Bulimia Nervosa: What Happens

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What Happens

Bulimia can develop after a person has followed a very restrictive diet. Binging may also be triggered by a stressful event, when food gives you a sense of comfort. Feeling guilty and ashamed of binging can cause you to purge to avoid weight gain. This starts the cycle of binging and purging that becomes a habit.

As bulimia develops, you may not eat at the beginning of the day, but later you may binge to comfort yourself, especially at the end of a stressful day.

Vomiting causes the body to release endorphins—natural chemicals that make you feel good.¹ Eventually you may make yourself vomit even if you have not overeaten so that you can feel good. Soon, you lose control over the binge-purge cycle. Repeated vomiting, fasting, exercising too much, or misusing laxatives, diuretics, ipecac syrup, or enemas will eventually cause serious, long-term health problems.

After bulimia becomes a pattern, it is very difficult to return to normal eating without help. Unhealthy eating behaviors can continue for many years before a person seeks treatment.

If not treated, bulimia can lead to serious, long-term health problems. It is common for people to hide the condition from others for years. By the time others discover the disorder, many people with bulimia already have serious problems. These range from mild to severe, depending on the type of purging behaviors and how long they have continued.⁵ Health problems caused by bulimia include:

• Tooth decay, toothaches, swollen gums, gum disease (gingivitis), and erosion of tooth enamel. These are caused by acid in the mouth from vomiting.
• Osteoporosis.
• Electrolyte imbalances and changes in metabolism that can lead to heart problems, such as arrhythmia and even death.
• Dehydration, which can lead to weakness, fainting, or kidney damage.
• Inflammation or tears of the esophagus, which may cause bloody vomit.
• Swollen salivary glands.
• Fainting or loss of consciousness, usually because of low blood pressure.
• Abnormal heartbeat (arrhythmia).
• Low body temperature.
• Suicide risk when feeling discouraged about having bulimia or a relapse or about ongoing body image issues.
• Long-term problems with bowel movements because of laxative abuse.

Overuse of medicine (such as ipecac syrup) to cause vomiting can lead to diarrhea, weakness, low blood pressure, chest pain, and difficulty breathing. A person can die from prolonged overuse of these medicines.

Other mental health problems often occur along with bulimia, which may make treatment take longer or make bulimia more difficult to treat.⁴ These conditions include:

• Depression, which commonly occurs with eating disorders and increases related feelings of guilt, anxiety, and obsession.
• Substance abuse, which occurs in around one-fourth of those with bulimia.
• Borderline personality disorder, which more commonly occurs with bulimia than with other eating disorders.
• Anxiety and anxiety disorders.
• Obsessive-compulsive disorder.
• Social anxiety disorder or other phobias.
• Panic disorder or panic attacks.

Although bulimia is a long-term disorder linked to serious health problems, it can be successfully treated. About half of people with bulimia recover completely with treatment. More than 9 out of 10 people who seek treatment for bulimia get better.⁶

Although treatment is usually successful, bulimia is a long-term disorder, and setbacks can occur. A return of symptoms (relapse) is especially common if a person continues to diet or have rituals related to food (such as planning the day around a time to binge) and is not sure that he or she is ready to change.⁷ But with ongoing treatment and patience, most people can eventually overcome bulimia.

Bulimia among teens with type 1 diabetes is becoming more common. These teens often lose weight before their diabetes is discovered, then quickly gain weight when treatment begins. Some learn that they can lose weight by skipping insulin doses. This causes poor control of their diabetes and can result in serious problems that can lead to blindness or kidney failure.

Last updated:	October 04, 2007
Author:	Jeannette Curtis
Reviewed By:	Kathleen Romito, MD - Family Medicine, W. Stewart Agras, MD - Psychiatry
Editors:	Susan Van Houten, RN, BSN, MBA, Pat Truman, MATC