What is bulimia nervosa?

Bulimia nervosa, often known as bulimia, is a severe eating disorder that can result in very serious complications if not treated early. People experiencing bulimia may covertly binge and purge, seeking to burn off the additional calories in an undesirable way. Binging is defined as consuming excessive amounts of food without self-control.

Individuals with bulimia may also employ a range of techniques to burn calories and avoid gaining weight. For instance, following bingeing, the individual might attempt self-induced vomiting or abuse laxatives, diet pills, diuretics, or enemas. Others may try other strategies to burn calories and avoid gaining weight, such fasting, tight dieting, or excessive overexercising.

Our specialists at Schoen Clinic have been treating eating disorders for over 35 years and are highly regarded as leaders in the field of clinical research and optimised patient outcomes. If you need support with bulimia or any other eating disorder, we're here to help.

Bulimia risk factors

Like other eating disorders, bulimia nervosa is complex, which means that it can have a variety of underlying causes, such as genetics, neurochemical imbalances, and environmental stressors like abuse or trauma exposure. A person who is inclined to having an eating disorder is also often affected by other psychological and emotional problems, such as an anxiety condition, depression, and poor self-esteem.

Understanding the underlying causes of bulimia nervosa and recognising its warning signs can help people seek out early treatment that can greatly enhance the outcomes for those who are suffering from the disorder. Since there are several contributing factors to bulimia, there are many different therapy options accessible in order to get the best possible outcome.

The physical effects of bulimia nervosa

Bulimia Nervosa is an eating disorder with physical effects on the body which are serious, harmful and if left untreated, can result in long-term problems. Although the physical effects of Anorexia Nervosa, including the condition’s mortality rate, are perhaps better recognised, the physical effects of Bulimia are multiple and should not be under-estimated. Bulimia effects can, for some, become life-threatening and certainly for many, bulimia can have a long-term health impact.

The frequent, recurrent pattern of bingeing and purging that characterises bulimia can have detrimental repercussions on a person's physical health. Bulimia treatment is essential: the longer the condition persists without effective treatment, physical effects become increasingly serious and lasting.

Here, we will break down the;

  • Immediate physical signs of Bulimia
  • Long-term physical effects of Bulimia
  • Treatment and support

Physical signs of bulimia

There are a range of immediate physical effects of Bulimia. The effect on each individual will vary according to the pattern of their eating disorder and individual physiology.

Physical signs can include:

  • Russell’s sign
  • Swollen face
  • Tooth decay
  • Sore throat
  • Dehydration

One of the most well-known Bulimia effects is ‘Russell’s sign’: calluses on the knuckles and hands caused when inducing vomiting as in doing so, this part of the hand scrapes against the teeth. Russell’s sign however, is not present in all people with Bulimia; many will purge without causing this Bulimia effect and may depend on other types of purging (laxatives, over-exercising).

When someone has bulimia, their outward look frequently conceals the reality that they have a harmful eating condition. Along with a host of other grave bodily symptoms, a person's oral health may deteriorate as the condition worsens. Tooth decay is closely linked to the binge-vomit cycle because the contents of the stomach are highly acidic and repeated cycles of vomiting cause tooth enamel to break down through this acidic content. Bad breath is another bulimia effect. These effects of an eating disorder vary depending on its degree and duration, but the longer an individual is affected by it, the more serious the condition becomes. People can recover and heal, as well as have the majority, but not all, of the physical effects reversed, with prompt and appropriate treatment.

Often, the first person to spot bulimia symptoms is a dentist. Teeth are permanently degraded by vomiting, and they may start to darken or vary in size, shape, or length. They frequently weaken, grow more transparent, and become fragile. Gums and soft tissues in the mouth are also harmed in addition to the teeth being damaged. By inducing vomiting with fingers or any another object, those who purge may develop sores on the inside of their cheeks, on the back of their throat, or on the roof of their mouth.

Face swelling is one of the bulimia effects sufferers find most distressing: sometimes described as ‘bulimia face,’ the swelling can make people feel their face ‘looks fat’. What is taking place is the body’s reaction to self-induced vomiting and the dehydration it causes. The body reacts by trying to hold on to as much water as possible and this is most evident in the parotid glands (around the jawline and side of the face).

Warning signs of bulimia

If you're worried that a friend or loved one may be bulimic it's important to know what to look out for. If you do believe they have bulimia, reach out to them in a safe, non-judgmental way to let them know you care for them, or seek advice from a specialist. It's important they get professional help as early as possible to provide them with the best chance of overcoming the condition.

