The complications of bulimia

The effects of bulimia on the body

Symptoms of poor overall health and medical complications are commonly observed in those with bulimia. For example, somatic (i.e. relating to the body) symptoms such as chest pain, shortness of breath, joint pain, menstrual issues, gastrointestinal problems and headaches may occur. The medical complications that arise as a result of bulimia will depend on the frequency and method used for purging (i.e. misusing laxatives, enemas or diuretics or most commonly, self-inducing vomiting).

Treatment for the complications at hand will include discontinuing purging. Bear in mind, abruptly stopping purging is also associated with a number of complications, this includes pseudo-Bartter syndrome – a rare condition that describes a set of autosomal (i.e. relating to a chromosome that is not a sex chromosome) renal tubular conditions. This can lead to a predisposition to significant oedema (swelling/water retention).

The information that follows describes the most commonly identified complications in patients suffering from bulimia:

Malnutrition

Bulimia can be a life-threating condition and as will be discussed below, may affect a number of the body’s organs as a result of malnutrition. Malnutrition as a result of bulimia is a condition caused by a lack of nutrients in the body. Some of the symptoms of malnutrition include:

• Weight loss
• Dizziness
• Muscle weakness
• Weak immune system – Getting sick a lot and taking a longer time to recover
• Stunted growth
• Fatigue
• Fainting

Those with bulimia will suffer from malnutrition as a result of laxative and diet pill abuse, as well as self-induced vomiting. This may lead to low blood pressure where the person will experience cold hands and feet, fainting, abnormal electrolyte levels, failure to ovulate (this results in missed periods in women), abnormal hormone levels and a delay in puberty. These will be discussed in detail in each of the relevant sections.

Integumentary system

The integumentary system is an organ system that includes the skin, exocrine glands (these are glands that produce and secrete substances, for example perspiration, through ducts to the skin’s surface), nails and hair.

These external parts of the body are often affected by bulimia. Complications associated with dehydration are the main underlying cause of the effects on the integumentary system. When dehydrated, the hair can become frizzy and dry, hair loss may also occur. Dry and brittle nails, as well as dry skin is a chronic (i.e. long-term) side effect of bulimia. The skin may become scaly and rough which is a sign that friends and loved ones may notice in someone with bulimia.

Hands and fingers

One of the most obvious signs of bulimia is known as Russell’s sign. This is the result of the individual with bulimia frequently putting their finger down their throat to purge (vomit). When this is done on a constant basis, the person may develop callouses or scraped and raw sores on the back of their hands, specifically on the knuckles due to this area rubbing against the incisors. Repeated exposure to stomach acid during vomiting may also scar the skin on the fingers and hands.

Bulimia cheeks (Parotid and submandibular (salivary) gland hypertrophy (i.e. enlargement))

Those with bulimia may exhibit one of the most common signs of the eating disorder known as “bulimia cheeks”, also referred to as acute sialadenosis. This sign refers to the cheeks appearing enlarged or swollen, colloquially referred to “chipmunk cheeks”.

This enlargement or puffiness of the cheeks is a result of the parotid tissue being inflamed, and the associated swelling of the parotid glands, the largest salivary glands. The parotid glands are situated at the back of the mouth, in front of and beneath the ear and are only visible when severely inflamed. The main function of these glands is the secretion of saliva to allow for food to be chewed, swallowed and digested easily.

If someone with bulimia chooses to purge through self-induced vomiting on a continual basis, then these glands may become inflamed from the exposure to and irritation caused by stomach acids. The severity of the inflammation will depend on the number of times the person purges. The more someone vomits, the more the cheeks will swell and enlarge, this sign will only subside when purging stops and it may take a number of weeks for the inflammation to go down completely.

Bulimia cheeks is often a disheartening symptom for bulimia sufferers as those with this eating disorder are typically obsessed with the way their body looks and want to achieve a specific aesthetic ideal of being thin or lean, and bulimia cheeks tend to make one appear ‘puffy’ or overweight.

