Bulimia Nervosa Side Effects

What is bulimia nervosa?

Bulimia nervosa is a type of eating disorder that is becoming increasingly prevalent all over the world. According to the DSM-5 criteria¹American Psychiatric Association. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.: DSM 5. Virginia: American Psychiatric Association; 2013., to receive a diagnosis of bulimia nervosa the person must display:

1. Recurrent episodes of binge eating, which are characterised by both of the following:
   1. Eating, in a discrete period of time (2-hour period), an amount of food that is larger than most people would eat during a similar period of time and under similar circumstances.
   2. A sense of loss of control over eating during this episode, i.e., a feeling that one cannot stop eating or control how much or what one is eating.
2. Recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, fasting, or compulsive exercise.
3. These behaviours both occur, on average, at least once a week for three months.
4. Regarding weight and shape as central to one’s self-worth (i.e., “overvaluation of shape/weight”).
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Bulimia nervosa is connected to a whole host of negative physical, psychological, and social outcomes. In this article, I will provide a comprehensive review of the different effect’s bulimia nervosa has on a person’s functioning.

Physical Effects of Binge Eating

Effects on the stomach

People who binge eat consume a lot of food in a short period of time.

Therefore, in some cases the effects of binge eating on the stomach can be intense and painful and can leave a person feeling breathless²Fairburn CG. Overcoming binge eating. London, UK: Guilford Press 2013..

In extreme and rare cases, the stomach may actually stretch so much that it tears³Agras WS, Walsh T, Fairburn CG, Wilson GT, Kraemer HC. A multicenter comparison of cognitive–behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Archives of General Psychiatry 2000; 57(5): 459-66..

Seek immediate medical help if this occurs.

Effects on body weight

Prolonged binge eating is associated with weight gain⁴Wilson GT, Grilo CM, Vitousek KM. Psychological treatment of eating disorders. American Psychologist 2007; 62: 199-216..

Although people with bulimia nervosa vomit deliberately to compensate for the excess calories consumed, this method of weight control only expels around 50% of the calories consumed⁵Kaye WH, Weltzin TE, Hsu LG, McConaha CW, Bolton B. Amount of calories retained after binge eating and vomiting. American Journal of Psychiatry 1993; 150-969..

The repeated cycle of restriction and binge eating means that body weight will constantly fluctuate in people with the bulimia nervosa.

Physical Effects of Self-induced Vomiting

• Dental consequences: Repeated vomiting erodes the dental enamel on the inner surface of the front teeth⁶Mehler PS. Medical complications of bulimia nervosa and their treatments. International Journal of Eating Disorders 2011; 44(2): 95-104.. Other abnormalities in the oral cavity include reduced salivary flow rate, tooth hypersensitivity, dental caries, and xerostomia (dry mouth)⁷Westmoreland P, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa and bulimia. The American journal of medicine 2016; 129(1): 30-7.. Gum disease is also common after prolonged self-induced vomiting⁸Westmoreland P, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa and bulimia. The American journal of medicine 2016; 129(1): 30-7..
• Throat damage: Self-induced vomiting stimulates the gag reflex with a significant degree of force. Injury and infection to the back of the throat is common⁹Mehler PS. Medical complications of bulimia nervosa and their treatments. International Journal of Eating Disorders 2011; 44(2): 95-104.. A chronic sore throat it also typical.
• Oesophagus damage: Prolonged vomiting can tear the wall of the oesophagus, causing significant bleeding¹⁰Fairburn CG. Overcoming binge eating. London, UK: Guilford Press 2013.. This is a medical emergency and help should be sought.
• Dehydration and electrolyte imbalance: Repeated vomiting flushes out much of the bodily fluids and can cause severe dehydration. It can also cause severe depletion of potassium and sodium levels¹¹Westmoreland P, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa and bulimia. The American journal of medicine 2016; 129(1): 30-7.. Symptoms of dehydration and electrolyte imbalance include:
  • Irregular heartbeat
  • Extreme thirst
  • Dizziness
  • Swollen arms and legs
  • Lethargy
  • Death

Physical Effects of Laxative and Diuretic Use

Both of these compensatory behaviours can also cause dehydration and electrolyte imbalance¹²Mehler PS, Rylander M. Bulimia Nervosa–medical complications. Journal of eating disorders 2015; 3(1): 12..

In extreme cases, prolonged and extreme laxative use can permanently damage the intestines¹³Mehler PS. Medical complications of bulimia nervosa and their treatments. International Journal of Eating Disorders 2011; 44(2): 95-104..

Diuretic use can also cause muscle cramps, headaches, and frequent urination¹⁴Westmoreland P, Krantz MJ, Mehler PS. Medical complications of anorexia nervosa and bulimia. The American journal of medicine 2016; 129(1): 30-7..

