Bulimia nervosa natural history, complications and prognosis

Bulimia typically tends to start in late teens or early 20s. Bulimics go through cycles of over-eating and purging, that may be severe and devastating to the body. This cycle may be repeated several times a week or, in serious cases, several times a day. Bulimics may appear underweight, normal weight or overweight. Bulimia may cause several complications including malnutrition, dehydration, electrolyte imbalance, and vitamin and mineral deficiencies. The Eating Disorders Association of UK estimates it at 10%. An 18% mortality rate has been suggested for anorexia.

• Bulimia typically tends to start in late teens or early 20s.
• Bulimics go through cycles of over-eating and purging, that may be severe and devastating to the body.
• They sometimes involve rapid and out-of-control feeding that stops when the bulimic is interrupted by another person or when his/her stomach hurts from over-extension.
• This cycle may be repeated several times a week or, in serious cases, several times a day.^[1]

• Some bulimics eat secretly, others eat socially but are bulimic in private.
• They also differ in “how much” they purge. Some can vomit without gagging themselves after eating.
• Often when the urge hits, they go to great lengths to purge, as if an uncontrollable urge is making them do so.
• Medical evidence shows that the chemicals released when purging may make a person feel “high”. This can also lead to extreme dehydration and electrolyte imbalances.

• Some bulimics do not regard their cycles as a problem, while others despise and fear the vicious and uncontrollable cycle.^[2]
• Bulimics may appear underweight, normal weight or overweight.

Bulimia can cause following health problems:^[1]

• Malnutrition
• Dehydration
• Electrolyte imbalance, which can cause cardiac arrest or brain damage by stroke
• Hyponatremia
• Damaging of the voice
• Vitamin and mineral deficiencies
• Teeth erosion and cavities, gum disease
• Salivary gland swelling (sialadenosis)
• Potential for gastric rupture during periods of binging
• Esophageal reflux
• Irritation, inflammation, and possible rupture of the esophagus
• Laxative dependence
• Peptic ulcers and pancreatitis
• Emetic toxicity due to ipecac abuse
• Swelling of the face and cheeks, especially the lower eyelids, due to the high pressure of blood in the face during vomiting; for the same reason Purpura can occur, a rash caused by burst blood vessels.
• Callused or bruised fingers
• Dry or brittle skin, hair, and nails, or hair loss
• Lanugo
• Edema
• Muscle atrophy
• Decreased or increased bowel activity
• Digestive problems that may be triggered, including celiac, Crohn’s Disease
• Low blood pressure (hypotension)
  • Orthostatic hypotension
• High blood pressure (hypertension)
• Iron deficiency
• Anemia
• Hormonal imbalances
• Hyperactivity
• Depression
• Insomnia
• Amenorrhea
• Infertility
• High risk pregnancy, miscarriage, still-born babies
• Diabetes
• High blood sugar (hyperglycemia)
• Ketoacidosis
• Osteoporosis
• Arthritis
• Weakness and fatigue
• Chronic Fatigue Syndrome
• Cancer of the throat or voice box
• Liver failure
• Kidney infection and failure
• Heart failure, heart arrhythmia, angina
• Seizure
• Paralysis
• Death caused by heart attack or heart failure; lung collapse; internal bleeding, stroke, kidney failure, liver failure; pancreatitis, gastric rupture, perforated ulcer, depression and suicide.

• Eating disorders have one of the highest death rates of all mental illnesses.
• The Eating Disorders Association of UK estimates it at 10%. An 18% mortality rate has been suggested for anorexia.[3]
• These death rates are higher than those of some forms of cancer.