Dear Alice,

I have been a bulimic for over two years and I am indecisive about whether or not I should get help. I would like to know about the long term and short term effects of this eating disorder. I would also like to know whether or not I can prevent these long term effects if I decide to quit in the near future because at this moment I have fourteen new cavities (which I'm currently getting fillings for) and one partially decayed tooth (which the dentist was barely able to save) and I have swollen salivary glands (which I hope are irreversible because they make me look like a chipmunk).

— Theodora

Dear Theodora,

Coping with an eating disorder and deciding whether or not to get help can be complicated and emotionally challenging, so kudos to you for reaching out! As you’ve alluded to, bulimia nervosa has many short-term and long-term health effects — some of which can be reversible, while others may be irreversible and even life-threatening (more on those in a bit). While it’s ultimately up to you to determine whether you want to seek help, speaking with a trusted health care provider can help you to better understand the symptoms you’re currently experiencing and how they may affect you in the future. If you decide to begin the recovery process, other professionals such as a mental health professional or dietitian can also help you through the process.

People living with bulimia nervosa frequently binge-eat and purge foods to encourage weight loss or prevent future weight gain. While vomiting is a common form of purging, it also happens to be the most physically destructive to the body. The process of vomiting repeatedly exposes a person’s teeth to stomach acid, which may cause the teeth to decay as well as be more sensitive to foods and drinks that are acidic and vary in temperature. In cases of longer-term vomiting, a person’s teeth may eventually erode away and fall out. Furthermore, vomiting may infect and irritate the salivary glands, causing them to swell. Fortunately, swollen glands tend to resolve after the cycle of bingeing and purging has stopped.

It’s also critical to be aware that bulimia affects more than a person’s oral health. In fact, it may also impact a number of different organs:

  • Heart: Vomiting and laxative abuse (another common purging behavior) may also cause electrolyte imbalances, which makes an individual more prone to an irregular heartbeat, weakened heart muscle, high blood pressure, and heart attack. In fact, heart failure is the leading cause of fatality related to bulimia.
  • Stomach: It’s possible for the vomiting associated with bulimia to damage nerves in the stomach that are responsible for signaling to the brain that a person is satiated or full. Additionally, some other potential consequences include ulcers and pancreatitis.
  • Kidneys: In order to lose water weight, individuals may abuse diuretics, which causes prolonged dehydration and nutrient deficiencies, leading to kidney infection and kidney failure.
  • Bones: During the purging process, vitamins and minerals are lost, in addition to calories. Without sufficient vitamin D, phosphorus, or calcium, a person’s bone mineral density may not adequately develop, which could increase the risk of osteoporosis.
  • Ovaries: It’s not uncommon for individuals to experience irregular periods (amenorrhea) or no menstruation at all when the body doesn’t have an adequate amount of nutrients. In some cases, this may lead to infertility.
  • Brain: Individuals with bulimia often find it difficult to concentrate and make decisions. Moreover, they’re more likely to experience depression and suicidal ideation, which may lead to self-harm.

It's great that you're asking this question, as there are some serious health risks associated with bulimia, and being aware of them can help inform your decisions. Ultimately, it’s your decision whether or not to seek help. The good news is you’ve already taken a crucial step by recognizing your condition and the symptoms that may be associated with it. The benefits of seeking help to address the condition at this stage include preventing, reducing, or reversing the associated health risks. However, the reality is that the decision to seek help can take time for some people, and only you know if and when you're ready to do so.

While treatment and recovery certainly comes with their share of challenges, you may find peace and comfort in knowing you don't have to go it alone. There are many sources of support available, such as speaking with a medical provider or mental health professional, joining a support group, or contacting the National Eating Disorders Association’s (NEDA) helpline via phone, text, or chat. Seeking support in the way that you're most comfortable can help to address the acute effects you're experiencing now, and can hopefully mitigate the long-term health risks. No matter how you choose to proceed, here’s to wishing you courage and strength through this process.

Take care,

Alice!

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