Long Term Effects & Complications of Bulimia
Long-term complications of bulimia
Bulimia nervosa (BN) is a serious eating disorder consisting of cycles of binge eating followed by purging.
Some patients with bulimia can experience long-term effects of their disorder, especially for those whose eating disorder is left untreated or for those who experience either:
- Severe BN (8-13 binge/purge episodes per week)
- Extreme BN (14+ binge/purge episodes per week).
While most complications resolve with treatment, some persist.
Long-term effects of purging
Purging behaviors, like self-induced vomiting and laxative or diuretic misuse, can cause a variety of issues that can contribute to long-term health problems, like:
We highlight some of the more common and serious complications associated with BN below.
Long-term dental issues
Dental complications are one of the most common and visible symptoms of bulimia nervosa, but when left untreated they can also be some of the most difficult to resolve.
Dental erosion (perimylosis)
A common and potentially long-term complication of bulimia nervosa is dental erosion, also known as perimylosis.
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
- Infection
- Discoloration
Pain, hypersensitivity and damage to the teeth can also make chewing or eating more difficult, which can exacerbate disordered eating behaviors, like food restriction, and make it difficult to get adequate nutrition.
Periodontitis
Chronic irritation from exposure to stomach acid can cause the gums to become inflamed. 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
Long-term digestive complications
Purging through vomiting or laxative abuse can cause a wide range of complications in the gastrointestinal tract. While many of these complications resolve shortly after purging stops, some do not.
Gastroesophageal reflux disease
Gastroesophageal reflux disease (GERD) is a condition characterized by a weakened esophageal sphincter, causing a reflux of stomach contents into the esophagus.
With early identification and treatment, the damage of GERD may be reversible. However, those who have been experiencing symptoms of acid reflux alongside self-induced vomiting for several years are at risk for more severe complications. Symptoms include:
- Difficulty swallowing (dysphagia)
- Sensation of having a lump or something stuck in the throat (globus sensation)
- Chronic coughing
- Hoarseness
- Sore throat
Barrett’s esophagus
Due to the esophageal mucosa being chronically exposed to stomach contents, there may be an increased risk of developing Barrett’s esophagus, a pre-cancerous condition.
Mallory-Weiss syndrome
Rarely, the sudden rise in pressure in the stomach or the lower part of the esophagus during vomiting can tear the lining in the upper gastrointestinal tract near where the esophagus meets the stomach, causing bleeding. Symptoms of Mallory-Weiss tears include vomiting blood and dark, sticky stools.
While most of the time Mallory-Weiss syndrome resolves on its own, persistent or recurring tears may need to be treated with an endoscopic injection, a heat treatment or an inserted clip that closes the tear.
Cathartic colon syndrome
Chronic laxative abuse can lead to severe constipation, also known as cathartic colon syndrome. 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.
Cardiac complications
Electrolyte imbalances found in those in bulimia nervosa put patients at risk for various cardiac arrhythmias.
Atherosclerosis
BN is associated with atherosclerosis, the thickening or hardening of the arteries, typically because of plaque buildup.
Atherosclerosis is not fully reversible and lifestyle changes are necessary to manage coronary artery disease. If left untreated, atherosclerosis may lead to:
- Blood clots
- Heart attack
- Stroke
Atherosclerosis can also contribute to the development of coronary artery disease (CAD), also known as ischemic heart disease or coronary heart disease (CHD).
Coronary artery disease
Coronary artery disease is a narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart, typically due to plaque buildup.
CAD develops over time and slowly limits the amount of blood that can reach the heart. CAD can cause chest pain, shortness of breath and fatigue. Coronary artery disease also puts patients at risk for:
- Blood clots
- Heart attack
- Sudden cardiac death
Gynecological & obstetric complications
Menstrual cycles can become irregular (oligomenorrhea) or cycles may stop altogether (amenorrhea). While fertility is preserved upon recovery, when actively suffering from an eating disorder, family planning can be more difficult.
Furthermore, pregnant women with eating disorders who engage in bingeing and purging behaviors face additional maternal and fetal complications, including an increased risk of:
- Miscarriage
- Premature birth
- Low birth weight
Psychiatric comorbidities
95% of people diagnosed with bulimia nervosa also receive a diagnosis for at least one more psychiatric disorder, including mood disorders, anxiety disorders, substance use disorders, personality disorders and neurodevelopmental disorders.
Some of the most common co-occurring psychiatric diagnoses in those with bulimia nervosa are:
- Anxiety disorders
- Mood disorders
- Borderline personality disorder (BPD)
- Post-traumatic stress disorder (PTSD)
Pulmonary Complications
Bulimia nervosa can cause serious damage to the pulmonary system, at times leading to sudden onset respiratory distress.
Pneumonitis & pneumonia
While throwing up, stomach contents can enter the lungs, causing irritation (pneumonitis). Potentially this can cause an infection of the lungs (pneumonia).
Bulimia recovery is possible
Many of the complications associated with BN resolve with timely and effective treatment, emphasizing the importance of early intervention and treatment for bulimia nervosa. Even for patients who have been living with untreated bulimia nervosa for a long time, recovery is still possible. Medical treatment and mental health support can improve outcomes regardless of how long an individual has been living with BN.
Resources
- Gibson D, Workman C, Mehler PS. Medical complications of anorexia nervosa and bulimia. The Psychiatric Clinics of North America 2019;42(2):263-74.
- Mehler PS. Hypokalemia: A marker of covert bulimia nervosa. The American Journal of Medicine 2015;128(9):e37.
- Mehler PS, Rylander M. Bulimia nervosa – medical complications. Journal of Eating Disorders 2015;3(1):12.
- Morgan JF, Lacey H, Chung E. Risk of postnatal depression, miscarriage, and preterm birth in bulimia nervosa: Retrospective controlled study. Psychosomatic medicine 2006;68:487-92.
- Tabler J, Utz RL, Smith KR, et al. Variation in reproductive outcomes of women with histories of bulimia nervosa, anorexia nervosa, or eating disorder not otherwise specified relative to the general population and closest-aged sisters. International Journal of Eating Disorders 2018;51(2):102-11.
- Tith RM, Paradis G, Potter BJ, et al. Association of bulimia nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry 2020;77(1):44-51.
- Trahan MJ. Pregnancy outcomes among women with bulimia nervosa [A217]. Obstetrics and Gynecology 2022;139(s5):63S.
Last Reviewed: September 2024 by Dennis Gibson, MD, FACP, CEDS
