Dear Alice,

I am bulimic and I would like to know exactly what harmful things this does to your body. Can you die from it? Can you actually be cured?

Dear Reader,

It's great that you're asking questions that may inform your health moving forward! Bulimia nervosa (bulimia) is a serious, potentially life-threatening condition in which someone consumes large amounts of food in a short amount of time, followed by a period of purging through vomiting, laxative use, or excessive physical activity in a cyclical pattern. This eating disorder, which is diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), can have a number of short and long-term health consequences. These consequences can be both physical and psychological; while some of these are life-threatening, it’s difficult to pinpoint bulimia as a cause of death. Recovery from bulimia may also focus on self-image, not just eating habits. However, there are treatment options, such as psychotherapy, medication, nutrition education, or inpatient care in a hospital, that have helped many people with bulimia feel better about themselves and adopt healthier eating patterns.

Individuals living with bulimia often binge food and many report feeling a lack of control while it’s happening. Following these binges, they often feel guilty and ashamed, which may lead to them engaging in compensatory behaviors. These behaviors could include vomiting, abusing laxatives, diuretics, or enemas (all of which are forms of purging). People may also over-exercise or not eating for several days. These practices usually take place about once a week for several months and may go on for years.

Bulimia can lead to a number of serious and even life-threatening complications. The type of complications someone experiences is often related to the purging method. Bulimia is associated with a number of issues and conditions impacting: 

  • Cardiovascular system: Electrolyte imbalances due to vomiting or not consuming enough calories can lead to life-threatening heart disorders. The purging process tends to dehydrate the body and lower the level of potassium in the blood, which can cause weakness and irregular heart rhythms. Low blood pressure and heart rates are also common concerns.
  • Oral health: Repeated vomiting washes up an excess of stomach acid over teeth and gums, which can cause a significant and permanent loss of dental enamel. Teeth may become ragged and chipped, and there may be an increase in dental cavities. Frequent or regular vomiting may also cause sores in the mouth or throat due to stomach acid irritation. Not only that, it’s possible for the salivary glands to swell because of the frequent vomiting.
  • Digestive system: Purging by vomiting or use of laxatives may irritate the walls of the esophagus and rectum. In severe cases, the esophagus can rupture, which can be life-threatening. Constipation may be caused by inadequate nutrition and repeated laxative use. If these laxatives are used long-term, the individual may become dependent on them, which can make constipation worse.
  • Neurological functioning: The brain uses almost one-fifth of the calories consumed to fuel itself, and when it doesn’t get enough calories, individuals might find they’re increasingly focused on food and have difficulty focusing. Bulimia may also lead to numbness or tingling in the extremities because the body doesn’t have the electrolytes it needs to send chemical and electrical signals from the brain.
  • Psychological health: Bulimia is often associated with depression, anxiety, and low self-esteem. People with bulimia may have trouble controlling impulsive behaviors, managing their moods or expressing anger. These individuals are also at an increased risk of misusing alcohol and other drugs.

Although the road to recovery may be challenging, people can overcome their bulimia. Treatment methods vary, including professional counseling, establishing consistent eating patterns, learning alternative coping strategies for stressful or lonely times, and taking antidepressant medication. For more information about eating disorders and treatments, check out the National Eating Disorders Association website and the related Q&As. If you want to further explore your relationship with food, reaching out to a health care provider, registered dietitian, or a mental health professional may be a great way to start and help determine what type of support you may need. With some medical and social support and motivation, it’s possible to improve your relationship with your body and food.

Alice!

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