Dangers and Health Effects of Bulimia Nervosa

Overall, bulimia nervosa causes fewer negative health effects than anorexia nervosa. The effects of binge eating and purging are also generally less serious than the complications of starvation that so often afflict anorexics.

 

This is not to say that the effects of bulimia cannot be serious: Bulimia can, in fact, be fatal. The dangers of laxative and ipecac syrup abuse as well as the effects of binge eating, can result in serious conditions that require medical attention.

Self-induced vomiting is a common purging technique used after binge eating. Frequent vomiting can result in metabolic alkalosis, an imbalance in the body's acid/base balance. The effects of metabolic alkalosis range from slowed breathing (including instances of apnea, the cessation of breathing during sleep) to irritability to irregular heartbeat to convulsions and coma.

More noticeable are the effects repeated vomiting has on the teeth. Stomach acid gradually erodes dental enamel, discoloring teeth and causing unusual numbers of dental cavities. As dental enamel continues to erode, teeth become more sensitive to hot and cold foods and liquids.

Frequent vomiting also increases the likelihood of lung aspiration, which can cause damage to lung tissue. Aspirated vomit may cause pneumonia, shock and respiratory distress.

Many bulimics induce vomiting with ipecac syrup. Ipecac is an emetic designed to induce vomiting in poison victims. Ipecac is available without a prescription, making it easy for people with bulimia to access.

 

The effects of repeated use of ipecac can be serious. Ipecac misuse causes muscle weakness and tachycardia (an abnormal, and potentially dangerous, rapid heart rate). Ipecac abuse can also result in cardiomyopathy, a condition in which the heart muscle can no longer pump sufficient blood. Ipecac-induced cardiomyopathy is a factor in many bulimia nervosa fatalities.

Like ipecac syrup, laxatives are often abused by bulimics. Laxatives are used to quickly purge calories ingested during binge eating. Regular use of laxatives leads to laxative dependency. The minor effects of laxative misuse include dehydration, constipation and hemorrhoids.

 

Prolonged use of laxatives affects the normal functioning of the bowel and colon. Restoration of normal bowel function may take weeks after laxatives are discontinued. In cases where laxatives are severely abused (some bulimics take up to fifty laxatives a day) surgery may be required to restore bowel function.

Abusing laxatives can be fatal. Laxatives can induce hypokalemia, an abnormally low potassium level in the blood, which may lead to electrolyte imbalances. Misusing diuretics and self-induced vomiting also increase the risk of electrolyte imbalances.

Electrolytes are dissolved minerals used by the body to conduct electricity. Potassium, sodium and calcium are all important for proper electrolyte balance. Laxatives, diuretics, and other purging techniques prevent the body from maintaining a proper level of electrolyte minerals.

Electrolytes are vital for proper electric signals in the heart. One of the most serious dangers of electrolyte imbalance in bulimia is heart arrhythmia (irregular heartbeat). A heart problem is not only one of the dangers of bulimia; it is a leading cause of death associated with bulimia nervosa.

While complications of laxative abuse and vomiting are more common than serious binge eating complications, binge eating can also cause serious health effects. In rare cases, the lining of the esophagus or stomach tears or ruptures due to the pressure of binge eating. This is a serious and life-threatening effect of binge eating that requires immediate and emergency medical treatment.

 

Less serious health effects of binge eating include ulcers, and acid reflux from the stomach into the esophagus (a condition known as GERD, or gastroesophageal reflux disease).

Mental disorders such as depression and anxiety often arise as a result of, or in combination with, bulimia nervosa. Preexisting obsessive compulsive disorder, depression, or impulsivity disorders may worsen when bulimia nervosa develops.

Treating the health effects of bulimia nervosa, whether they are mental disorders, abuse of laxatives, or the consequences of binge eating, is vital if the treatment of bulimia nervosa is to succeed.

Resources

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Behrman, R.E. & Kliegman, R.M. (ed). Nelson Essentials of Pediatrics, 3rd Edition. W.B. Saunders Company, Philadelphia, 1998.

Food and Drug Administration. (nd). Ipecac: Clinical summary.

Gowers, S. & Bryant-Waugh, R. (2004). Management of child and adolescent eating disorders: The current evidence base and future directions. Journal of Child Psychology and Psychiatry 45, 63-83.

MedicineNet. (updated 2002). Bulimia nervosa.

Mehler, P.S. (2003, August 28). Bulimia nervosa. The New England Journal of Medicine 349(9), 875-881.

National Library of Medicine. (updated 2003). Bulimia. MedlinePlus Medical Encyclopedia.

Rome, E.S. & Ammerman, S. (2003, December). Medical complications of eating disorders: An update. Journal of Adolescent Health 33(6), 418-426.