Medical complications of bulimia nervosa

Summary & key facts

This review describes the medical problems that can come with bulimia nervosa (BN). BN is a mental illness marked by binge-eating followed by purging such as vomiting, laxative or diuretic use, or insulin misuse. It is more common than anorexia, often affects people of normal or higher weight, and can damage many body systems—especially the kidneys and the body’s electrolytes. Some complications improve when purging stops, but others do not.

Key facts:

• Bulimia nervosa is reported to be about 4 times more common than anorexia nervosa (abstract statement).
• Self-induced vomiting and laxative misuse make up more than 90% of purging behaviors in BN (review data).
• Lifetime prevalence estimates differ by criteria: about 1.0% using older DSM-IV rules and about 4%–6.7% with the broader DSM-5 rules (pooled WHO data and review).
• Severity of BN is defined by weekly frequency of inappropriate compensatory behaviors: mild 1–3, moderate 4–7, severe 8–13, and extreme 14 or more episodes per week (DSM-based definitions).
• More than 70% of people with eating disorders have at least one other psychiatric disorder (affective, anxiety, substance use, or personality disorders are common).
• People with BN report a 33% lifetime rate of nonsuicidal self-harm and are nearly 8 times more likely to die by suicide than the general population; standardized mortality rates for BN are reported at about 1.5%–2.5% (reviewed estimates).
• Electrolyte and metabolic disturbances are the most common medical causes of sickness and death in BN. The review gives an example of severe low potassium (hypokalemia) with a potassium level of 2.9 mmol/L (reference range 3.7–5.1 mmol/L).
• The review notes that hypokalemia in BN should be managed aggressively to prevent electrocardiographic changes and dangerous arrhythmias such as torsades de pointes (authors’ clinical point).
• Parotid gland enlargement (sialadenosis) can occur in more than 50% of people who purge by vomiting and often appears 3–4 days after stopping the vomiting (review data).
• Dental erosion is the most common oral sign of chronic vomiting. The vomit’s acidity (reported pH about 3.8) damages tooth enamel, and these erosions are irreversible once they develop (review findings).

Abstract

Bulimia nervosa, a mental illness 4 times more common than anorexia nervosa, is characterized by binge-eating followed by compensatory purging behaviors, which include self-induced vomiting, diuretic abuse, laxative abuse, and misuse of insulin. Patients with bulimia nervosa are at risk of developing medical complications that affect all body systems, especially the renal and electrolyte systems. Behavior cessation can reverse some, but not all, medical complications.

Topics

Eating Disorders and Behaviors Obsessive-Compulsive Spectrum Disorders

Categories

Clinical Psychology Psychology Social Sciences

Tags

Anorectic Anorexia nervosa Binge eating Bulimia nervosa Eating disorders Food intake Internal medicine Medicine Psychiatry Vomiting