Eating disorders of all kinds can have significant negative effects on both mental and physical health, and have the potential to be fatal. Each different diagnosis, however, poses distinct risks, and understanding the nuances of each one can help illustrate why early intervention and treatment is so necessary. Read on to learn everything you need to know about the physical and mental health risks of bulimia, and how to seek help.

What is bulimia?

Formally known as bulimia nervosa, bulimia is a particular type of eating disorder characterized by a recurring cycle of bingeing and purging. “Bulimia is marked by episodes of binge eating, which is eating an amount of food in a discrete period of time that is definitely larger than what most people would eat in a similar period of time,” explains Equip family nurse practitioner, Sarah Curran, FNP-C. “These binge episodes are followed by compensatory behaviors to prevent weight gain, including self-induced vomiting; misuse of laxatives, diuretics, or enemas; excessive exercise; fasting; and strict diets.”

While binge eating disorder also involves binge eating, registered dietitian Amy Dahl, MS, RD, CEDS explain that bulimia is different in that it involves behaviors to “make up for” the binge.

“Binge eating and bulimia share many characteristics, but what sets bulimia apart from binge eating disorder is that there is a compensatory behavior that is associated with the binge,” Dahl says. “This behavior is a result of the intense fear of weight gain associated with bulimia, and there is often a restriction of food intake in between episodes of binge eating.”

Studies have indicated that bulimia is a serious issue that affects people of all genders (up to 3% of females and 1% of males, though these numbers are likely low due to all the people who go undiagnosed). The average age of onset for bulimia is 18, but it affects people of all ages. Likewise, people with bulimia are often at or above what’s considered a “normal” weight, but people of all body sizes struggle with bulimia.

What are the physical health risks of bulimia?

Both the short-term and long-term consequences of bulimia can be devastating. In fact, research suggests that bulimia multiplies a person’s mortality risk by five. From dehydration and dental problems to life-threatening organ damage, the health risks associated with this eating disorder make clear just how vital it is to find evidence-based treatment that addresses this eating disorder.

Short-term physical health risks of bulimia

While every person is different, it often doesn’t take long for the short-term effects of bulimia to appear. The immediate consequences of bingeing and purging may show up in issues like facial swelling, digestive issues, or fainting, which Curran says can be attributed to the dehydration due to fluid loss from vomiting or using laxatives.

Here’s a snapshot of the short-term physical health risks of bulimia:

Effects on the cardiovascular system

• Hypotension (abnormally low blood pressure)
• Orthostasis (a significant change in blood pressure or heart when going from lying to standing)
• Electrolyte abnormalities
• Heart palpitations
• EKG changes

Effects on the musculoskeletal system

• Stress fractures due to compulsive exercise
• Muscle weakness
• Bone density loss

Effects on the digestive system

• Acid reflux or GERD from stomach acid
• Damage to the esophagus from repeated vomiting.
• Constipation, diarrhea, gas, bloating or other digestive issues caused by binge eating

Effects on dental and oral health

• Swollen salivary glands
• Sore throat
• Worn tooth enamel and cavities due to stomach acid from vomiting
• Gum disease

Effects on the skin and body

• Edema (fluid retention)
• Dry skin
• Thinning hair
• Brittle nails

Long-term physical health risks of bulimia

Over time, the symptoms of bulimia can be life-threatening, with bulimia carrying a 3.9% mortality rate. “Cycling episodes of binging and purging through various compensatory behaviors can take a major toll on the body,” Curran says. “Those with bulimia are at risk for long-term complications including cardiovascular disease, diabetes, menstrual irregularities, digestive issues, and low bone density.”

Dr. Navya Mysore, MD echoes this, explaining that the long-term effects of bulimia can severely impact the cardiovascular, reproductive, and digestive systems, among other bodily functions. “Long-term problems can include heart rhythm issues, severe constipation, loss of period, osteoporosis, and permanent dental issues,” she says.

Dahl adds that over time, a sudden interruption in the behaviors associated with bulimia can also cause severe problems. “If someone is engaging in purging behaviors and these behaviors stop, a condition called pseudo-bartter syndrome may occur,” she says. “With pseudo-bartter syndrome, the body has existed in a dehydrated state for so long that when it starts to be rehydrated, the body will hold onto more water to prevent the body from being dehydrated again, which can cause significant swelling and edema.” It’s important to note that this is not a reason to keep using disordered behaviors: with the risk support, this risk can be mitigated, and pseudo-bartter syndrome is much more manageable and finite than the health risks of continuing to engage in the binge-purge cycle.

What are the mental and emotional health risks of bulimia?

While bulimia carries significant physical health risks, it is also a mental illness, and has a major impact on a person’s emotional and psychological health. “Bulimia can often lead to self-isolation, fear of eating around others, and chronic low self esteem,” Curran says. “Research shows an increased incidence of suicidal ideation and suicide attempts among those struggling with bulimia and eating disorders in general.”

