/10.1210/jc.2009-2304
- Jain, A., & Yilanli, M. (2022). Bulimia Nervosa. In StatPearls [Internet]. Treasure Island, FL: StatPearls Publishing. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK562178/
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