The presence of swollen, puffy cheeks is often used by doctors to diagnose bulimia as a number of patients hide their eating disorder. Therefore, “bulimic/bulimia cheeks” are a symptom that a medical professional will notice during an examination, which may lead to the diagnosis and subsequent treatment of those suffering from the eating disorder. Professional treatment is a necessity for anyone who is struggling with an eating disorder as various health factors need to be closely managed and monitored to prevent serious and potentially fatal complications during recovery and refeeding (known as refeeding syndrome).

During recovery from bulimia professionals will help to guide the patient in the process of ending the cycle of bingeing and purging, which is often difficult and trying for those attempting to do this on their own.

The effects of bulimia on the mouth, teeth and gums

Self-induced vomiting that is done on a continual basis may result in severe damage to the teeth and mouth. Vomiting is a particularly toxic and harmful form of purging as stomach acids enter the mouth along with food that is brought back up. These acids are strong enough to break down and digest food, which gives one an idea of what they are able to do to the teeth.

Stomach acids are corrosive to the mouth and will eventually wear down the enamel that covers and protects the teeth. Tooth decay can also result from brushing one’s teeth after vomiting as the protective covering is at its weakest after acid exposure and brushing the teeth may contribute to further erosion. It may take up to two years for the effects of bulimia on the mouth and teeth of those suffering from the disorder to become noticeable.

Mouth sores

In the same way that stomach acid can wear down tooth enamel, it may also wear down the tissues on the sides and roof of the mouth and damage the throat.

The associated damage can result in the development of painful sores in the affected areas, which may become inflamed and infected. This is also one of the reasons why a number of people with bulimia who vomit as a means of purging have a chronically sore throat.

Dry mouth

A dry mouth, also known as xerostomia, pronounced “zeer-o-STOE-me-uh”, may result in decreased salivary flow from repeated self-induced vomiting as well as the overuse of diuretics and laxatives. This makes an individual with bulimia feel as though their mouth is constantly parched.

Do not mistake this condition as a minor annoyance, a continually dry mouth can further damage the teeth. This is because saliva aids in washing away the bacteria that leads to tooth decay and the progression of any existing dental conditions.

A dry mouth and the inevitable nutritional deficiencies that result from an eating disorder may also cause varying degrees of infection in the corners of the mouth as well as gum disease.

Cavities

Stomach acid may erode the tooth enamel to such a point that cavities develop in the teeth. Cavities are a form of tooth decay that lead to permanently damaged areas in the teeth that develop into tiny holes. Apart from stomach acid exposure, another factor contributing to tooth decay and the development of cavities in those with bulimia is bingeing on junk food such as sugary drinks and foods.

When one suffers from dental decay, bleeding gums when brushing the teeth is evident. It is vital that those with cavities get these filled by a dentist as these can eventually lead to tooth loss if cavities are permitted to progress.

Brittle, yellow teeth

As erosion due to exposure to stomach acids progresses, the teeth may begin to undergo changes in colour and texture, also becoming weaker and more brittle than normal. The teeth may chip easily and have ragged edges.

In some cases, teeth may turn a yellow colour with a glassy appearance. Bulimia can also change the length and shape of the teeth through erosion.

Periodontal disease (gum disease)

Various acts of purging, which include self-induced vomiting, and/or the overuse of laxatives and diuretics may lead to chronic dehydration, malnutrition and tooth decay. This can also increase one’s risk of periodontal disease as a person with bulimia is unable to heal as fast as they should due to inadequate nutritional intake to fuel their immune system. To add to these risk factors for gum disease, those suffering from bulimia may already have issues with mouth sores and the erosion of tooth enamel and cavities (induced vomiting). These issues, as well as a lack of saliva to wash away bacteria contribute to the development of periodontal disease which leads to gum infections, receding and bleeding gums.

