By the numbers
Statistics on eating disorders are gathered independently by separate institutions, through different reports and studies, so it's difficult to come by universal, or universally agreed-upon statistics, including for the number of people experiencing eating disorder behaviors, and those who succumb to these conditions.
One 2016 study conducted in Germany found a death rate of 1.49 for bulimia nervosa, meaning people struggling with the condition were 1.49 times more likely to die than those without the disorder.1
Meanwhile in the United States, a 2009 study—one of the most recent and widely-cited on the topic—uncovered an estimated death rate of 3.9% for people struggling with bulimia nervosa, which came in second only to anorexia nervosa in terms of deadliest mental illnesses.2
Still, it can be difficult to parcel out whether these deaths are caused directly by the disordered eating behaviors, including binge eating and purging, associated with bulimia nervosa, or by the many mental and physical health complications that often accompany these conditions.
Bulimia nervosa and suicidality
Bulimia nervosa may manifest in a very physical way, but, above all, the condition is a mental illness. As such, the psychiatric disorder is often connected to a number of other mental health conditions, which may also contribute to the overall mortality rate of BN.
People who struggle with bulimia nervosa are far more likely to experience mood disorders, with one study finding up to 75% of patients having some type of affective disorder, and anywhere from 50-65% struggling with major depression.5 Other statistics show people with bulimia are also diagnosed with an anxiety disorder 80% of the time, and with a substance use disorder 36% of the time.6
And while these can become complicating factors in and of themselves, these types of comorbid—or co-occurring—conditions can also lead to increased experiences of suicidality.
Compared to the general population, those with BN were seven times more likely to complete suicide, according to one study.7 And those with BN—along with those with anorexia nervosa—had a much higher prevalence of suicidality overall, with an estimated 25-35% of people with bulimia nervosa attempting suicide at some point.7
The eating behaviors and co-occurring mental health concerns associated with BN aren't the only complications connected to the condition. Different methods of purging tend to carry their own complications and risk factors.
For those who purge through self-induced vomiting, many systems within the body can be thrown off, sometimes fatally. This action can lead to serious electrolyte imbalances, which frequently leads to heart failure, a fatal arrhythmia, or sudden death.4 It can also cause serious gastric ruptures or ruptures along the esophagus, which can be deadly or at the very least extremely painful and difficult to manage.4
Similarly, those who engage in laxative abuse as a form of purging are in danger of developing chronic bowel problems, such as cathartic colon and chronic constipation, which can snowball into further health complications.4
Purging through excessive exercise can carry its own complications, such as increased risk of injury or exhaustion. And Other potential complications caused by bulimia nervosa include:3
- Increased risk of cardiovascular disease
- Dental erosion
- Chronic inflamed or sore throat
- Inflamed salivary glands, AKA chipmunk cheeks or bulimia cheeks
- Acid reflux, GERD, and other digestive issues
While on their own, these complications may not be deadly, they can lead to a severely decreased quality of life or develop into more serious issues.
Seeking help for bulimia
Bulimia nervosa may have one of the highest mortality rates, but happily, the condition also has one of the highest recovery rates among eating disorders, with one study finding as many as 62.8% of participants making a full recovery.8
The National Eating Disorders Association (NEDA) recommends seeking treatment as early as possible, to head off as many of these potential complications as possible, before they've developed to a dangerous level.
Compulsive eating is often a major factor in bulimia, and the longer that type of behavior is allowed to persist, the more difficult it becomes to eradicate from someone’s daily routine. Additionally, the longer someone struggles with bulimia, the more likely it is they will develop physical complications and even be at risk for premature death.
NEDA suggests that those showing signs and symptoms of an eating disorder get a medical exam, to help determine their status and potentially receive advice about the best next steps.9