Characteristics to be aware of:

  • Social exclusion
  • Bathroom use immediately after eating
  • Mood or personality change
  • Avoiding eating in front of others
  • Dental decay, receding gum lines, and yellow, painful teeth
  • Talking about food or weight all the time
  • Acting impulsively
  • Excessive or recent drinking or drug usage
  • A strong dread of gaining weight
  • Obsession with appearance
  • Keeping or concealing food

  • Obsession with plain, loose-fitting apparel

  • Calorie counting and weight tracking

  • Body image distortion

  • Withdrawing from the outside world

  • Frequently weighing themself

Long-term physical effects of bulimia

Bulimia has a devastating impact upon the whole body in the long term, causing multiple serious effects:

  • Electrolyte imbalance, particularly potassium
  • Chronic fatigue
  • Loss or disruption of menstrual cycle
  • Bone weakness

Electrolytes are electrically charged salts, or ions, used by the body to regulate hydration, together with nerve and muscle function. They are determined by hydration: how much water is present in the body.

A long-term pattern of purging leaves the body’s electrolytes in a persistent imbalance, with the risk of affects on heart and kidney function. Potassium is an electrolyte (and also classified as a mineral) which is often depleted by the binge purge cycle and is particularly important for heart function. People with bulimia should have a test of potassium levels and receive a supplement, if required because very low potassium levels can cause irregular heart rhythms and the breakdown of heart tissue fibres.

Other long-term physical effects of bulimia nervosa and potential risks include menstrual cycle disruption and associated fertility problems. Chronic fatigue caused by the constant depletion of nutrients during purges is also a risk, together with future problems with bone health, due to loss of calcium. Tooth decay caused by bulimia may be permanent and difficult to treat.

Gastrointestinal effects of bulimia

Due to frequent vomiting, laxative usage, and/or diuretic use, those with bulimia may have a range of gastrointestinal symptoms. Gastrointestinal bleeding and reflux can be brought on by vomiting and abusing laxatives excessively. The oesophagus relaxes as a result of frequent vomiting, making it simple for the contents of the stomach to ascend up into the throat and mouth. An individual with bulimia may also involuntarily vomit if they lean over after eating or when they burp, for instance. Although rare, if the vomiting behavior isn't addressed and irritation of the esophagus becomes severe, it may result in a ruptured esophagus.

Electrolyte abnormalities and dependence on laxatives are common in those who overuse laxatives. In some cases, the colon may extend and weaken as a result of binge eating and laxative usage, leading to chronic constipation. In extreme cases, some people with bulimia have permanently lost their bowel function and must use a colostomy bag for the rest of their lives.

Bulimia treatment & support

Fortunately, there is good, established bulimia treatment, with strong evidence for its effectiveness. Bulimia treatment is based on a CBT (Cognitive Behavioural Therapy) based approach, supporting individuals to consider the links between their thoughts, feelings and behaviour. It is a practical, problem-solving approach and in bulimia treatment, the triggers for a binge are considered and how this could be overcome by changing the pattern of thoughts, feelings and behaviour.

Treatment is almost always provided in an outpatient setting (seeing a CBT therapist once a week), unless there are other problems which necessitate an inpatient admission. Group support may also be helpful.

Seeking treatment for Bulimia as early as possible is very important, both in terms of reducing your risk of long term, enduring physical side-effects and because it is recognised with Bulimia and other eating disorders, early treatment is linked to better outcomes. This is because the longer eating disorders persist, the more entrenched and difficult to treat they become.

Frequently asked questions

Bulimia FAQs

With the right care, people with bulimia nervosa may reverse the majority of their physical symptoms and resume leading a normal, healthy life. Unfortunately, dental problems including decay, breakage, and discoloration can sometimes be irreversible and call for medical attention.

It may take many months or perhaps a few years to recover from bulimia, depending on a variety of reasons. Bulimia-related repetitive and destructive behaviours must be replaced with healthy coping strategies, which requires time and commitment to a different way of thinking about and responding to stressful situations.

The body's dehydration during bulimic habits frequently results in swelling of the jaw or face. When we are severely dehydrated, our bodies instinctively strive to retain as much water as they can.

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Schoen Clinic Newbridge

Schoen Clinic Newbridge offers highly specialised inpatient treatment for children and young people (8-18 years) and a specialised outpatient service for young people (12-25 years) experiencing eating disorders and their associated problems. Welcoming NHS and private patients.

Schoen Clinic Chelsea

Schoen Clinic Chelsea is a leading London outpatient clinic in the heart of Chelsea.

Offering a specialised day treatment programme for children and young people (11-17 years) with eating disorders, as well as fast one-to-one Consultant appointments for young people (6-17 years) and adults (18+).

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Schoen Clinic York

Schoen Clinic York offers highly specialised inpatient treatment for adults (18 years +) with diagnosed eating disorders and their associated problems.

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