The eating disorder bulimia nervosa is traditionally thought to include purge behavior by means of vomiting.

However, the DSM-V encapsulates the full picture of bulimia nervosa by including all inappropriate compensatory behaviors used following binges such as laxatives, diuretics, other medications, fasting, or excessive exercise in addition to self-induced vomiting.

Individuals using compensatory behaviors often report increased distress and inability to tolerate the anxiety that follows after a subjective or objective binge. Individuals attempt to physically get rid of food and calories consumed by any means necessary.

The fear of gaining weight and wanting to feel “empty” is so strong that individuals often overlook how damaging these compensatory behaviors can be to their health.

The Laxative Myth

Individuals who seek to use laxatives attempt to avoid weight gain by inducing diarrhea. The tricky thing about using laxatives as a way to control weight is that it simply does not work. Laxatives actually work by targeting the large intestine.

This means that once food passes through the small intestine, nutrients from the food have already been absorbed into the body (Brown University Health Services, 2013). Any weight loss observed is solely from the loss of water- not calories or fat-and will only be temporary if the individual rehydrates themselves appropriately.

Physical Consequences and Complications

Dehydration

The most common consequence of laxative abuse is dehydration. Significant water loss is a side effect of diarrhea and can pose a great health risk. Symptoms of dehydration range from dizziness, weakness, confusion, fainting, and prolonged dehydration can lead to death.

Electrolyte Imbalance

Laxatives work near the end of the bowel and impact not only absorption of water but also crucial electrolytes such as sodium and potassium. Electrolytes are necessary to maintain nerve and muscle function throughout the body.

By depleting the supply of electrolytes, the imbalance in the body can lead to:

Low blood pressure
Confusion
Tachycardia (rapid heart rate)
Trembling
Muscle weakness
Stiff and achy joints
Sunken eyes

Prolonged and severe electrolyte imbalance can lead to shock, cerebral edema (swelling in the brain), seizures, and coma (Eating Disorders Review, 1999).

Bloating/Edema

As laxatives cause the loss of fluids, the body responds by trying to protect itself from dehydration and ends up retaining fluid.

Edema is the swelling of the fluid buildup and can decrease flexibility of the joints, cause tight or stiff skin, pain and difficulty walking, and decrease blood circulation.

Bleeding

Individuals may notice blood in their stools after excessive use of laxatives. Chronic blood loss can result in anemia. Symptoms of anemia include:

Exhaustion
Irregular heartbeat
Chest pain
Shortness of breath
Dizziness
Cold hands and feet

Constipation

It sounds contraindicative but prolonged use of laxatives actually results in constipation.

Excessive use of laxatives can result in “reflex constipation” as the bowel loses its ability to perform its natural function. Moreover, this constipation can cause individuals to increase the dosage of laxatives which only exacerbates these physical consequences.

Permanent impairment

Excessive use of laxatives can also result in permanent impairment of the digestive system.

This means that there is a chance of paralysis of the muscles used in digestion which can lead to the surgical removal of part or the entire colon and requires dependence of a colostomy bag.

Increased risk of cancer

Prolonged abuse of laxatives and damage to the colon increases an individual’s risk of colon cancer.

Laxative Withdrawal

The severity of laxative abuse is not an indicator of the severity of withdrawal. The best way to lessen effects of the withdrawal is to prepare in advance and develop a plan for coping. Common side effects are constipation, fluid retention, and temporary weight gain (Eating Disorders Review, 1999).

Just as any weight loss from using laxatives is temporary; it is important to remember that this weight gain is temporary and is mainly due to increased fluid retention. These symptoms can be especially difficult for an individual struggling with an eating disorder as they are highly reactive to weight gain and “feeling fat” (a statement often used to describe bloating, discomfort, and any unpleasant emotions). Withdrawal typically lasts anywhere from 1-3 weeks.

Seeking Help

It is crucial to seek help from a treatment team including a physician, therapist, and registered dietitian, specialized in eating disorders. Depending on the severity of the laxative abuse, hospitalization might first be required to stabilize these medical complications. There is hope and there is life after an eating disorder; full recovery is possible!

Contributor: By: Neathery Thurmond, LMSW, Staff Therapist, Hill Country Recovery Center

References:

Brown University Health Services. (2013). Laxative Abuse: Patient Education Series. Accessed
at www.brown.edu/health.
Eating Disorders Review. (1999). Laxative abuse: Medical complications. 10(5). Gurze Books.

The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on April 18th, 2015
Published on EatingDisorderHope.com

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Laxative Abuse in Bulimia: Physical Consequences, Complications and Ramifications