Gum disease (periodontitis) develops from gingivitis. Gingivitis refers to inflammation of the gums as a result of build-up of bacteria and plaque on the teeth due to poor oral hygiene. In those with bulimia, the body is unable to rectify the condition on its own as it is already dehydrated and malnourished, as such, if left untreated, gingivitis can progress and develop into periodontitis. This condition will need professional diagnosis and treatment so as to prevent further infection and the progression of existing dental issues such as cavities. Mouth and gum infections are typically treated with antibiotics.

Tooth and mouth pain

When tooth enamel continues to wear down, this may leave the sensitive inner parts of the teeth exposed. This exposure increases one’s sensitivity to food and drinks at different temperatures, making it uncomfortable and often painful to eat foods such as ice cream or drink hot tea.

The damage done to the soft palate and gums (due to gum disease and mouth sores) may lead to additional pain when chewing food or swallowing.

When a dentist is informed that their patient is battling with an eating disorder, they will begin dental treatments that include thorough home care hygiene habits to prevent further destruction of the structures of the teeth.

The effects of bulimia on the internal organs and systems

Bulimia is a condition that is physically demanding on the body and the effects of the disorder may result in fatigue and general body weakness. However, the impact of bulimia on the body doesn’t stop there and the condition can affect the internal organs and systems which we’ll discuss in the sections that follow.

Digestive system

In those suffering from bulimia the binge-purge cycle may eventually take a toll on the digestive system A sore throat and stomach aches are often the first symptoms noticed regarding the effect of bulimia on the digestive system.

