Contributor: Staff at Timberline Knolls Residential Treatment Center
Bulimia nervosa, often referred to as bulimia, is an eating disorder that can affect a person’s quality of life across multiple domains — from self-esteem and social relationships to health and daily functioning.
The disorder, which involves patterns of excessive eating followed by efforts to purge or severely reduce calorie intake, can cause many uncomfortable, debilitating, and dangerous physical effects. Health complications can arise due to the physical and nutritional impacts of the disorder as well as in response to co-occurring mental illnesses and addiction concerns that can develop.
When someone has bulimia, they experience recurring episodes of binge eating, which involves eating excessive amounts of food in a short period of time. During these binge-eating episodes, the person also has difficulty controlling and regulating their eating and often feels shame about their behavior.
People who are struggling with bulimia also regularly engage in compensatory behaviors like vomiting, using laxatives or diuretics, fasting, or exercising excessively. Bulimia can also lead to intense emotional difficulties, including stress, anxiety, and negative self-image, which may contribute to cycles of unhealthy eating and restrictive or purging behaviors.
Effects of Bulimia on Physical Health and Well-Being
The physical impacts of bulimia can present as painful and uncomfortable symptoms, many of which may result from purging — an act that stresses the body in various ways. These symptoms could include red eyes (caused by the force of vomiting), dehydration, sore or swollen throat, swollen face, scarred or callused hands (from inducing vomiting), and lightheadedness or lack of energy.
Physical symptoms of bulimia can also include:
- Chest pain
- Heart palpitations
- Mouth and stomach ulcers
- Constipation due to laxative abuse
- Dental concerns such as cavities and tooth sensitivity
In addition to contributing to dental problems, the acid in vomit may cause damage or irritation to a person’s digestive system, contributing to symptoms like heartburn, acid reflux, bloating, and diarrhea. People who are struggling with bulimia can also suffer from a low sex drive and may experience absent or irregular menstruation. Additionally, for people who are struggling with an eating disorder such as bulimia, dental problems might get worse over time due to fear and avoidance of the dentist .
Possible Health Complications of Bulimia
Many of the physical symptoms of bulimia can also lead to serious health complications. Although people who have bulimia usually don’t experience notable weight loss, the health consequences of binge eating and compensatory behaviors can be serious, and for many people, the symptoms of the disorder can last for multiple years.
Serious health complications from bulimia can include kidney failure, anemia, pancreatitis, and tearing of the esophagus known as Mallory-Weiss syndrome. People who are suffering from bulimia may also experience electrolyte imbalances, including hypokalemia (low potassium levels), which can lead to complications that include rhabdomyolysis, muscle weakness, and cardiac arrhythmias . Bulimia may also lead to a higher risk for miscarriage.
A longitudinal cohort study of more than 400,000 women found that women who were hospitalized for bulimia had a higher rate of cardiovascular disease and death compared with women who were hospitalized for pregnancy-related events . Moreover, women who had three or more bulimia-related admissions had the highest incidence of cardiovascular disease in the study .
Physical Effects Due to Co-Occurring Concerns
The emotional difficulties and co-occurring mental health and addiction concerns that often occur with bulimia can also contribute to the negative health outcomes of the disorder. People might struggle with concerns such as anxiety, depression, bipolar disorder, low self-esteem, and suicidal thoughts or behaviors, which can put their physical health at risk. Mental health conditions such as anxiety and depression can cause distressing physical symptoms that include headaches, stomach pain and nausea, and tightness in the chest.
In some cases, a person who is struggling with bulimia might also suffer from the physical effects of a co-occurring addiction. According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), at least 30% of people who have bulimia have also struggled with substance use during their lifetimes . Physical effects of addiction can include sleep difficulties, cognitive impairment, and damage to the heart. Additionally, research suggests that when someone struggles with both an eating disorder and an addiction, their risk for death may be greater than for each disorder alone .
Managing the Health Effects of Bulimia
When someone is suffering from bulimia, they may engage in behaviors that interfere with the natural processes that keep their body healthy and functioning, resulting in physical effects that can have serious health consequences. Therefore, to effectively manage and reduce the physical effects of bulimia, it’s important to treat the disorder and its symptoms directly and as early as possible.
It’s also important to raise awareness about bulimia, reduce stigma around the disorder, and help break the cycles of shame and secrecy that might prevent someone who is suffering from the condition from seeking treatment.
Additionally, understanding that the effects of bulimia can be diverse, it may be critical for people who have the disorder to access multidisciplinary treatment that includes medical care. And in the case of someone who is suffering from bulimia and a co-occurring addiction, it may be particularly important that they receive integrated care that accounts for the complex treatment needs of both disorders.
 Forney, K.J., Buchman-Schmitt, J.M., Keel, P.K., & Frank, G.K.W. (2016). The medical complications associated with purging. International Journal of Eating Disorders. 49(3), 249-259. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4803618/
 Sato, Y. & Fukudo, S. (2015). Gastrointestinal symptoms and disorders in patients with eating disorders. Clinical Journal of Gastroenterology. 8, 255-263. https://doi.org/10.1007/s12328-015-0611-x
 Tith, R.M., Paradis, G., Potter, B.J., Low, N., Healy-Profitós, J., He, S., & Auger, N. (2020). Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry. 77(1), 44-51. https://jamanetwork.com/journals/jamapsychiatry/fullarticle/2752386
 American Psychiatric Association. (2013). Feeding and eating disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm10
 Compton, W.M. & Han, B. (2022). Substance use disorders are deadly. The American Journal of Psychiatry. 179(1), 11-13. https://doi.org/10.1176/appi.ajp.2021.21101069
About Timberline Knolls
Timberline Knolls is a residential treatment center located on 43 beautiful acres just outside Chicago, offering a nurturing recovery environment for women and girls age 12 and older who are struggling with eating disorders, addiction, trauma, and co-occurring mental health conditions. An adult partial hospitalization program (PHP) is available for step-down and for women to directly admit. By serving with uncompromising care, relentless compassion, and an unconditional joyful spirit, we help our residents and clients help themselves in their recovery. For more information, please visit www.timberlineknolls.com.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Published on July 1, 2022. Published on EatingDisorderHope.com
Reviewed & Approved on July 1, 2022 by Jacquelyn Ekern, MS, LPC