According to the National Institute of Mental Health, 1 percent of people will be diagnosed with bulimia nervosa (BN) at some point in their lives. BN is characterized by persistent episodes of binge eating that is followed by compensatory behavior, which can include self-induced vomiting, use of laxatives, over-exercise and/or restricting that is used to “make up” for the food that was consumed during the binge episode.

Beyond the associated psychiatric symptoms, which often include substance use, anxiety, depression and/or self-injurious behavior, there are many potential medical risks that can make bulimia a particularly life-threatening condition.

Electrolyte imbalances and dehydration

Electrolyte imbalances are a constant risk for those living with bulimia due to common electrolyte loss resulting from compensatory behaviors. Electrolytes such as sodium, potassium, calcium and chloride are essential for the body to function at its optimum capacity. If those electrolytes have been purged from the body without being adequately replaced, the levels will fall, resulting in a disruption in the body’s delicate balance.

Electrolyte imbalances are closely linked to dehydration, a condition in which the body lacks the water volume to properly perform its various functions. Those with bulimia are at heightened risk for dehydration because water volume can drop so quickly during a purging episode. If too much water is purged from the body, it can result in serious medical complications including hypovolemic (low blood volume) shock, seizures and kidney or heart failure.

Digestive issues, peptic ulcers and pancreatitis

Laxative abuse is common among those with bulimia and can disrupt the body’s natural gastrointestinal functioning causing the intestines to lose muscle tone and leading to dependence on laxatives to produce a bowel movement (BM). When laxative use stops, constipation can result, which often causes bloating and an uncomfortable feeling of fullness.

Peptic ulcers are sores in the lining of the stomach (gastric ulcers) or the first part of the small intestine (duodenal ulcers). These small breaks can be caused by excessive acid in the stomach or duodenum dissolving the lining in those areas resulting in painful, bleeding sores. Pancreatitis, or inflammation of the pancreas, can also result and can be life-threatening.H2: Tooth decay

For those who engage in frequent self-induced vomiting behavior, staining and erosion can occur due to excess acid build-up in the mouth area. Depending on how long and how frequent this behavior is performed, teeth can erode so severely that chewing and swallowing can become difficult and necessitate the need for dental repair work or even full replacement or dentures.

Stomach rupture

Binge eating episodes carry with them a risk of gastric rupture or perforation, a tearing of the stomach’s lining. During these episodes, the stomach expands to accommodate the larger than normal volume of food. This stretching can rupture the blood vessels that supply that area, which cut off the blood supply. A lack of blood in the area weakens the tissue making each successive binge more dangerous and more likely to tear the stomach’s wall.

Esophageal inflammation and swollen salivary glands

The caustic stomach acid present in vomit can irritate the esophagus (the muscular tube leading from the throat to the stomach), causing irritation and sometimes tearing. This irritation can result in erosion and damage to the pharynx (throat) and vocal cords causing a sore throat, difficulty swallowing, and a hoarse voice. The salivary glands (located just in front of the ears at the base of the jaw) can also become swollen causing the cheeks to puff out.

Excessive vomiting can also lead to an esophagus rupture (or tear) causing the contents to spill into the chest and lead to serious lung complications. Esophageal ruptures can cause severe chest pain, vomit containing blood (hematemesis), nausea, rapid breathing, and fever. This is a medical emergency and must be treated immediately with surgery to repair the tear.

Acid reflux

Another potential complication of frequent, excessive vomiting is acid reflux, which is the result of the gradual weakening of the lower esophageal sphincter (LES). When functioning properly, the LES opens to allow food/fluids to pass from the esophagus to the stomach and closes to prevent stomach contents from flowing backward. Frequent vomiting can cause the LES to lose muscle tone, which prevents it from closing properly. Failure to close properly allows for stomach contents to splash back into the esophagus, causing heartburn, chest pain, and difficulty swallowing.

The medical complications arising from bulimia can become life-threatening and extend beyond these risks. Swelling in the hands and feet (edema), irregular heartbeat, organ failure, loss of menstruation, infertility, broken blood vessels in the eyes (petechiae) due to vomiting episodes, and other complications associated with pregnancy can also result from BN.

We know finding care can be tough. Walden is here for you. If you are concerned that you, or a loved one, may have an eating disorder, please reach out by completing the form on this page or email us at

Sean Jacquet (he/him/his) is a Psychiatric Mental Health Nurse Practitioner at Walden. Sean joined Walden in 2016 as a Registered Nurse in Walden’s Residential Eating Disorder Program. He received his Bachelor of Arts in Journalism from UMASS Amherst and started his career with Gate House Media as a sports staff writer for MetroWest Daily News and Daily News Tribune before going back to school and receiving his Bachelor of Science in Nursing from Massachusetts College of Pharmacy and Health Sciences. Prior to joining Walden, he was a staff nurse and a Nursing Supervisor in the Arbour System.

*This blog post does not necessarily represent the views of Walden Behavioral Care and its management. The Walden Blog is meant to represent a broad variety of opinions relating to eating disorders and their treatment.