It is common for people with bulimia nervosa to hide the condition from others for years. By the time it becomes apparent, many complications of the disorder may have developed. Complications range from mild to severe, depending on the type and duration of purging behaviors.1 Common bulimia complications include:

• Tooth decay, toothaches, swollen gums, gum disease (gingivitis), and erosion of tooth enamel, caused by acid in the mouth from vomiting.
• Osteoporosis from low amounts of calcium in the diet.
• Electrolyte imbalances and changes in metabolism that can lead to heart problems such as arrhythmia and even death.
• Dehydration, which can lead to weakness, fainting, or kidney damage.
• Esophageal inflammation or tears or stomach ulcers. The first sign of this may be bloody vomit (hematemesis).
• Swollen salivary glands.
• Syncope or loss of consciousness usually due to low blood pressure.
• Abnormal heartbeat (arrhythmia).
• Low body temperature.
• Suicide risk when feeling discouraged about having bulimia, relapse, or continued obsessive body image issues.
• Chronic irregular bowel movements and constipation as a result of laxative abuse.

Overuse of medication (such as ipecac syrup) to cause vomiting can lead to diarrhea, weakness, low blood pressure, chest pain, and difficulty breathing. A person can die from prolonged overuse of these medications.

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Reviewed: 03/2006