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,

Eating disorders are complex and don’t always fit into a perfect diagnosis. Just because an eating disorder doesn’t look exactly like bulimia or anorexia doesn’t mean that it’s without serious health risks — unspecified eating disorders or disordered eating behaviors can cause many medical complications. To answer your question about the birth control pill, it can usually be absorbed after about two hours in a person’s body. However, the absorption process may be affected by the purging, so it’s hard to determine the effects that it may have (more on this in a bit). At the end of the day, a health care provider is the person most equipped to give you a diagnosis and treatment recommendations, but here’s some basic information to start.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), 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, people with anorexia nervosa attempt to lose weight by inducing starvation, often coupled with rigorous physical activity, and may also attempt to accelerate weight loss by vomiting, taking laxatives, or using diuretics. The DSM-V also has a classification of Other Specified Feeding or Eating Disorders (OSFED), which includes behaviors around food that cause distress or impairment but that don’t fall into a bulimia or anorexia diagnosis. Included in this category are purging disorders, which refers to frequent purging (using laxatives or vomiting) without binge-eating. Even though not everyone fits neatly into a specific diagnosis, this doesn't mean that health consequences similar to bulimia or anorexia will be absent. Repeated, self-induced vomiting packs a carries significant health risks.

Some risks that may occur regularly or immediately following routine vomiting include:

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

More serious health consequences of frequent purging include:

  • Chronic constipation or irregular bowel movements
  • Intestinal concerns such as obstruction or infection
  • Seizures and muscle cramps from long-term electrolyte deficiency
  • Inflammation and possible rupture of the esophagus
  • Developing ulcers or pancreatic disease
  • Rupturing or inflammation of the esophagus
  • Pancreatitis
  • Irregular heartbeats or even heart failure due to electrolyte imbalance

When it comes to birth control pills, typically two hours is long enough for the pill to absorb into an individual’s system, depending on the dosage and how or when it is taken. That being said, frequent purging is highly stressful for your body. Frequent purging is likely to disrupt bodily response to birth control pills or other medications, possibly including digestion and metabolism of birth control pills. For example, when the body isn't receiving enough nourishment, the small intestines might struggle to absorb medication. Therefore, it's difficult to determine how your body may be absorbing the pill. Your contraceptive method will likely be most effective if you’re managing other medical conditions, such as disordered eating behaviors, with your health care provider's knowledge and support.

While there’s a clear physiological component to purging, there’s usually also a psychological component. It may be useful for you to explore this issue more. Some resources 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 level and with the support of professionals, such as a health care provider or mental health professional. 

Navigating an eating disorder or disordered eating behaviors may be overwhelming. It's great that you're asking questions about how the impact of purging may affect your birth control. Reaching out to a health care provider to learn more about the impact that purging might have on your health could be a great next step.

Good luck along the way,

Alice!

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