Bulimia nervosa Q+A:“What are the long-term effects of bulimia?”

May 19, 2025
2:12 pm

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Clinical answers to common questions

Bulimia nervosa is a serious and often misunderstood eating disorder. It’s marked by a cycle of binge eating followed by compensatory behaviours like self-induced vomiting, excessive exercise, fasting, or misuse of laxatives or diet pills1. While it may not always result in dramatic weight changes, bulimia has profound impacts on both physical and mental health – particularly if left untreated.

It’s more common than many people realise. According to NICE, the prevalence of bulimia nervosa in Europe may be as high as 2% of the entire adult population2 – with a crude mortality rate of 4%, including an increased risk of suicide3. The condition tends to develop in adolescence or early adulthood, but it can affect people of all ages, genders, and backgrounds.

Crucially, bulimia is not about vanity or attention. It is a complex mental health condition rooted in difficult emotions, low self-esteem, perfectionism, and distorted body image. It often co-occurs with anxiety, depression, and trauma-related experiences. Despite how isolating it can feel, it’s important to remember: help is available, and recovery is possible.

As actor Lily Collins – who has openly discussed her experience with eating disorders – shared with Harper’s Bazaar4: “Even when my closest friends and family said something to me about it, at the beginning, you want to deflect, you don’t want to listen – you might even get angry. But the more you hear it, the more you realise that you’re not being discreet about it […] Don’t give up on someone if you [reach out] once and get negative feedback. You don’t give up on the ones you love and this shouldn’t be any different. It’s sensitive, but it’s worth the fight.”

If you or someone you know appears to be living with an eating disorder, contact our expert team today for specialist support.

“Is bulimia really that serious in the long term?”

Yes – bulimia nervosa is a serious, potentially life-threatening condition. While it may sometimes be misunderstood or minimised5, especially because it often occurs in private, the long-term health consequences can be extensive.

Repeated cycles of bingeing and purging place intense strain on the body. Over time, this can lead to complications6 such as tooth decay, gum disease, and damage to the throat and digestive tract from repeated exposure to stomach acid. Electrolyte imbalances can affect heart function, increasing the risk of irregular heartbeat or, in severe cases, cardiac arrest. Chronic dehydration may lead to kidney issues, and digestive problems like bloating, acid reflux, and constipation are also common. Hormonal disruption and bone thinning can occur, particularly in young people.

The psychological toll is equally significant. Many individuals live with persistent low self-worth, anxiety, depression, and difficulties maintaining relationships or work.

“Physically and mentally, what are the long-term effects of bulimia?”

The long-term effects of bulimia nervosa can impact nearly every part of a person’s life7: from physical health to emotional wellbeing. While some symptoms might ease with recovery, others can persist or leave lasting damage if the condition goes untreated.

Physically, frequent bingeing and self-induced vomiting, laxative use, or excessive exercise can lead to:

Tooth decay and enamel erosion, due to repeated contact with stomach acid
Acid reflux and gastro-oesophageal reflux disease (GORD)
Electrolyte imbalances, which can trigger irregular heartbeat, weakness, or in severe cases, cardiac arrest
Chronic dehydration and kidney damage
Digestive problems, including constipation, bloating, or stomach pain
Hormonal disruptions, which may result in missed periods or fertility issues
Weakened bones (osteoporosis), particularly in younger individuals
Swollen salivary glands and damage to the oesophagus or stomach lining

Mentally and emotionally, bulimia is often accompanied by persistent issues that affect self-image, confidence, and daily functioning. For instance, many people live with:

Low self-esteem and intense shame or secrecy around food and body image
Anxiety, depression, and obsessive thoughts
Emotional exhaustion from managing difficult feelings and behaviours in isolation
Social withdrawal, avoiding shared meals or events where eating is involved
A disrupted sense of control, often leading to challenges in relationships and work life

As with many eating disorders, the effects of bulimia tend to become more severe over time if left untreated. The sooner professional support is put in place, the greater the opportunity to protect long-term health and reclaim wellbeing.

“Can bulimia cause permanent damage?”

