Long Term Effects of Bulimia Nervosa

Sharing is caring!

Last updated on December 19th, 2023 at 01:10 am

Bulimia nervosa can lead to an array of physical changes in your body.  There are both short and long-term effects of bulimia nervosa on the body which we will walk through in this article.

Some of the most common effects of bulimia include: 

• Dental erosion
• Dental Caries 
• Xerostomia (dry mouth)
• Weight loss
• Decreased bone mineral density
• Loss of period (in women) 
• Female athlete triad (in women)
• Electrolyte imbalance 
• Upper GI tract bleeding
• Swelling of Parotid glands (face swelling)
• Barretts esophagus
• GERD
• Changes in microbiome 
• Dehydration

Some of the effects of bulimia nervosa are short-term, while others may have long-term impacts on the body. 

The best method of preventing or reducing the severity of long-term impacts of bulimia nervosa is to work with a skilled healthcare team including a medical doctor, physician, and eating disorder dietitian. If you have the warning signs of bulimia, the best way to prevent long-term effects is by early intervention.

Seeking early and aggressive intervention is key to effective bulimia recovery that minimizes the impacts of bulimia.

Let’s explore some of the common symptoms we see with bulimia nervosa and their impacts on overall health. 

What is “Bulimia Face?” 

Bulimia face is the swelling of the face as a result of self-induced vomiting producing swollen salivary glands. 

Contributors to bulimia face include: 

• Reduced salivary flow rate resulting from vomiting 
• Swelling of the three salivary glands including the parotid gland which is the largest
• The appearance of “chipmunk like” cheeks as a result of the swelling

The appearance of a bulimia face is that of “chipmunk cheeks” or puffy cheeks. 

Is Bulimia Face Swelling Reversible

Yes.  Bulimia face swelling is temporary as long as the person completely discontinues intentional vomiting. 

Salivary glands begin to decrease in size about 8 weeks after someone completely stops vomiting. 

Will Everyone With Bulimia Nervosa Experience Bulimia Face Swelling

No. 

While up to 80% of those with bulimia nervosa will experience face swelling, many will not.  

Face swelling is only one symptom of bulimia nervosa and bulimia should not be ruled out because someone does not have face swelling. 

Swelling of the face in bulimia depends on

• Frequency of purging
• Genetics
• Overall level of malnutrition
• How long the person has experienced bulimia

Bulimia Face Treatment

Swollen glands that occur in treatment can be painful. Ultimately, getting rid of swollen glands from purging will require complete cessation from purging.

Even purging one time can quickly elicit symptoms of swollen glands in the mouth.

Treatment for swollen glands after discontinuing purging includes:

• Applying heat to swollen glands
• Sucking on lemon drops to increase salivary flow
• Increasing fluid intake
• NSAIDs or prescription medication to reduce inflammation
• Swishing your mouth with lemon juice (initially this can be painful but will reduce swelling)
• Correcting any malnutrition

Bulimia and Teeth

Those with bulimia nervosa may experience dental caries and dental erosion. 

This is a result of: 

• Changes in pH of the mouth with continuous vomiting 
• Changes in bacteria of the mouth
• Dry mouth 
• Decreased salivary flow 
• The lower ability for saliva to acquire pellicle (a defense against acid erosion)

Gastric acid which has a pH of 2.7 begins to dissolve tooth enamel. 

Long Term Effects Of Bulimia Nervosa

Potential impacts on the body from bulimia nervosa will relate to the type of purging the person is engaging in (vomiting, diuretic use, or withholding insulin in the case of type 1 diabetes) as well as the length of time the eating disorder has been happening.

Bulimia Nervosa Impacts On The Heart

Bulimia can have both short and long-term impacts on the heart. Some of the impacts on the heart you may see in bulimia are: 

• Changes in the structure of the heart
• Hypotension (low blood pressure)
• Bradycardia (slow heart rate)   
• Reduced left ventricular mass 
• QTc Interval prolongation (increases risk of cardiac arrest) 

Many changes to the heart that occur with bulimia nervosa are reversible with supervised weight restoration. 

However, it is very important to note that the rapid electrolyte shifts that occur with purging can cause the heart to stop at any time. This can lead to neurological damage that can’t be reversed or death. 

