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Learn more about the results we get at Within

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What are the long-term effects of bulimia?

If you or a loved one has experienced bulimia nervosa (BN), it is important to be aware of the long-term effects of this eating disorder. While BN can have a detrimental impact on the body, seeking treatment early can do a lot to mitigate, and even reverse, some of these long-term effects of bulimia nervosa. 

 minute read
Last updated on 
December 26, 2023
Long-term effects of bulimia
In this article

The complications of living with bulimia nervosa 

Those living with bulimia nervosa may experience a variety of edical complications associated with the disorder. Purging behaviors, which may include self-induced vomiting and laxative or diuretic misuse, can result in the following complications:10,18

  • Dehydration
  • Heart arrhythmias
  • Low blood pressure
  • Gastrointestinal (GI) emergencies

Seeking help from a healthcare team as soon as possible can improve short- and long-term outcomes for recovery. However, even if you have been struggling with bulimia nervosa for a long time without help, recovery is still possible, and getting support can make a big difference.


What are the long-term effects of bulimia nervosa? 

The long-term effects of bulimia nervosa can include serious medical consequences, especially if the eating disorder is left untreated.1 In the long term it can lead to physical, mental, and emotional effects.

Difficulties with conceiving

Infertility is one of the potential long-term effects of bulimia nervosa.1 However, the good news is that once your nutritional status improves with treatment and your vitamin and mineral levels have been restored, your chances of conception and overall fertility may improve as well.1

Diabetes and metabolic disturbances

The disordered eating behaviors of bulimia nervosa, including restricting, purging, and excessive exercise, can lead to a suppressed metabolic rate.18

Restoring metabolic rate after having an eating disorder, like bulimia nervosa, is possible and involves steadily increasing the patient’s caloric intake to gradually speed up their metabolism. As a person’s daily food intake steadily increases, so will their metabolism.2 Eating a balanced diet while in recovery from BN can also help address any remaining nutritional deficiencies.

Low bone density increases the potential for broken bones

Bone density is measured to determine how strong your bones are, as having a low bone density can mean your bones are more likely to be fractured or broken, placing you at a higher risk for serious injury.2

It’s natural as the body ages that bone density will decrease and bones will become more brittle. However, eating disorders like anorexia nervosa and bulimia nervosa have been linked to degrading old bone at a faster rate than normal.4 Malnutrition and stress have also been connected to low bone density.5

Some new methods may be able to help restore bone density in people recovering from eating disorders. A multidisciplinary team approach to treatment includes working with a nutritionist and movement therapist, who can develop a supplement program and address bone health.6

Throat damage

Recurring and regular episodes of self-induced vomiting can lead to inflammation of the esophagus. In long-term cases of bulimia nervosa, which is an eating disorder characterized by frequent purging, scarring, or even rupturing of the esophagus can occur, which is life-threatening.7

Acid reflux and gastroesophageal reflux disease (GERD), which is a more severe, chronic form of acid reflux, are also common in those living with bulimia nervosa.7 These issues can be alleviated through healthcare interventions, which may include medication and surgery. A medical team and a GI specialist can help create a healthcare plan to reduce further damage and discomfort from these stomach acid issues.

Sleep problems 

Irregular sleep patterns are a regular complaint of those suffering from bulimia nervosa, with difficulty falling asleep, increased day sleep, and reduced REM sleep being common sleep disturbances.8,9

A lack of sleep can contribute to food cravings, potentially acting as a trigger for binging episodes. Furthermore, the quick surge of energy that follows a binge can interfere with a person’s regular sleep patterns, which can result in the continuation of the poor sleep and binge cycle.8 Normal circadian rhythms are more likely to be disturbed when binge episodes occur at night.8

Heart damage and high cholesterol

There may be residual heart damage and increased cholesterol in people who have experienced bulimia nervosa.18 A comprehensive treatment plan will include food, movement, stress reduction, and possibly medication and supplement recommendations to restore heart health.

GI disturbances

Upper and lower GI issues are common in those living with bulimia nervosa. Digestive issues caused by bulimia include acid reflux, GERD, stomach pain, nausea, rectal prolapse, and Mallory-Weiss tears.10

Getting treatment for BN will help determine your need for probiotics and/or supplements for your current GI symptoms. Your treatment team can create a complete plan of healing for the gut, which may involve addressing regular bowel movements, hemorrhoids, and other possible conditions.

Treating the long-term effects of bulimia after recovery

The good news is that many of the long-term effects of bulimia nervosa are treatable.

A comprehensive treatment program for bulimia nervosa often includes working with a dietitian and medical team who develop an appropriate and personalized eating plan, monitor labs for nutrient deficiencies, and recommend supplements and/or diabetes mitigation as needed.