Effects on the oesophagus, stomach and gastrointestinal tract 

• It is believed that abnormal oesophageal motility may be associated with self-induced vomiting and lead to difficulty in swallowing normally (dysphagia), painful swallowing (odynophagia), irregular oesophageal spasms or complications wherein the muscles of the lower oesophagus do not relax (this is known as achalasia).
• Stimulation of the gag reflex during self-induced vomiting causes contraction of the abdominal walls and stomach contents to be expelled. The oesophagus and mouth are exposed to stomach acid which causes irritation and damage to the mucosal wall lining resulting in mild oesophagitis, heartburn and acid regurgitation.
• GERD (gastroesophageal reflux disease) - Chronic acid reflux as a result of the sphincter, which is the valve that controls the connection between the oesophagus and stomach losing its strength and allowing stomach acid to enter the oesophagus and mouth involuntarily.
• Laryngopharyngeal reflux – Also known as silent reflux, this condition describes the reflux (black flow) of gastric (i.e. stomach) content into the larynx (voice box) and pharynx (the cavity that connects the nose and mouth to the oesophagus). Data suggests that there is a link to gastroesophageal reflux disease (GERD) and laryngopharyngeal reflux and those with GERD often experience silent reflux.
• Loss of gag reflex - Also referred to as the laryngeal spasm or pharyngeal reflex, the gag reflex is a natural contraction of the back of one’s throat that is triggered by an object that touches the roof of the mouth or back of the tongue/throat area. Those who purge through self-induced vomiting may overstimulate this reflex in order to purge which can eventually result in the loss of it.
• Heme-stained emesis – Vomiting of blood, this may be a result of a rupture in the oesophagus.
• Barrett’s oesophagus – This condition is associated with GERD. It results in the rupturing of the oesophagus can due to erosion of the lining of the oesophagus. Although widely debated, it is thought to be a precursor to oesophageal cancer in a small number of people. Reddening and irritation (erythema) of the superficial mucosal lining of the stomach and/or duodenum.
• Mallory-Weisssyndrome (MWS) - Constant self-induced vomiting may result in tears of the oesophagus, these are known as Mallory Weiss Tears, and are diagnosed in those with Mallory-Weiss syndrome (MWS). Minor tears of the oesophagus may heal within a week or so, however, more severe tears may result in significant bleeding which is present in the vomit. 
• Boerhaave’s Syndrome – This rare condition involves the spontaneous rupturing of the oesophagus which typically occurs as a result of forceful emesis (i.e. vomiting). The difference between Boerhaave’s Syndrome and Mallory-Weiss syndrome (MWS) is that Boerhaave’s refers to a transmural perforation, wherein a tear occurs through the entire wall of the oesophagus, whereas MWS (Mallory-Weiss syndrome) describes a tear or perforation of the oesophagus that is non-transmural, however, both of these conditions are associated with forced vomiting.
• Stomach issues – Episodes of bingeing and purging can impair the natural system and flow of digestion in the body. The prevention of food from passing through the intestines (as a result of self-induced vomiting) is able to severely slow down digestion. This impairment, as well as damage to the digestive tract, may result in:
  • Bloating
  • Nausea
  • Diarrhoea and malabsorption
  • Delayed gastric emptying
  • Indigestion
  • Constipation
  • Stomach cramps Irritable bowel syndrome
• Protein-losing enteropathy (PLE) – This rare condition refers to the loss of protein across the digestive tract, or more specifically, across the intestinal mucosa. The cause of this condition is often linked to gastrointestinal conditions linked to damage within the digestive tract.
• Gastric dilation – Also known as stomach dilation, this refers to a condition wherein the stomach rotates and over stretches as a result of excess gas. This disorder is caused by binge eating.
• Gastric rupture – Although rare, overstretching of the stomach can result in a gastric rupture, this is a condition wherein the contents of one’s stomach spill into the abdominal cavity and is considered a medical emergency.
• Hypokalaemia ileus – Hypokalaemia describes a low level of potassium in the blood, and ileus refers to an obstruction within the bowels. Hypokalaemia ileus describes a condition wherein a low level of potassium results in muscle weakness, or more severe cases, muscle paralysis and/or paralytic ileus which refers to an obstruction in the intestines due to the paralysis of the muscles in the digestive tract known as the intestinal muscles.
• Colonic dysmotility – This condition refers to muscles in the colon not working effectively which can result from IBS (irritable bowel syndrome) causing changes in the functioning of colonic muscles. This disorder may also be a result of the malabsorption of carbohydrates⁷.
• Ulcers - Irritation of the stomach lining can lead to the development of ulcers. Peptic ulcers, also known as stomach ulcers are breaks or holes in the digestive lining that form when the stomach or intestine’s protective layering deteriorates due to prolonged exposure to stomach acid. When this occurs, the digestive acids, containing hydrochloric acid and an enzyme known as pepsin, damage the stomach tissue or intestine.
• Pancreatitis – This describes inflammation of the pancreas. Mild pancreatitis may be a consequence of bulimia as a result of chronic malnutrition⁸.
• Steatorrhea – This symptom refers to stools that contains a large amount of fat. This is often a sign that food is passing through the digestive system and is not being digested effectively. This issue is linked to malabsorption in those with bulimia.
• Melanosis coli – This condition is associated with the chronic use of laxatives that contain anthraquinone and refers to the harmless pigmentation of the lamina propria, this is a layer of lining of the large intestine/colon.
• Rectal prolapse – This condition may occur as a result of the chronic use of laxatives and refers to a part of rectal lining protruding through one’s anus. This condition is treated with surgery.

Other digestive issues that result from the abuse of laxatives or diuretics:

• Severe dehydration is often seen in those who frequently use laxatives or diuretics
  • The symptoms of dehydration ranging from mild to severe include:
    • A dry mouth
    • Increased thirst
    • Fatigue
    • Headache
    • Dizziness
    • Diarrhoea
    • Vomiting
    • A weak or rapid pulse
    • Seizures
    • A low level of consciousness
  • Impairment of kidney function as a result of chronic depletion of one’s blood flow caused by dehydration.
  • Bowel movements may become dependent on the use of laxatives.
  • Chronically straining the bowels from the constant passing of faecal matter as a result of the use of laxatives may cause haemorrhoids (haemorrhoids). This disorder, also known as piles, refers to inflamed veins in the anus and rectum resulting in bleeding and discomfort.
  • Chronic overstimulation of the nerves responsible for a bowel movement caused by the frequent use of laxatives may result in a complete shutdown of the bowels, this is known as cathartic colon. When this condition occurs as the sufferer’s colon is incapable of moving faecal matter, the person may need a partial or a complete colon resection, also known as a colectomy. This procedure involves surgically moving one end of the large intestine to the outside of the abdominal wall and attaching a colostomy bag to the abdomen to assist in the passing of faecal matter.
  • Stopping the use of laxatives or diuretics ‘cold turkey’, which refers to abruptly stopping these purging methods without weaning off of them, may result in an extreme shift of fluids, renal shutdown and even a severe imbalance of electrolytes, all of which can be life-threating. Due to this, doctors and experts involved in the treatment and recovery of bulimia will carefully monitor their patients to ensure that they slowly taper off of laxatives and diuretics.

Circulatory system

Renal complications and electrolytes – The complications linked to the imbalances of electrolytes (electrolytes are minerals and salts in the body that are responsible for conducting electrical impulses) that are most commonly associated with bulimia nervosa include⁹:

**My Med Memo – The imbalance of electrolytes as a result of nutrient loss through purging contributes to fatigue, weakness, and in more severe cases, may even predispose the person to cardiac arrhythmias and even sudden death⁹.   

• Dehydration - Dehydration is commonly observed in those with bulimia as a result of the purging of fluids from the body. This can lead to extreme fatigue and weakened muscles. Dehydration also causes an imbalance of electrolytes in the body.
• Hypokalemia – This refers to low levels of potassium in the blood. Potassium is vital for muscle and nerve cell function, paticularly for the muscles of the heart. The kidneys control potassium levels in the body. Low levels of potassium put one at risk of cardiac arrhythmia (i.e. an irregular heartbeat), as the heart’s cardiac muscle cells are affected by an imbalance in muscle and nerve activity. The heart needs potassium to regulate blood pressure and beat properly. A number of muscle contractions depend on the potassium levels present in the body, if these are at an unhealthy level, several health issues may arise such as vomiting, diarrhoea and disorders concerning the adrenal glands. It is also possible for sudden death to occur as a result of extremely low levels of potassium in the body, which can result in the heart stopping.
• Hypochloremia – This electrolyte imbalance occurs when there are low levels of chloride in the blood. Chrloride is vital to the functioning of the body’s metabolism, it also aids in maintaining the acid and base balance in the body. The kidneys control chloride levels. There are no specific symptoms associated with this issue.
• Hyponatremia – This issue arises when sodium levels in the blood are too low. Low sodium levels can result in the water levels in the body rising and causing the cells to swell. Should the sodium concentration in the bloodstream be too high, then water will move from the cells and into the bloodstream in an attempt to dilute and in turn, lower the concentration of sodium. This works both ways, if the sodium levels are too low, then water levels in the body will rise and result in the cells swelling.
  Low sodium levels may lead to a number of issues such as nausea and vomiting, fatigue, headache and confusion and in some cases, hyponatremia can result in seizures, coma and death.

• Metabolic alkalosis – The blood in the body consists of bases and acids. Metabolic alkalosis is a condition that develops as a result of the body gaining too much base or losing too much acid. An example of this would be the loss of stomach acid caused by chronic vomiting or when a person loses an excessive amount of electrolytes such as potassium and sodium, as well as fluids, this affect the ability of the kidneys to maintain the body’s acid-base balance.
• Hypomagnesemia – Magnesium is another vital electrolyte in maintaining the function of the heart and nervous system within the body, and low levels thereof (referred to as hypomagnesemia) can result in cardiac arrhythmia, muscle cramps and spasms, anxiety and seizures.
• Hypophosphatemia – This condition refers to phosphate levels in the blood that are abnormally low. Phosphate aids in filtering out waste products in the kidneys and plays a vital role in how energy is used and stored in the body. It is needed for the repair of all cells and tissues.

