Eating Disorders: Anorexia and Bulimia

Description

Alternative Names

Complications of Bulimia

Most studies report that patients with bulimia that is not accompanied by severe weight loss have a much better outlook than patients with anorexia. Some studies have suggested that between 60% and 80% of bulimic patients are in remission within three months of treatment. However, relapse is common and over half of women with bulimia continue to battle disordered eating habits for years. In one study, bulimia itself persisted in 10% to 25% of patients after treatment.

Direct Adverse Effects of Bulimic Behavior on the Body

The following are medical problems directly associated with bulimic behavior, including self-induced vomiting and laxative abuse:

• Teeth erosion, cavities, and gum problems.
• Water retention, swelling, and abdominal bloating.
• Occasionally, fluid loss with low potassium levels. This occurs from excessive vomiting or laxative use. In severe cases it can cause extreme weakness, near paralysis, or lethal heart rhythms.
• Acute stomach distress.
• Problems in swallowing. This is an area of possible concern because of repetitive assaults on the esophagus (the food pipe) from forced vomiting. It is not clear, however, if this problem is common.
• Rupture of the esophagus, or food pipe. (Cases have been reported with forced vomiting but are not common.)
• Weakened rectal walls. In rare cases, walls may weaken to the extent that they protrude through the anus. This is a serious condition that requires surgery.
• Irregular periods. (It should be noted that menstrual irregularities in patients with bulimia do not have the serious effects, particularly bone loss, as they do in patients with anorexia.)

Long-Term Health Problems

Studies have been mixed on the long-term health consequences for bulimic people who maintain normal weight and who do not go on to become anorexic. Some report no major problems. A 2002 study, however, reported that eating disorders during adolescence put these young people at risk for a variety of psychologic and medical problems later on, even in those without severe eating disorders. Health problems included circulatory disorders (such as high blood pressure), neurologic symptoms (such as seizures), chronic fatigue, headache, frequent flus and colds, and insomnia, regardless of weight loss. Even worse, only 22% of the subjects had received any psychiatric treatment. The study did not break down specific eating disorders, but related the health problems with specific behaviors. Furthermore, another 2002 study reported that bulimic patients were at higher risk for bone fractures. (The risk was lower than with anorexia and, unlike in anorexia, it returned to normal within a year of diagnosis and treatment.)

In all cases, patients who have both bulimia and anorexia are in greatest danger of health risks.

Long-Term Psychiatric Problems

In the 2002 study mentioned above, eating disorders, even with normal weight, were associated with a higher risk for anxiety and depressive disorders and with suicide attempts.

Effect on Pregnancy

Most pregnant women with a history of eating disorders have healthy pregnancies, although they face higher risks for a number of complications, including cesarean sections, postpartum depression, miscarriages, and complicated deliveries. Their babies may also have a higher risk for low birth weight, prematurity, and malformation. A 2004 study of women who had been previously hospitalized for eating disorders found that their risk of pre-term delivery was increased by 70-80%, and their chance of having a low-birth-weight infant doubled.

Self-Destructive Behavior

A number of self-destructive behaviors occur with bulimia:

• Smoking. Many teenage girls with eating disorders smoke because it is thought to help prevent weight gain.
• Impulsive Behaviors. Women with bulimia are at higher-than-average risk for dangerous impulsive behaviors, such as sexual promiscuity, self-cutting, and kleptomania. Some studies have reported such behaviors in half of those with bulimia.
• Alcohol and Substance Abuse. An estimated 30% to 70% of patients with bulimia abuse alcohol, drugs, or both. This rate is higher than that of the general population and for people with anorexia. It should be noted, however, that this higher rate of substance abuse may be a distortion because studies are conducted only on diagnosed patients. Bulimia tends not to get diagnosed. And reports of bulimia in the community (where the incidence of the eating disorder is higher than statistics suggest) indicate that substance abuse is actually lower than in people with anorexia.

Abuse of Over-the-Counter Medications

Women with bulimia frequently abuse over-the-counter medications, such as laxatives, appetite suppressants, diuretics, and drugs that induce vomiting (e.g., ipecac). None of these drugs is without risk. For example, ipecac poisonings have been reported, and some people become dependent on laxatives for normal bowel functioning. Diet pills, even herbal and over-the-counter medications, can be hazardous, particularly if they are abused.