Hello Alice.

Once a day, after meals — whenever my roommate isn't around, I stick my fingers down my throat and throw up most of the food that I had just eaten. I do not binge — I only purge. I understand from my Psychology professor that the diagnosis of bulimia nervosa requires that the person binge and then purge. I am curious, then, what I have — do I have a form of anorexia nervosa or what? Also, I am on birth control pills and I am afraid that I might hurt their effect by throwing up. How long does it take for the pill to get absorbed into my system? I usually don't throw up until about 5 or six hours after I have taken the pill. Will this hurt the effect of the pill?

— Curious

Dear Curious,

The world of eating disorders is complex; many individuals may have unhealthy behaviors or tendencies related to eating that do not fit neatly into diagnostic categories. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), published by the American Psychiatric Association and universally used in diagnosing eating disorders, bulimia includes both binging and purging, which is mostly likely what your professor was referencing. By contrast, sufferers of anorexia nervosa attempt to lose weight by inducing starvation, often coupled with rigorous exercise, and may also attempt to accelerate weight loss by vomiting, taking laxatives, and/or using diuretics.

It seems that your behavior may be a conglomerate of a few different eating disorder tendencies. Even though not everyone fits neatly into a specific diagnosis, this does not mean that health consequences associated with bulimia or anorexia will be absent. Repeated, self-induced vomiting packs a serious punch in terms of health risks.

In terms of your birth control pills, typically five to six hours is long enough for the pill to absorb into a woman's system. But keep in mind that frequent purging is highly stressful for your body, and is likely to disrupt normal bodily response to birth control pills or other medications, possibly including digestion and metabolism of birth control pills. Your contraceptive method will be most effective if you are successfully managing other medical conditions, such as eating disorder tendencies, with your health care provider's knowledge and support.

Some risks that may occur regularly and/or immediately following episodic vomiting include:

  • Fatigue, which may become chronic or persistent.
  • Sore throat.
  • Tooth decay and/or tooth pain.
  • Puffiness in cheeks and strained or broken blood vessels underneath eyes.

More serious health consequences of frequent purging include:

  • Constant electrolyte imbalance as a result of frequent vomiting can overly stress the heart, leading to irregular heartbeats and possible heart failure.
  • Inflammation and possible rupture of the esophagus.
  • Chronic constipation and/or irregular bowel movements.
  • Developing ulcers or pancreatic disease.

While there is a clear physiological component to purging, there is undeniably also a psychological component that is driving your actions. It may be useful for you to explore this issue more. Some starting points are the National Institute of Mental Health's page on Eating Disorders, the National Association of Anorexia Nervosa and Associated Disorders (ANAD), and the National Eating Disorders Association, all with loads of information on how to approach this issue on a personal and medical level.

Eating disorders are complex and confusing; asking questions about the impact that purging can have on your health can be a great first step on the path toward managing and recovering from any type of disordered eating. Good luck along the way,


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