Purging will also lead to blood volume depletion in the body which may also lead to hypotension (low blood pressure), anaemia (anaemia), dizziness and a weak pulse. A low white blood cell count may also occur in those with bulimia. If the white blood cell count is low, immunity is affected, and chances of infection become elevated.

**My Med Memo – Anaemia is a condition wherein the individual doesn’t have enough healthy blood cells and haemoglobin to ensure adequate oxygen flow to the organs and tissues of the body.

Endocrine

Muscular-skeletal system

The deterioration of muscle tissue, known as rhabdomyolysis has been reported in several patients suffering from bulimia⁹ as a result of dehydration and hypokalaemia (low levels of potassium). The symptoms of muscle break down (i.e. rhabdomyolysis) include tender and weak muscles and dark coloured urine. This condition is considered a medical emergency and will typically be treated by attempting to correct the issue through hydration. In those with severe damage to the kidneys, dialysis may be required. There have also been reports of hypokalaemic paralysis as a consequence of the abuse of diuretics.

Softening of the bones, known as osteomalacia has been associated with the abuse of the laxative phenolphthalein. This condition describes the abnormal formation of bones that is linked to aching pain experienced at night or when weight is applied to the bone. Osteomalacia will increase an individual’s chance of fractures occurring and may be diagnosed through thorough clinical examinations, lab tests for phosphorus and calcium deficiencies, X-rays and, if necessary, a bone biopsy can be conducted.

The signs for both of the above-mentioned conditions will typically become evident during the diagnosis and treatment of bulimia.

Reproductive system

Female fertility and bulimia

In some sufferers, bulimia may interfere with the menstrual cycle, although this is highly variable presenting in approximately 37% to 64% of cases, and amenorrhea (the cessation of periods) occurring in 5% to 40% of sufferers¹⁰.  

Should a woman’s ovaries stop releasing eggs (this is what is known as anovulation) as a result of bulimia nervosa related amenorrhea (when the menstrual cycle stops due to nutritional and hormonal imbalances caused by bulimia), she is unable to fall pregnant as sperm cannot fertilise non-existent eggs.

If a woman who is bulimic does not experience fertility issues and manages to fall pregnant and continues to binge and purge, this can create a number of health risks and complications for both the mother and the unborn baby as her body may struggle to support both herself and the developing foetus.

Another observation noted in women with bulimia, and encountered in 75% to 100% of patients, is the link between the eating disorder and an abnormal polycystic (i.e. multiple cysts) ovarian morphology.

Polycystic Ovary Syndrome (PCOS) describes a condition that is characterised by menstrual abnormalities, an overproduction of the androgenic hormone testosterone, as well as enlarged ovaries containing a number of small follicles or cysts that resemble a string of pearls (hence the name polycystic ovarian syndrome). PCOS has been associated with a resistance to the hormone insulin or the abnormal secretion of insulin which may be a result of binge eating.

Complications associated with bulimia and pregnancy

Overall, there seems to be a general consensus that eating disorders such as bulimia, carry an excessive risk for a mother suffering from the condition and her foetus¹¹. Pregnancy is often an anxious and stressful time for a number of women, particularly those with eating disorders. The weight gain that accompanies being pregnant and the changes in body shape that come with it may lead to the progression or recurrence of an eating disorder. On the other hand, bulimia may temporarily abate as a result of the expecting mother’s worries regarding the health effects an eating disorder may have on her baby.

Studies conducted¹¹ on women with bulimia found that they were significantly more likely to suffer a miscarriage, while those with anorexia nervosa were more likely to give birth to smaller babies in comparison to the general population. In another study, women with an eating disorder or a history of the eating disorder, were found to have a higher risk of miscarriage and premature labour¹¹.

