Medical Complications of Bulimia Nervosa: What to Monitor During Recovery

Recovery from Bulimia Nervosa (BN)is not only psychological - it is also medical. Even when you feel physically “okay,” bulimia can quietly affect multiple systems in the body. Regular medical monitoring is a crucial part of protecting your health during recovery.

Current clinical guidelines recommend that individuals with bulimia nervosa see a physician every 3–4 months, even when medically stable. Research suggests that up to 32% of individuals with BN experience significant medical complications requiring treatment (de Zwaan & Mitchell, 1999). Your physician may recommend more frequent monitoring depending on symptom severity, purging behaviors, or weight status.

This article is not a substitute for medical care. Rather, it is intended to help you understand common medical complications of bulimia nervosa, what symptoms to watch for, and when to contact your physician.

Recovery is rarely immediate. Your role is to support healing by monitoring symptoms, communicating openly with your medical provider, and practicing consistent self-care.

Recommended Medical Monitoring for Bulimia Nervosa

An initial medical evaluation typically includes:

* Weight and height

* Pulse and blood pressure (sitting, standing, and lying down)

* Hydration status

* Cardiac exam and EKG

* Abdominal examination

* Complete blood count (CBC)

* Serum electrolytes (especially potassium and bicarbonate)

* Calcium, magnesium, and phosphorus

Additional tests may be required if you are underweight or experiencing frequent purging.

Common Medical Complications of Bulimia Nervosa

Electrolyte Abnormalities

Low potassium (hypokalemia) is the most common and dangerous electrolyte abnormality in bulimia nervosa. Vomiting, laxatives, and diuretics disrupt the body’s fluid balance, placing significant strain on the heart and kidneys.

Hypokalemia can cause:

* Weakness and fatigue

* Heart rhythm disturbances

* Kidney failure

It is one of the leading causes of death in eating disorders (Pomeroy & Mitchell, 2002).

Mild deficiencies may be treated with oral supplementation, while severe cases require intravenous treatment. Regular bloodwork is essential, especially if purging behaviors are ongoing.

Gastrointestinal Complications

Acid reflux and esophageal irritation are common in bulimia nervosa. Symptoms may include sore throat, hoarseness, heartburn, or chest discomfort. Acid-reducing medications are often prescribed.

If reflux does not improve after several weeks of treatment - or if vomiting includes blood - contact your physician immediately, as this may indicate more serious esophageal injury (Waldholtz, 1999).

Bloating and early fullness are often caused by delayed stomach emptying (gastroparesis), especially in individuals who restrict food or are underweight. This discomfort improves with consistent eating and weight restoration, typically over 4 - 6 weeks.

Constipation is also common. Bowel habits vary widely, and going several days without a bowel movement can still be normal (Waldholtz, 1999). However, laxative abuse must stop immediately, as it can lead to Cathartic Colon Syndrome, which may be irreversible. Physician support is essential when discontinuing laxatives.

Cardiovascular Complications

All forms of purging increase the risk of cardiac abnormalities, particularly when low potassium is present. Laxatives, diuretics, and ipecac significantly elevate this risk (Powers, 1999).

Symptoms requiring immediate medical attention include:

* Dizziness or fainting

* Heart palpitations

* Chest pain

* Cold extremities

* Leg cramps

An EKG and regular vital sign monitoring are standard parts of care.

Patient with eating disorder receiving medical consultation.

Oral and Dental Complications

Enamel erosion occurs in approximately 38% of individuals with bulimia nervosa due to repeated exposure to stomach acid. The most effective treatment is stopping vomiting.

Until then:

* Avoid brushing immediately after vomiting

* Rinse with a baking soda solution (1 tsp per quart of water) to neutralize acid (Steele & Mehler, 1999)

Enlarged salivary glands affect up to 50% of individuals with BN. While usually painless, swelling can be distressing. Symptoms typically resolve with cessation of purging. Warm compresses and tart candies may offer temporary relief.

Gynecological and Endocrine Complications

Menstrual irregularities and amenorrhea may occur due to stress, low weight, or hormonal suppression. Underweight individuals lack sufficient fat stores to maintain estrogen production.

If estrogen deficiency is present, your physician may recommend hormone therapy.

Osteopenia and osteoporosis are serious risks for underweight individuals with amenorrhea. Bone loss can be profound and, in some cases, irreversible. Bone density scans, calcium, vitamin D, and other medications may be necessary (Hofeldt, 1999).

Supporting Your Medical Recovery

Bulimia nervosa affects the entire body, not just eating behavior. Medical monitoring is not a sign of failure - it is a form of protection and care. Many complications improve with nutritional rehabilitation, symptom reduction, and time.

Open communication with your physician, therapist, and treatment team is one of the most powerful tools you have in recovery.

References

de Zwaan, M., & Mitchell, J. E. (1999). *Medical evaluation of the patient with an eating disorder: An overview*. In P. S. Mehler & A. E. Anderson (Eds.), **Eating Disorders: Medical Care and Complications** (pp. 44–62). Johns Hopkins University Press.

Hofeldt, F. D. (1999). *Gynecology, endocrinology, and osteoporosis*. In P. S. Mehler & A. E. Anderson (Eds.), **Eating Disorders: Medical Care and Complications** (pp. 118–131). Johns Hopkins University Press.

Pomeroy, C., & Mitchell, J. E. (2002). *Medical complications of anorexia nervosa and bulimia nervosa*. In C. G. Fairburn & K. D. Brownell (Eds.), **Eating Disorders and Obesity: A Comprehensive Handbook** (2nd ed., pp. 278–285). Guilford Press.