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Bulimia nervosa complicates and disrupts every aspect of daily life and health, with long-term medical consequences.

The National Eating Disorders Association tells us that only six percent of people who have bulimia nervosa ever receive treatment for their condition. When they do consult their physicians, it is usually for help with weight loss, despite being thin. As a result, the changes in lifestyle that bulimics make to accommodate their disease result in a number of long-term health complications that make full recovery very challenging.

Bulimia changes basic health habits

Habitual binging and purging changes basic health habits that in turn generate complications. People who live with bulimia often realize they have a problem they cannot solve on their own, but they are too embarrassed to ask for help with it. They fall into a cycle of low self-esteem and self-criticism that makes their emotional distress worse, which in turn drives the binging and purging cycle.
  • Anxiety, depression, and mood swings. Some people living with bulimia nervosa turn to alcohol and street drugs rather than medication to deal with these problems.
  • Disturbances in self-image, and lying to cover up the binge and purge habit. These habits carry over to relationships with doctors, nurses, and therapists.
  • Neglecting work, school, social relationships, hobbies, and exercise to make time for binge-eating and the purging that follows. Bulimics may avoid parties and family meals when they fear they will lose control over their eating in front of large groups of people.
  • Self-injury, such as cutting, and suicide attempts. Over one-quarter of bulimics attempt suicide at some time during the course of their disease.
  • Substance abuse to deal with anxiety, depression, problems with impulse control, and problems with self-esteem. Substance abuse tends to run in families, either due to shared brain characteristics, lack of parental supervision, or both. Sometimes teenagers who have bulimia try to fast-track social acceptance by using and sharing illicit substances.

An important component of recovery from bulimia is regaining the sense of self-worth that empowers changes in basic health habits. Without that change, medical complications are inevitable.

Many bulimics don't realize they have the disease. If you wonder whether you have bulimia, consider the following six questions. Do you eat so much that you make yourself feel sick? Are you concerned that you have lost control over how much you eat? Have you lost more than 15 pounds (about six kilograms) over the last six months? Do feel you are fat even though other people tell you that you are thin? Do you feel that food has taken over your life? If the answer to three or more of these questions is yes, you may have bulimia.

Bulimia has long-term health consequences

The medical consequences of bulimia aren't always noticeable until very late in the disease. At first, it can be hard to tell whether a symptom is related to bulimia or one of a long list of alternative conditions. People who binge and purge often have bad breath. Repeated exposure to stomach acid during self-induced vomiting eats away at the enamel on the back side of the teeth. Repeated exposure of the parotid glands to stomach acid can result in "puffy cheeks" syndrome. Bulimics who reach down their throats to stimulate vomiting develop deformities of the knuckles. But much worse medical complications often follow.

  • Abnormally low prolactin levels. People who with bulimia have low levels of the hormone associated with feeling good after making emotional connections.
  • Aspiration pneumonitis. Vomited food and stomach acid can be aspirated into the lungs and cause pneumonia.
  • Chronically increased production of stress hormones, coupled with reduced ability to respond to life changes with appropriately increased levels of stress hormones. People who live with bulimia are stressed out all the time, but they don't have "get up and go" to deal with short-term challenges.
  • Chronically inflamed throat and esophagus, with the potential for a ruptured esophagus (tears that penetrate the wall of the esophagus). Symptoms of a ruptured esophagus include abdominal and chest pain, and possibly fever. The rupture has to be repaired with surgery.
  • Chronically irregular bowel movements, pancreatitis, peptic and duodenal ulcers. The stomach's production of acid outpaces the food needed to be digested. Bulimics who learn how to make themselves vomit without putting a hand or toothbrush down their throats may develop involuntary release of stomach acid into the throat.
  • Circulatory problems in the brain. It's not clear whether bulimia causes or is caused by poor circulation to parts of the brain involved in decision making and complex reasoning.
  • Colon problems from laxative abuse. Stimulant laxatives can reduce the response of the nerves lining the bowel to stimulation, causing chronic constipation. Enemas can cause dangerously high phosphate levels.
  • Hypoglycemia (low blood sugar levels) even after binging. Insulin production is reduced, but insulin responses become deranged.
  • Infertility. About 50 percent of women who have bulimia never have periods. They are infertile. Most of the remaining women who have bulimia have irregular periods and are only occasionally fertile. Bulimia has inconsistent effects on male fertility.
  • Severe dehydration with severe electrolyte disturbances. This combination of persistent problems results in a rapid, weak pulse. When potassium, calcium, and/or magnesium in the bloodstream is largely depleted, there can be cardiac arrhythmias that lead to death.

  • Fetissov SO, Harro J, Jaanisk M, et al. Autoantibodies against neuropeptides are associated with psychological traits in eating disorders. Proc Natl Acad Sci U S A. 2005 Oct 11. 102(41):14865-70.
  • Franko DL, Becker AE, Thomas JJ, Herzog DB. Cross-ethnic differences in eating disorder symptoms and related distress. Int J Eat Disord. 2007 Mar. 40(2):156-64.
  • Mehler PS, Birmingham LC, Crow SJ, Jahraus JP. Medical Complications of Eating Disorders. Grilo CM, Mitchell JE. The Treatment of Eating Disorders: A Clinical Handbook. New York: The Guilford Press. 2010. 66.
  • Photo courtesy of SteadyHealth

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