Other maternal issues that were reported in those with an eating disorder included:

• Anaemia
• Postnatal depression - This is depression that is experienced after the baby is born
• Psychological upset
• Preterm birth

Bulimia and the effect it has on the postpartum period

As previously mentioned, women who suffer from bulimia have a higher risk of developing postnatal depression. It is thought that changes in body image, loss of control over their changing bodies and weight gain contribute to this risk, making women with bulimia more vulnerable to depression.

Women who have recovered from an eating disorder may suffer from a relapse as a result of their pregnancy. Women with an eating disorder also tend to stop breastfeeding sooner than others in order to gain control over the hunger associated with this practice.

Female fertility and recovering from bulimia

Women who are recovering from bulimia and have a normal menstrual cycle may have a good chance of falling pregnant and experiencing a healthy and safe pregnancy. However, women with a history of an eating disorder may have a more difficult time falling pregnant than women who have never suffered from an eating disorder and may take between six months and a year to conceive.

Male fertility and bulimia

Fluctuating body weight and nutritional issues will interfere with the sex hormones in both men and women and affect their fertility. Men battling bulimia nervosa may experience diminished sperm mobility and quality, this refers to the sperm’s ability to effectively move through a woman’s reproductive system and implant into an egg. Men may also have a lowered sperm count due to bulimia related weight loss.

Bulimic men who partake in excessive exercise to combat the calories ingested during a bingeing episode may risk the temperature of their testicles increasing on a constant basis, which may damage sperm.

Bulimia and its effects on mental and emotional health

Eating disorders often stem from a person’s initially good intentions of wanting to lose a little weight or control their eating for health purposes. However, in some cases, good intentions may progress to severe extremes in terms of dietary and caloric restriction which in turn triggers cravings and binge eating. Purging may ensue as a result of guilt, frustration in not seeing weight loss results from dieting, fear of gaining weight after bingeing or having to control one’s eating due to issues with blood sugar such as diabetes becoming an obsession.

Bulimia is classified as an eating disorder, however, the condition is also regarded as a mental health condition. Experts believe that other pre-existing mental conditions may also be a risk factor in the development of bulimia. Sufferers may, in addition to bulimia, also experience (as a result of the eating disorder or prior to its development) issues such as anxiety, depression and OCD (obsessive-compulsive disorder). These conditions bring about sadness, stress and a drivenness towards perfectionism in sufferers.

Irritability and moodiness may occur due to poor nutrition and a lack of vital vitamins and minerals in the body as a result of bulimia. The constant monitoring of weight and food as can develop into an obsession, taking precedence over all else.

Compulsive exercising, a non-purging type of bulimia, is associated with feelings of anxiety and a compulsion to rid the body of extra calories. Those with this type bulimia may also obsess over thoughts of food in terms of what they want to eat, or binge on and how to rid themselves of the calories after eating.

A person suffering from bulimia may also exhibit signs of addiction and engage in substance abuse, using alcohol and drugs to deal with their insecurities.

These acts and their associated emotions often lead to the withdrawal of the sufferer from social situations and personal relationships. Most feel as though they have hide their condition from their friends and loved ones in order to continue this behaviour without interruption, avoid unwanted attention and possible attempts at intervention, as the mere thought of not being able to purge after bingeing evokes panic. This behaviour compounds feelings of anxiety, isolation and loneliness, yet still, the draw towards being in control is somehow almost always more appealing.

Over the long term, the cycle of these emotions can result in suicidal thoughts and tendencies as the affected person begins to be overwhelmed by these feelings, discontent with their own body image and the lack of understanding of those around them.

This is why seeking a proper diagnosis and professional medical treatment is so vital for those suffering from bulimia nervosa. The guidance of trained professionals not only helps a sufferer physically, emotionally and psychologically but may ultimately save their life.