As with other eating disorders, bulimia is associated with a preoccupation with body shape and weight and body image distress, as well as feelings of guilt and shame around disordered behaviors. People struggling with bulimia also tend to withdraw from family and friends, becoming socially isolated; this can be due to feelings of guilt and shame, or a desire to hide their disordered behaviors, or a combination of both.

Curran also points out that, as with many other eating disorders, bulimia often co-occurs with other mental health conditions including anxiety and depression. Research indicates that 80.6% of people with bulimia will experience an anxiety disorder at some point during their lives and about 68% of individuals with bulimia have at least one anxiety disorder. Additional research has also shown that while 23-48% of adolescents with eating disorders have comorbid depression, there is a higher prevalence in patients with bulimia (50%) than those with anorexia (11%).

Is it possible to reverse the negative physical and mental impacts of bulimia?

Because bulimia is a potentially fatal illness, early intervention can mean the difference between life and death. But experts encourage seeking treatment at any stage of the disease, and emphasize that recovery is within reach for all. “The good news is that full recovery from bulimia is absolutely attainable, and it is possible to reverse most, if not all, physical and mental impacts of this illness,” Curran says. “The key is reaching out for support.”

Mysore explains that whether or not you can undo the effects of bulimia is impacted by a few factors. “Once treatment has started for bulimia, many of the short-term physical issues improve if the patient is no longer having binge-purge cycles,” she says. “Depending on how long you have been struggling with bulimia and whether or not you’ve been diagnosed with long-term issues secondary to the eating disorder, it can be more challenging to completely reverse the physical and mental impacts.”

Dahl agrees, noting that the level of support necessary to address the symptoms and consequences of bulimia may vary widely from person to person, depending on how long they’ve struggled with the illness. “Many of the side effects of bulimia can be reversed by reducing the compensatory behaviors and engaging in nutritional rehabilitation,” Dahl says. “For those at risk for serious complications of nutritional rehabilitation, including pseudo-bartter syndrome and cardiac arrhythmias, a higher level care of an eating disorder facility may be needed to safely reintroduce foods. Unfortunately some of the side effects of malnutrition, such as osteoporosis, may be more permanent.”

What to do if you or a loved one is struggling with bulimia

Becoming aware of bulimia’s short- and long-term risks is an important first step toward recovery, but seeking treatment can be challenging for those who are struggling. “It is important to reiterate how dangerous and life-threatening the behaviors associated with bulimia can be, and how critical prompt intervention is,” Curran says. “With appropriate treatment, it’s possible to address the impacts that bulimia has on your physical and mental health. There are several treatment avenues to pursue, including but not limited to hospitalization, cognitive behavioral therapy, and support groups.”

While self-isolation is often a hallmark symptom of bulimia, cultivating a community can also be a critical step in the treatment process. “Building a support network is one of the most essential aspects of lasting recovery,” Curran says. “This can include members of your treatment team, family members, close friends, or anyone you feel comfortable confiding in.”

For those struggling with how best to help a loved one experiencing bulimia, Mysore suggests starting with a frank conversation and an offer to show up in person for initial evaluation. “Try to gently bring up the behavior changes you are noticing in them and that you are worried about their health,” she says. “Another option is to accompany them to see their primary care provider to discuss what you’re worried about and come up with a plan to help support them.”

Moving forward through recovery, Dahl reiterates the importance of working with a multidisciplinary team of experts. “If you suspect someone you care for has an eating disorder, it is best to speak to an eating disorder professional to assess your loved one,” Dahl says. “A multidisciplinary eating disorder team can include a medical doctor, dietitian, therapist, and psychiatrist, and these individuals can make the best recommendation on the most appropriate level of care to provide as much medical and psychological support as possible.”

If you’re struggling with bulimia, or worried a loved one might be, it’s hard to overstate how important it is to seek help as soon as possible. Talk to your doctor or a mental health professional, or schedule a call with our team to talk through your concerns.

Frequently asked questions about the health risks of bulimia

What are the main physical health risks associated with bulimia?

Bulimia negatively impacts physical health in many different ways. The main health risks include:

• Hypotension (abnormally low blood pressure)
• Electrolyte abnormalities
• Heart palpitations
• Bone density loss
• Acid reflux or GERD from stomach acid
• Damage to the esophagus from repeated vomiting
• Swollen salivary glands
• Worn tooth enamel and cavities due to stomach acid from vomiting
• Edema (fluid retention)

How does bulimia affect mental and emotional health?

Bulimia is a serious mental illness that can have a major impact on a person’s emotional and psychological health.

The mental health risks of bulimia include:

• Body image distress
• Preoccupation with body shape and weight
• Feelings of guilt and shame
• Self-isolation
• Fear of eating around others
• Low self-esteem
• Increased risk of suicidal ideation

What are the long-term consequences of untreated bulimia?

The long-term consequences of bulimia can be life-threatening: bulimia has a 3.9% mortality rate, and people with bulimia are five times likelier to die than those without the disease.

Long-term consequences of bulimia include:

• Death
• Cardiovascular disease
• Osteoporosis
• Diabetes
• Permanent dental issues