Impacts On the GI Tract Of Bulimia Nervosa 

Bulimia nervosa has impacts on the GI tract which include: 

• Delayed gastric emptying 
• Cathartic colon syndrome (colon is unable to move stool resulting in severe constipation)
• Nausea
• Cramping 
• Lack of hunger cues
• Pancreatitis (inflammation of the pancreas)
• Kidney stones

Delayed gastric emptying can cause you to feel extreme bloating, pain, and early fullness. This can make it even more difficult to eat which worsens the condition. Weight restoration can help with delayed gastric emptying. 

Different GI symptoms may occur with different types of purging (vomiting versus laxative abuse) Fox example, laxative abuse is more likely to result in pancreatitis and kidney stones. 

Stomach relaxation after meals is significantly reduced in patients with bulimia nervosa. 

Bulimia Nervosa Impacts On The Bones

Bulimia nervosa can lead to a decrease in bone mineral density.  This can have long-term impacts on health leading to osteopenia (weak bones) or osteoporosis. 

Bone loss in patients with bulimia can be related to: 

• Estrogen Deficiency 
• Excess glucocorticoid
• Malnutrition 
• Reduced body mass 

While some bone mineral density restoration is possible once weight is restored and normal nutrition is resumed, some impacts may be lasting. 

The long-term risks of bone disease in those with bulimia will depend on: 

• How long someone goes without a period
• The level of calcium deficiency 
• The intensity of the physical activity that was done 

Damage To The Esophagus and Throat With Bulimia Nervosa 

Frequent vomiting long term effects of bulimia such as: 

• Acid reflux 
• Gerd
• Barrett’s Esophagus 
• Upper GI tract bleeding 
• Ulcers
• Partial thickness tears in the esophagus (mallory-weiss tear or Boerhaave syndrome)

Purging through vomiting can cause the upper GI tract to bleed. The stomach becomes irritated by stretching following a binge and then vomiting. This can produce ulcers as well.

While some of these symptoms impacting the GI tract with bulimia are reversible, some such as GERD or Barrett’s esophagus may be lifelong.  Symptoms such as Boerhaave syndrome are uncommon but can be deadly.

What Does Bulimia Do To The Brain? 

Structural changes can occur in the brain of someone with bulimia nervosa including 

• Enlarged ventricles 
• Sulcal widening (often seen with aging)
• Nodal strength changes in sensorimotor and visual regions, hippocampus, and orbitofrontal cortex. 

The structural anatomy of the brain and the reward systems are altered with bulimia nervosa. 

People with bulimia nervosa are likely to experience extreme food guilt after eating. Changes in the brain also make a mechanical eating plan. a crucial part of the recovery process.

Structural changes in the brain make it critical to have a support team in place to help a person with bulimia nervosa with meal support challenging fear foods and following their meal plan as they often cannot do it alone.    

Can Bulimia Nervosa Cause Permanent Damage 

Yes. 

Long-term effects of bulimia that may not be reversible take place in:

• The heart
• The gastrointestinal tract 
• Bone mineral density 
• The throat and the esophagus 

There is no safe way to engage in purging behaviors associated with bulimia nervosa. There will be short-term and potentially permanent complications from the disorder if qualified medical and therapeutic interventions are not sought out as early as possible. 

Can the Body Fully Recover From Bulimia 

The extent to which the body can recover from bulimia will depend on: 

• How long the symptoms of bulimia have been occurring 
• The extent to which purging of any sort occurred 
• The level of nutritional intake the person consumed during and after their eating disorder
• Compliance with the treatment program 
• Compliance with the eating disorder recovery meal plan 
• Ability to appropriately restore weight 
• Access to care for eating disorder treatment

Unfortunately, some effects of bulimia nervosa will not be reversible. Treatment with a qualified healthcare team must be received as soon as possible to prevent any further physical damage to the body. 

How Can I Prevent Long-term Effects of Bulimia

The best and only way to prevent permanent damage from bulimia nervosa is to initiate eating disorder treatment intervention as early as possible. 

Even if someone is at a point where they are suffering long-term consequences of bulimia, treatment is critical to prevent any physical damage from bulimia from getting worse. 

If you’re looking for more support and resources on your recovery journey, check out these eating disorder recovery books.  

A full recovery from your eating disorder IS possible and you deserve to live a life free from rules and rituals around your food and your body.