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What are the complications of bulimia?

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Bulimia nervosa (BN) can be a particularly difficult disorder to endure, both mentally and physically. The disorder’s frequent purging can take a toll on the body, while the unhelpful thoughts behind the behavior can contribute to stress, anxiety, and depression.

If you or someone you love is struggling with bulimia, it may be helpful to learn about different complications of the disorder, to understand all the potential risks at play, and hopefully guide yourself or your loved one to the appropriate treatment that can lead to healing.

Last updated on 
October 27, 2022
In this article

Physical complications of bulimia

Bulimia may be considered a mental health condition, but the disorder can lead to quite a number of physical difficulties.

A majority of physical bulimia complications are directly tied to the disorder’s purging behavior. While self-induced vomiting is the most commonly used method, there are a number of other ways a person struggling with bulimia may experience purging, including through excessive use of laxatives, excessive exercising, or periods of severe food restriction.

The specific types of physical bulimia complications a person may encounter can depend on the purging methods being used. But, generally, the disorder impacts nearly every system of the body.

Digestive system

The primary bodily system bulimia affects is the digestive system. 

The disorder’s demanding cycles of binging and purging can bring on a range of short- and long-term effects, including:

  • Stomach irritation, heartburn, or gastroesophageal reflux disease (GERD)
  • Irritated, torn or ruptured esophagus
  • Chronic sore throat
  • Puffy cheeks (also called “bulimia cheeks”), a result of inflamed glands in the face
  • Sores in the mouth, tooth sensitivity, or tooth decay (1)

Those who purge through self-induced vomiting may also see calluses or sores on their fingers or the backs of their hands, due to that area’s frequent contact with stomach acid, or possibly from accidental biting down on the hand while purging.

And those who purge through the use of laxatives could also see complications arise in their bowel movements. Bloating, diarrhea, or chronic constipation could become an issue for someone whose body begins relying too heavily on laxatives to stimulate release. Hemorrhoids are another common problem. (3)

Endocrine system

Bulimia can also wreak havoc on the endocrine system, which is responsible for the regulation of hormones. As hormones play a key role in nearly every bodily function, this can have a detrimental domino effect within the body, resulting in:

  • Low sex drive
  • Fertility issues in people of all genders
  • Potential pregnancy complications, including higher risk for:
  • High blood pressure
  • Gestational diabetes
  • Miscarriage
  • Amenorrhea (loss of menstruation) 

Aside from contributing to these physical difficulties, imbalanced hormones can also play a role in the mood disorders that may exacerbate or prolong a person’s struggle with bulimia.

Circulatory system

Hormones aren’t the only aspect of the body that can fall out of balance when someone is struggling with bulimia. Electrolytes—or, the electrically-charged essential minerals in the blood and other bodily fluids—can also diminish over time as someone continues participating in purging behavior.

This can lead to a number of issues, including muscle weakness, extreme fatigue, and dizziness. 

Electrolytes are also essential in the upkeep of heart health. An imbalance can play a part in difficulties such as:

  • Low blood pressure or a weak pulse
  • Anemia
  • Heart failure in severe cases

And those who purge through self-induced vomiting also run a risk of rupturing small blood vessels through the act, especially those in the eyes. (3)

Integumentary system

Most people don’t think of skin as an organ, but it is, in fact, the body’s largest organ. Indeed, the covering comprises an entire organ system, called the integumentary system.

Made up of the skin, hair, and nails, this system, too, is not immune to the impact of bulimia. The biggest bulimia complication to the integumentary system is typically dehydration brought on by the excessive output of purging. 

Without proper levels of water and electrolytes, the skin, hair, and nails can turn brittle, flaky, or scaly. People with bulimia may also experience premature hair loss or thinning. (3)

Emotional/psychological complications of bulimia

Bulimia nervosa is also closely tied to a person’s mental and emotional state, causing another set of complications for the person struggling with the illness.

Some of those mental and emotional complications can be caused by the uneven diet and lack of many nutrients, vitamins, and other essential compounds that result from restricting and purging.

Hormonal imbalance, for example, can directly lead to or worsen mood disorders, such as anxiety and depression, which, in turn, often play a big role in sustaining bulimia. It’s also possible for these conditions to have existed before someone developed the disorder, or for a person to have a higher risk factor for developing depression or anxiety disorders generally.

Once someone is entrenched in the behavioral patterns of bulimia, other emotional and psychological complications may come to the surface, including:

  • Obsessive-compulsive behaviors, such as compulsive exercising
  • Obsessive rituals, especially around eating and meals
  • Low self-esteem, self-isolation, and acts of self-harm
  • Intense fear of gaining weight
  • Feeling a loss of control when eating (3)

As with the effects of most eating disorders, many of the psychological complications of bulimia can either cause the disorder, be caused by the disorder, or both.

When to seek treatment for bulimia

Encouragingly, it’s entirely possible to make a full recovery from bulimia and continue along the road to better health and healing.

When asking when to seek treatment for bulimia, the answer is almost always as soon as possible. The disorder can have detrimental long- and short-term effects on mental and physical health, which tend to get worse the longer it goes on. And people struggling with bulimia have, unfortunately, been found to have a higher risk of both suicidal ideation and suicide attempts. (1)

If you are asking yourself whether you or a loved one should seek treatment for bulimia, it’s likely time to start. Luckily, there are a number of therapies, treatments, and other services that can help make a positive difference and help get you or your loved one on the way toward a full recovery. WIthin Health offers virtual care programs attuned to your specific needs. Call us today to learn more about getting started.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Smith, A. R., Zuromski, K. L., & Dodd, D. R. (2018). Eating disorders and suicidality: What we know, what we don’t know, and suggestions for future research. Current Opinion in Psychology, 22, 63–67. https://doi.org/10.1016/j.copsyc.2017.08.023 
  2. Mehler, P. S., & Rylander, M. (2015). Bulimia nervosa – medical complications. Journal of Eating Disorders, 3(1). https://doi.org/10.1186/s40337-015-0044-4 
  3. Pietrangelo, A. (2019, March 15). The effects of bulimia on your body. Healthline. Retrieved April 17, 2022, from https://www.healthline.com/health/bulimia/effects-on-body#Central-nervous-system-(mental-and-emotional-health)


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