Medical Dangers of Bulimia

Medical Dangers of Bulimia

Bulimia can be a fatal disease. Mortality rates for eating disorders vary widely between studies, with sources listing anorexia nervosa deaths from .3% to 10%. One fairly new study compared the records of individuals who had been treated at specialized eating disorders clinics with the National Death Index. Their findings for crude mortality rates were: 4% for anorexia, 3.9% for bulimia, and 5.2% for EDNOS (Crow, 2009).

The most common causes of sudden death in bulimia are cardiac or respiratory arrest, the result of electrolyte imbalances from excessive purging. Electrolytes, which are minerals in the blood—like potassium, chloride and sodium—help maintain a regular heart rhythm, as well as the function of the muscles that enable the heart to pump and the lungs to breathe. When these chemicals are depleted due to purging—often made worse by weight loss and excessive water drinking—heart arrhythmia (irregular heartbeat) can occur. Since this can lead to sudden death, it is important to have blood tests to monitor electrolytes, and medical treatment if they are amiss. This danger resolves when proper health and nutrition are restored.

Less common causes of death in bulimia include choking, rupture of the esophagus or stomach, and suicide. Kidney failure is another possible life-threatening side-effect of prolonged low potassium (Mehler, 2010).

Gastrointestinal symptoms may result from vomiting or laxative abuse. Severe acid reflux causing inflammation of the esophagus and heartburn, spontaneous regurgitations, and chest pain are the more common GI symptoms from vomiting. Constipation or diarrhea (or both), gas, bloating, abdominal cramping, dehydration, and blood in feces occur from laxative use. Also, the lower bowel can lose muscle tone, becoming limp and unable to produce contractions.

Oral and dental problems frequently occur due to vomiting. These include erosion of tooth enamel and subsequent cavities or loss of teeth, gum inflammation, sore throat, dry mouth, and difficulty swallowing.

Individuals with bulimia may also experience cold hands and feet, and develop calluses on the back of the hand from rubbing against teeth when inducing vomiting (called “Russell’s sign” after Gerald Russell, a British psychiatrist who wrote the first academic article on bulimia nervosa in 1979). Other potentially serious complications include internal bleeding, pancreatitis, irregular or absent menstrual periods, impaired fertility, bone loss leading to osteoporosis, muscle loss, and brain changes.

Some bulimics use syrup of ipecac, detergents, or foreign objects to induce vomiting—all of which are extremely dangerous. Ipecac, a horrible tasting liquid, is used to treat poison victims, and its abuse can result in both muscle weakness and cardiac arrest (Mickley, 1999; Mitchell, 1997).

Some medical conditions have been documented as risk factors for eating disorders, although we can only speculate about the mechanism. These include: diabetes mellitus, cystic fibrosis, inflammatory bowel diseases such as Crohn’s disease, and mononucleosis. Incidentally, as many as one in three teenaged girls and young women with type 1 diabetes mellitus purposely manipulate doses of insulin to lose weight, a practice shared on the Internet and called “diabulimia.” This leads to poor control of blood sugars associated with the development of diabetic complications, such as blindness and kidney failure, within just a few years (Bock, 1999; Yager, 2007; Zerbe, 1995).

It is difficult, if not impossible, to know which bulimics are at greatest risk for developing any of these specific conditions. Certainly, the longer the bulimia continues, the greater the risk of cumulative damage. However, even someone who has only started to purge faces the possibility of serious physical consequences, even death.

Reprinted with permission from Bulimia: A Guide to Recovery
By Lindsey Hall and Leigh Cohn
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