Severe Bulimia Nervosa Complications

The primary methods of purging exhibited in bulimia nervosa—self-induced vomiting and laxative abuse—can cause serious medical consequences.

Among individuals suffering from severe bulimia nervosa, the favored methods of ridding the body of extra calories include self-induced vomiting and abuse of stimulant laxatives. Not surprisingly, these dangerous purging behaviors can result in a host of medical complications affecting vital organs and bodily systems, depending on the mode and frequency of use. 

Self-Induced Vomiting

Excessive vomiting can result in a wide range of complications in the digestive tract, beginning with the mouth. Repeated exposure to the high acid content in vomit can erode tooth enamel and permanently damage an individual’s teeth and gums. The acid can also irritate or tear the esophagus, and it can cause chronic acid reflux, which may lead to difficulty swallowing, chronic coughing, hoarseness, sore throat and indigestion, and often esophageal cancer. 

Vomiting can also result in dehydration, which leads to weak muscles and fatigue, and may cause an imbalance in essential electrolytes such as potassium, magnesium and sodium. This imbalance can result in a dangerous strain on the heart, leading to an irregular heartbeat, a weakened heart muscle and heart failure, as well as low blood pressure, a weak pulse and anemia. 

The nutritional deficiencies that result from repeated purging via self-induced vomiting can also lead to hormonal imbalances. In women, menstrual cycles can become irregular or cycles may stop altogether. Furthermore, pregnant women who engage in bingeing and purging behaviors face additional complications for themselves and the fetus, including premature birth, low birth weight, birth defects and still births. 

Laxative Abuse

Dehydration and electrolyte imbalances are also common complications of laxative abuse, as fluid and vital nutrients are lost at abnormally high rates in diarrhea. 

Gastrointestinal complications of laxative abuse include bloody stools, diarrhea, hemorrhoids and rectal prolapse. In this condition, the rectum (the last part of the large intestine) slides out through the anal opening. Ironically, chronic laxative abuse can cause severe constipation. Also known as cathartic colon syndrome, the colon is converted into an inert tube incapable of propagating feces, causing severe constipation. In severe cases, it may ultimately be necessary for patients with cathartic colon syndrome to have some or all of their colon removed. 

Bulimia can also cause serious damage to the central nervous system, the pulmonary system and the circulatory system. Most bulimia nervosa complications resolve following medically-supervised cessation of purging behaviors, although many medical providers lack experience and training in this area. Patients experiencing severe medical instability as a result of purging, or have a history of developing edema and marked weight gain upon cessation of purging behaviors, may require specialized treatment to restore medical and/or psychiatric stability prior to entering a traditional eating disorder treatment program.

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