The Physical Effects of Bulimia

Bulimia is an eating disorder with physical effects on the body which are serious, harmful and left untreated, can result in long-term problems. Although the physical effects of anorexia nervosa, including the condition’s mortality rate, are perhaps better recognised, the physical effects of bulimia are multiple and should not be under-estimated. Bulimia effects can, for some, become life-threatening and certainly for many, bulimia can have a long-term health impact.

There are multiple effects from the cycle of binging and purging that is characteristic of bulimia. Bulimia treatment is essential: the longer the condition persists without effective treatment, physical effects become increasingly serious and lasting.

Here, we will break down this

  • Immediate physical signs of bulimia
  • Long-term physical effects of bulimia
  • Treatment and support

Immediate physical signs of bulimia

There are a range of immediate physical effects of bulimia. The effect on each individual will vary according to the pattern of their eating disorder and individual physiology. Physical signs can include:

  • Russell’s sign
  • Swollen face
  • Tooth decay
  • Sore throat
  • Dehydration

One of the most well-known bulimia effects is ‘Russell’s sign’: calluses on the knuckles and hands caused when inducing vomiting, as in doing so, this part of the hand scrapes against the teeth. Russell’s sign, however, is not present in all people with bulimia; many will purge without causing this bulimia effect and may depend on other types of purging (laxatives, over-exercising).

Tooth decay is closely linked to the binge vomit cycle because the contents of the stomach are highly acidic and repeated cycles of vomiting cause tooth enamel to break down through this acidic content. Bad breath is another bulimia effect.

Face swelling is one of the bulimia effects sufferers find most distressing: sometimes described as ‘bulimia face,’ the swelling can make people feel their face ‘looks fat’. What is taking place is the body’s reaction to self-induced vomiting and the dehydration it causes. The body reacts by trying to hold on to as much water as possible and this is most evident in the parotid glands (around the jawline and side of the face).

Long-term physical effects of bulimia

Bulimia has a devastating impact upon the whole body in the long term, causing multiple serious effects:

  • Electrolyte imbalance, particularly potassium
  • Chronic fatigue
  • Loss or disruption of menstrual cycle
  • Bone weakness

Electrolytes are electrically charged salts, or ions, used by the body to regulate hydration, together with nerve and muscle function. They are determined by hydration: how much water is present in the body.

A long-term pattern of purging leaves the body’s electrolytes in a persistent imbalance, with the risk of affects on heart and kidney function. Potassium is an electrolyte (and also classified as a mineral) which is often depleted by the binge purge cycle and is particularly important for heart function. People with bulimia should have a test of potassium levels and receive a supplement, if required because very low potassium levels can cause irregular heart rhythms and the breakdown of heart tissue fibres.

Other long-term physical effects of bulimia nervosa and potential risks include menstrual cycle disruption and associated fertility problems. Chronic fatigue caused by the constant depletion of nutrients during purges is also a risk, together with future problems with bone health, due to loss of calcium. Tooth decay caused by bulimia may be permanent and difficult to treat.

Treatment and support

Fortunately, there is good, established bulimia treatment, with strong evidence for its effectiveness. Bulimia treatment is based on a CBT (cognitive behavioural therapy) based approach, supporting individuals to consider the links between their thoughts, feelings and behaviour. It is a practical, problem-solving approach and in bulimia treatment, the triggers for a binge are considered and how this could be overcome by changing the pattern of thoughts, feelings and behaviour.

Treatment is almost always provided in an outpatient setting (seeing a CBT therapist once a week), unless there are other problems which necessitate an inpatient admission. Group support may also be helpful.

Seeking treatment for bulimia as early as possible is very important, both in terms of reducing your risk of long term, enduring physical side-effects and because it is recognised with bulimia and other eating disorders, early treatment is linked to better outcomes. This is because the longer eating disorders persist, the more entrenched and difficult to treat they become.


Outpatient clinic

We have an outpatient clinic for adults as well as young people, treating eating disorders including bulimia and binge eating disorder.

Our outpatients’ clinic remains open, including to new requests for advice and support. We are following the Department of Health and Public Health England Coronavirus guidelines and all our consultations are being conducted by video conference or telephone. You are welcome to contact us to discuss your needs. Please be assured, we continue to support and offer outpatient programmes via digital and telephone communications.

Find out more about our outpatient clinic

Eating disorders help: our services in London and York

Newbridge House is part of the Schoen Clinic group, 26 high quality hospitals and services across Germany and the UK. Schoen Clinic Chelsea provides private outpatient and day treatment for adults, adolescents and children with eating disorders, anxiety and depression. You can self-refer to our service in Chelsea. Additionally, Schoen Clinic York is an adult inpatient service for adults with eating disorders and complex personality disorders.