Complications associated with exercise bulimia

Exercise bulimia is a non-purging form of bulimia which involves the sufferer partaking in excessive, vigorous forms of exercise as a form of compensation for episodes of bingeing. Some experts note that ‘compulsive’ is a better adjective to describe the type of exercise associate with this form of bulimia nervosa¹².

Those who partake in healthy forms of exercise will typically organise their exercise routine around their personal and work life, whereas those who are dependent on exercise will organise their lives around it. Excessive, or compulsive forms of exercise may develop in those who feel an extreme need to control their lives, and in the case of those with bulimia, exercise becomes a compensatory measure for bingeing, and an activity that assuages feelings of guilt and anxiety associated with possible weight gain as a result of their ‘lack of control’.

While exercise is generally considered a necessary aspect of optimum health, too much exercise can have negative effects on the body and place extra pressure on the heart which can lead to an irregular heartbeat. Excessive exercise may also place a great deal of stress on the joints and bones which may lead to stress fractures, chronic joint pain and arthritis.

High intensity exercise promotes an increase in cortisol levels in the body, cortisol is also known as the stress hormone. Cortisol is responsible for a number of functions in the body, and normal levels are this hormone aid in metabolic functions such as regulating metabolism, reducing inflammation and assistance with memory formulation. It also has an effect on the water and sodium balance within the body and helps to control blood pressure.

When cortisol levels are chronically high as a result of compulsive exercise, anxiety and other stress-related factors, this can disrupt a number of functions within the body resulting in the sufferer experiencing one or more of the below issues:

• Feeling sad or depressed
• Gaining weight
• Suffering from headaches
• Having digestive issues
• Struggling to sleep
• Having a higher risk for heart disease

A weakened immune system is also seen in those with bulimia as a result of electrolyte imbalances and nutritional deficiencies. Compulsive exercise can further fatigue the body, making it more difficult to heal from current infections and health conditions or to produce the immunity necessary to fight off potential pathogens.   

When to see a doctor for bulimia

People who are exhibiting the symptoms of bulimia should seek medical attention as soon as possible, if the condition is left untreated it may lead to severe physical and mental health complications which may become life-threatening.

Helping a friend or loved one who is struggling with bulimia

Some of the more noticeable signs of bulimia that are seen as red flags for the condition include the affected person:

• Constantly complaining about being overweight and worrying about their weight even when their weight is normal (or only slightly over normal).
• Having a body image that is excessively negative and distorted
• Repeatedly eating excessively large amounts of food (bingeing) during one sitting, particularly consuming foods that he or she normally avoids.
• Avoiding eating in front of others or in public places.
• Going to the toilet right after finishing a meal.
• Exercising excessively
• Having worn down or damaged teeth

Bear in mind however that just because someone might exhibit one of the signs of bulimia mentioned above, does not mean they definitely have the eating disorder. It is best to speak to a professional about what to be aware of should you suspect a friend or loved one is struggling with bulimia.

If these symptoms and signs are evident in a friend or loved one you suspect may be suffering with bulimia, then try to have an open and honest talk with, voicing your concerns in a loving and non-judgemental manner. It is not advised that you force them to seek professional treatment, but rather offer your support and encouragement. With their consent you can suggest making an appointment for the two of you to talk to a doctor or mental health professional or give them the option of going alone.

Do not become upset if your concern is met with denial, anger or withdrawal, these are common emotions exhibited by sufferers in response to attempts at intervention. It may take a great deal of time for a sufferer to realise that what they are doing to themselves is not only of concern to others but is actually harmful to themselves. Only when a sufferer wants to be helped, will any type of intervention or therapeutic treatment be effective.

 

 

^References:

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^{8. NCBI. 2004. Recurrent acute pancreatitis in anorexia and bulimia. Available: https://www.ncbi.nlm.nih.gov/pubmed/15254353 [Accessed 07.03.2018]}

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