Once you are admitted to an eating disorder treatment program, your multidisciplinary treatment team will conduct a diagnostic evaluation to determine which interventions and treatments will be the most effective in helping to address all of the physical and mental health side effects of BN. 

For individuals living with any of the long-term effects of bulimia, in addition to renourishing your body and altering eating disorder behaviors, there are many treatments available that can be effective and can improve the quality of your life.

The types of psychotherapies that have been found to be effective in the treatment of bulimia nervosa include:11-16

  • Acceptance and commitment therapy (ACT)
  • Cognitive behavioral therapy (CBT)
  • Cognitive remediation therapy (CRT)
  • Dialectical behavioral therapy (DBT)
  • Emotionally focused therapy (EFT)
  • Exposure therapy
  • Internal family systems (IFS)
  • Interpersonal therapy (IPT)
  • Eye movement desensitization and reprocessing (EMDR)
Treatment is within reach

If you or someone you love requires treatment for bulimia nervosa or another serious eating disorder, our team is here to help. Reach out to our care team today to receive compassionate care for bulimia nervosa. We'll be there throughout your recovery process and help you deal with any medical complications.

Call us | (866) 293-0041

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. Bulimia nervosa. (n.d.). Bulimia nervosa | Office on Women's Health. (n.d.). Retrieved April 13, 2023.
  2. Boost metabolism after anorexia. (2017, May 1). EatingDisorders.com. Retrieved April 14, 2023.
  3. Mayo Foundation for Medical Education and Research. (2022, September 21). Bone Density Test. Mayo Clinic. Retrieved April 17, 2023.
  4. Robinson, L., Aldridge, V., Clark, E. M., Misra, M., & Micali, N. (2016). A systematic review and meta-analysis of the association between eating disorders and bone density. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 27(6), 1953–1966.
  5. U.S. Department of Health and Human Services. (n.d.). What people with anorexia nervosa need to know about osteoporosis. National Institutes of Health. Retrieved April 14, 2023.
  6. Chen, L. R., Hou, P. H., & Chen, K. H. (2019). Nutritional Support and Physical Modalities for People with Osteoporosis: Current Opinion. Nutrients, 11(12), 2848.
  7. Gouda, A., & El-Kassas, M. (2022). Barrett's esophagus in a patient with bulimia nervosa: A case report. World Journal of Clinical Cases, 10(17), 5841–5845.
  8. Hunnicutt, C. (2022, February 1). The connection between eating disorders and sleep problems. Monte Nido. Retrieved April 14, 2023.
  9. Cinosi, E., Di Iorio, G., Acciavatti, T., Cornelio, M., Vellante, F., De Risio, L., & Martinotti, G. (2011). Sleep disturbances in eating disorders: a review. La Clinica Terapeutica, 162(6), e195–e202.
  10. Mehler, P. S., & Rylander, M. (2015). Bulimia nervosa – medical complications. Journal of Eating Disorders, 3(1).
  11. Manlick, C. F., Cochran, S. V. & Koon, J. (2013). Acceptance and Commitment Therapy for Eating Disorders: Rationale and Literature Review. Journal of Contemporary Psychotherapy, 43, 115–122.
  12. Huurne, E. D. T., de Haan, H. A., Postel, M. G., et al. (2021). Long-term effectiveness of web-based cognitive behavioral therapy for patients with eating disorders. Eating & Weight Disorders, 26(3), 911-919.
  13. Kass, A. E., Kolko, R. P., & Wilfley, D. E. (2013). Psychological treatments for eating disorders. Current Opinion in Psychiatry, 26(6), 549–555.
  14. Ivanova, I., & Watson, J. (2014). Emotion-focused therapy for eating disorders: Enhancing emotional processing. Person-Centered & Experiential Psychotherapies, 13(4), 278–293.
  15. Butler, R. M., & Heimberg, R. G. (2020). Exposure therapy for eating disorders: A systematic review. Clinical Psychology Review, 78, 101851.
  16. Lester, R. J. (2017). Self-governance, psychotherapy, and the subject of managed care: Internal Family Systems therapy and the multiple Self in a US eating-disorders treatment center. American Ethnologist, 44(1) 23-35.
  17. Miniati, M., Callari, A., Maglio, A., & Calugi, S. (2018). Interpersonal psychotherapy for eating disorders: Current perspectives. Psychology Research and Behavior Management, 11, 353-369.
  18. Tith, R. M., Paradis, G., Potter, B. J., Low, N., Healy-Profitós, J., He, S., & Auger, N. (2020). Association of Bulimia Nervosa with long-term risk of cardiovascular disease and mortality among women. JAMA Psychiatry, 77(1), 44.


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