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• Highlights
• Introduction
• Risk Factors
• Causes
• Complications of Bulimia
• Complications of Anorexia
• Symptoms
• Diagnosis
• Treatment
• Treatment for Bulimia
• Treatment for Anorexia
• Therapy
• Resources
• References

Eating disorders

Description

An in-depth report on the treatment and prevention of eating disorders.

Alternative Names

Anorexia; Bulimia; Binge eating

Complications of Bulimia

Most studies report that patients with bulimia that is not accompanied by severe weight loss have a much better outlook than patients with anorexia. Some studies have suggested that 60 - 80% of bulimic patients are in remission within 3 months of treatment. However, relapse is common, and over half of women with bulimia continue to battle disordered eating habits for years. In one study, bulimia itself persisted in 10 - 25% of patients after treatment.

Direct Adverse Effects of Bulimic Behavior on the Body

Many medical problems are directly associated with bulimic behavior, including:

• Tooth erosion, cavities, and gum problems
• Water retention, swelling, and abdominal bloating
• Acute stomach distress
• Fluid loss with low potassium levels (due to excessive vomiting or laxative use; can lead to extreme weakness, near paralysis, or lethal heart rhythms)
• Irregular periods
• Swallowing problems and esophagus damage

Forced vomiting causes repetitive assaults on the esophagus (the food pipe) from forced vomiting. It is not clear, however, if swallowing problems are common.

• Rupture of the esophagus, or food pipe
• Weakened rectal walls (rare, but serious condition that requires surgery)

Long-Term Health Problems

Studies have been mixed on the long-term health consequences for bulimic people who maintain normal weight and who do not go on to become anorexic. Some report no major problems. A 2002 study, however, reported that eating disorders during adolescence put these young people at risk for a variety of psychological and medical problems later on, even in those without severe eating disorders. Health problems included circulatory disorders (such as high blood pressure), neurologic symptoms (such as seizures), chronic fatigue, headache, frequent flus and colds, and insomnia. Even worse, only 22% of the subjects had received any psychiatric treatment. The study did not break down specific eating disorders, but related the health problems with specific behaviors.

Furthermore, another 2002 study reported that bulimic patients were at higher risk for bone fractures. (The risk was lower than with anorexia and, unlike in anorexia, it returned to normal within a year of diagnosis and treatment.)

In all cases, patients who have both bulimia and anorexia are in greatest danger of health risks.

Long-Term Psychiatric Problems

In the 2002 study mentioned above, eating disorders, even with normal weight, were associated with a higher risk for anxiety and depressive disorders and with suicide attempts.

Self-Destructive Behavior

A number of self-destructive behaviors occur with bulimia:

• Smoking. Many teenage girls with eating disorders smoke because it is thought to help prevent weight gain.
• Impulsive Behaviors . Women with bulimia are at higher-than-average risk for dangerous impulsive behaviors, such as sexual promiscuity, self-cutting, and kleptomania. Some studies have reported such behaviors in half of those with bulimia.
• Alcohol and Substance Abuse. An estimated 30 - 70% of patients with bulimia abuse alcohol, drugs, or both. This rate is higher than that of the general population and for people with anorexia. However, this higher rate of substance abuse may be a distortion because studies are conducted only on diagnosed patients. Bulimia tends not to get diagnosed. And reports of bulimia in the community (where the incidence of the eating disorder is higher than statistics suggest) indicate that substance abuse is actually lower than in people with anorexia.

Abuse of Over-the-Counter Medications

Women with bulimia frequently abuse over-the-counter medications, such as laxatives, appetite suppressants, diuretics, and drugs that induce vomiting (ipecac). None of these drugs is without risk. For example, ipecac poisonings have been reported, and some people become dependent on laxatives for normal bowel functioning. Diet pills, even herbal and over-the-counter medications, can be hazardous, particularly if they are abused.

• Review Date: 12/13/2006
• Reviewed By: Harvey Simon, MD, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital.

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