Psychological Effects

The psychological consequences of bulimia nervosa are profound, debilitating, and can significant impact the functioning of those afflicted by the disorder. Common psychological effects of bulimia nervosa include:

• Depression: ~60% of with bulimia nervosa also have clinically significant depression¹⁵Godart N, Radon L, Curt F, et al. Mood disorders in eating disorder patients: Prevalence and chronology of ONSET. Journal of Affective Disorders 2015; 185: 115-22.. In fact, early research has shown that the severity of depressive symptoms in those with bulimia nervosa are comparable to those with a depressive disorder!¹⁶Cooper PJ, Fairburn CG. The depressive symptoms of bulimia nervosa. The British Journal of Psychiatry 1986; 148(3): 268-74.. The relationship between bulimia nervosa and depression is bidirectional – that is, both tend to cause or influence each other¹⁷Puccio F, Fuller‐Tyszkiewicz M, Ong D, Krug I. A systematic review and meta‐analysis on the longitudinal relationship between eating pathology and depression. International Journal of Eating Disorders 2016..
• Anxiety: ~65% of people with bulimia nervosa also have a clinically significant anxiety disorder¹⁸Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry 2004; 161: 2215-21.. The most common comorbid anxiety disorders are obsessive-compulsive disorder and social phobia. Comorbid anxiety symptoms usually intensify in situations that involve eating (e.g., going to a wedding or a party) or some degree of body exposure (e.g., going to the beach). This can explain why some people with bulimia nervosa isolate themselves¹⁹Fairburn CG. Overcoming binge eating. London, UK: Guilford Press 2013..
• Alcohol and substance abuse: abusing alcohol or drugs are common behaviours in nearly 70% of people with bulimia nervosa²⁰Fouladi F, Mitchell JE, Crosby RD, et al. Prevalence of alcohol and other substance use in patients with eating disorders. European Eating Disorders Review 2015; 23(6): 531-6.. People with bulimia nervosa typically have poor emotion regulation strategies, so they often resort to drugs and alcohol (in addition to eating) as a means to cope with negative situations. The devastating and seemingly chronic symptoms of bulimia nervosa can instill a sense of hopelessness, forcing people to resort to alcohol or drugs.
• Low self-esteem: a pervasive negative view of the self is both a cause and consequence of bulimia nervosa. It causes the disorder because it encourages people to achieve in the valued domain of weight and shape (the core psychopathology of bulimia nervosa)²¹Fairburn CG. Overcoming binge eating. London, UK: Guilford Press 2013.. And it is a consequence of the disorder because the repeated dietary failures that cause binge eating forces people to be extremely self-critical. Interestingly, self-esteem deficits in bulimia nervosa may even be lower than the self-esteem deficits observed in people with a depressive or anxiety disorder ²²Silverstone PH, Salsali M. Low self-esteem and psychiatric patients: Part I–The relationship between low self-esteem and psychiatric diagnosis. Annals of general hospital psychiatry 2003; 2: 2..

Social Effects

The social effects of bulimia nervosa are also quite significant. In fact, many psychological treatments for bulimia nervosa aim to overturn these negative social effects, with the belief that fostering healthier social skills will indirectly address the core symptoms of bulimia nervosa.

Some important social effects include:

• Relationship breakdowns: It is extremely common for people with bulimia nervosa to destroy the relationships they have with significant others. The reasons for this are complex. However, it may have to do with the fact that these people (a) tend to isolate themselves in order to achieve in their valued domain of weight and shape, and (b) are secretive and will go to great lengths to hide their behaviours²³Fairburn CG. Overcoming binge eating. London, UK: Guilford Press 2013..
• Comparison making: People with bulimia nervosa will regularly compare themselves to others. The comparisons are unfair; people with bulimia nervosa will heavily scrutinize themselves to the nth degree while simultaneously making a very superficial assessment of the other person with which they are comparing to ²⁴Fairburn CG. Overcoming binge eating. London, UK: Guilford Press 2013.. Frequent comparison making can cause people to feel down, lonely, isolated, and worthless.
• Intimacy problems: Intimacy problems are a core side effect of bulimia nervosa. Many romantic partners and spouses report that they feel second place to the eating disorder and emotionally and physically distant from their partner. Low body weight, physical complications, and hormonal imbalances can decrease a woman’s sexual drive, which can explain why women with bulimia nervosa avoid sexual intercourse²⁵Pruitt NA, Kappius RE, Oorman PW. Bulimia and fear of intimacy. Journal of clinical psychology 1992; 48(4): 472-6.. Other characteristics of the disorder that have a direct effect on romantic intimacy include low self-esteem, body image distortion and shame.

Conclusion

As highlighted in this article, the consequences – both physical, psychological, and social – of bulimia nervosa are profound and take an enormous toll on the functioning of those affected by the disorder.

Many of these consequences can be reversed if the disorder is adequately treated. There are a range of evidence-based treatments for bulimia nervosa, including cognitive-behaviour therapy, interpersonal psychotherapy, and family therapy.

It is recommended that you seek out resources to get in control of this disorder. Various self-help books can be purchased. Or seek out professional counselling from a trained mental health professional.