For someone who struggles with bulimia, using behaviors for emotional relief or to counteract weight gain can become habitual and all-consuming. When you’re deep in the cycle of bulimic behaviors, whether they include binging and self-induced vomiting, laxative or diuretic abuse, other drug abuse, fasting, or overexercising, you may not stop to think, notice, or be particularly concerned about the consequences and side effects of their use. However, bulimia can lead to debilitating and even fatal side effects including physical consequences, emotional symptoms, and social impairment.
Physical Side Effects
Using behaviors of bulimia forces your body to engage in excessive or abnormal processes that could be particularly damaging. Subsequently, individuals with bulimic behaviors may experience new health concerns or an exacerbation of previous health issues as a result of their food and/or exercise behaviors:
Hormonal. As a result of bulimic behaviors, women may experience an irregularity or complete halting of their menstruation. A history of bulimia may also impact future pregnancy. Insulin and thyroid hormone levels can also fluctuate, as well as leptin, which helps with energy regulation and menstrual function.
Dental. Bulimia can produce dental concerns, as the acid from recurrent vomiting leads to tooth erosion and permanent loss of dental enamel. Subsequently, teeth may appear chipped or eroded, and may exhibit a frequency of dental caries. Recurrent vomiting may also lead to enlarged salivary glands.
Fluid/Electrolyte. As compensatory mechanisms are used to get rid of food, the nutrition of consumed food is not properly absorbed or utilized, which can lead to nutritional deficiencies and severe fluid and electrolyte imbalances: potassium, chloride, bicarbonate, sodium, and salivary enzymes. These can cause cardiac irregularities and seizures. Vomiting, laxative, and diuretic abuse can also lead to fluctuations in gastric acidity.
Gastrointestinal. Certain potentially fatal complications can result from excessive wear on gastrointestinal systems. For instance, vomiting can lead to esophageal tears, reflux, and inflammation, hematemesis, and gastric ruptures. Malnutrition can lead to gastroparesis, constipation, and high fat/cholesterol levels in the blood, as well as abdominal bloating and nausea. Binge eating may contribute to pancreatitis and gastric dilation or rupture. Bowel function may become impaired for someone who excessively relies on laxatives.
Cardiovascular. Eating and compensatory behaviors of bulimia can affect the cardiovascular system, including bradycardia, arrhythmias, changes in heart rate, low or high blood pressure, cardiomyopathy, and other serious heart complications.
Renal/Hematological. Individuals with bulimia can become dehydrated or face kidney impairment due to severe fluid restriction or vomiting. Problems with urination may also occur. Nutritional deficiencies can also affect the bone marrow, leading to lowered production of immune system cells, such as white blood cells.
Skeletal. Repeated use of purging behaviors and lack of nutrition can lead to skeletal abnormalities such as osteoporosis, joint pain, reduced bone density, and weakened skeletal muscles.
All physical side effects, in conjunction with the mental/emotional consequences of bulimia (see below), contribute to an overall elevated mortality risk for individuals with bulimia.
Emotional Side Effects
Dysregulation. The behaviors involved in bulimia are commonly preceded by negative emotions (sadness, boredom, anxiety, and fear) or stressors including interpersonal issues, trauma, and poor body image. Such disordered behaviors are frequently used to help alleviate, avoid, or numb unwanted feelings temporarily. However, their use induces further negative emotions, including guilt, shame, depression, and anxiety. Without adaptive coping tools to address their distress, individuals with bulimic behaviors continue to struggle with regulating their emotions.
Psychiatric comorbidity. Moreover, individuals who exhibit behaviors of bulimia are likely to suffer from other psychological concerns that occur before, during, and/or after the development of bulimic behaviors. These include mood (depressive, bipolar), anxiety (general anxiety, OCD), PTSD, substance abuse, and personality disorders, as well as self-harm. Moreover, individuals with bulimia exhibit an elevated suicide risk, contributing to the elevated mortality risk of this disorder.
Social Side Effects
Lastly, shame and secrecy tend to accompany bulimic behaviors; thus, individuals who struggle may isolate from social situations in order to engage in these rituals or as a result of poor body image. Moreover, using bulimic behaviors and encountering their subsequent physical and mental consequences can lead to role impairment in the individual, such as poor occupational or academic performance.
Whether or not you are experiencing some or all of these side effects of bulimia, you deserve to receive support and recover. All of these consequences as a whole lower an individual’s quality of life to various degrees. If you are engaged in bulimic behaviors or any other type of disordered eating, try to take a step back and consider your quality of life – are your behaviors interfering with your physical health? Are you struggling to regulate your emotions? Have your social and work life declined? Being honest with yourself is the first step to recovery.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (Fifth Edition). Washington, DC: American Psychiatric Association.
O’Brien, K. M., Whelan, D. R., Sandler, D. P., Hall, J. E., & Weinberg, C. R. (2017). Predictors and long- term health outcomes of eating disorders. PloS One, 12(7), e0181104. https://doi.org/10.1371/journal.pone.0181104
Bio: Bahar Moheban, M.A. is a clinical psychology doctoral candidate and registered psychological assistant in Torrance under the supervision of Dr. Nazanin Moali. She provides individual and group psychotherapy to adults and adolescents with disordered eating, negative body image, and comorbid disorders. If you are struggling with bulimic behaviors or any other type of disordered eating, contact Bahar for a counseling appointment.