It can – but not always. Whether bulimia leads to permanent damage depends on several factors: how long it’s been present, how intensely behaviours are repeated, and whether someone receives effective, ongoing treatment.

Bulimia often hides in plain sight. It can persist for years before anyone realises, largely because body weight doesn’t always change8 – and because many people become experts at concealing it9. That’s part of what makes long-term damage more likely: the secrecy, the shame, and the delay in accessing help.

But, with the right support, it’s absolutely possible to restore physical health, rebuild mental wellbeing, and reverse many of the impacts – even after years of living with bulimia.

“How does bulimia compare to other eating disorders?”

Bulimia nervosa is distinct from other eating disorders because it combines both binge eating and compensatory behaviours like self-induced vomiting, excessive exercise, or the use of laxatives. Unlike anorexia, where individuals often have a significantly low body weight, people with bulimia may maintain a weight that falls within a normal range or fluctuate. This can make bulimia harder to identify, but the emotional and physical toll it takes is just as severe.

While binge eating disorder also involves periods of excessive food intake, it lacks the compensatory behaviours seen in bulimia. Regardless of the type of eating disorder, each presents unique challenges and risks to both physical and mental health. Early intervention is key for all forms of eating disorders to prevent long-term complications and improve outcomes.

	Bulimia nervosa	Anorexia nervosa	Binge eating disorder	Atypical anorexia
Key symptoms	Binge eating episodes, followed by purging (vomiting, exercise, laxatives)	Extreme restriction of food intake, intense fear of gaining weight	Binge eating episodes without purging behaviours	Symptoms similar to anorexia, but individual may be of normal weight
Body weight impact	Normal or fluctuating weight	Low body weight	Overweight or obese	Normal weight
Compensatory behaviours	Vomiting, excessive exercise, laxatives	No compensatory behaviours; focus on food restriction	None (no purging behaviours)	Restrictive eating, intense preoccupation with food
Common health risks	Tooth decay, electrolyte imbalances, gastrointestinal issues	Malnutrition, bone density loss, organ failure	Obesity, high blood pressure, diabetes	Malnutrition, psychological distress

“Why do some people hide their bulimia?”

Bulimia often thrives in secrecy10. Unlike some other eating disorders, it doesn’t always result in noticeable weight loss – so outwardly, someone may appear “fine.” But internally, they may be struggling deeply with shame, fear of judgement, or a sense of losing control.

Many people with bulimia become skilled at hiding behaviours like bingeing and purging, especially in social situations or family settings. This is part of what makes bulimia so dangerous; it’s a serious condition that can be invisible, even to those closest.

“What role do emotions play in bulimia?”

A powerful one. Bulimia nervosa isn’t just about food – it’s often a way of coping with overwhelming emotions like anxiety, sadness, anger, or shame. Bingeing can serve as a temporary escape; purging might feel like regaining control. But these cycles don’t resolve the root emotional pain. Often, they deepen it.

That’s why effective treatment focuses not only on eating behaviours, but on helping people process difficult emotions in healthier, more sustainable ways11.

“Can someone recover from bulimia and live a healthy, fulfilled life?”

Yes. With the right support, recovery from bulimia is absolutely possible. Many people go on to lead fulfilling lives, build healthy relationships with food, and reconnect with their bodies12.

Treatment often involves a blend of psychological therapy, nutritional support, and medical care – personalised to the individual. Ultimately, recovery isn’t about ‘perfection’; it’s about progress, resilience, and rebuilding trust in oneself.

Final thoughts

Bulimia nervosa is often misunderstood – overshadowed by shame, silence, or the myth that it’s “not that serious.” But the truth is, bulimia can have profound and lasting effects on both physical and mental health. Left untreated, it can become life-threatening; but, with the right support, it’s also completely treatable.

Recovery doesn’t happen overnight, and it rarely follows a straight line. But it is possible – and it starts with compassion. If you or someone you care about is struggling with bulimia, you don’t have to navigate this alone. At Orchestrate Health, we offer discreet, personalised, and clinically-led treatment for eating disorders – delivered at home, on your terms.

Reach out to speak with one of our specialists →