The Physical Side Effects of Bulimia

Russell's Sign showing Physical Side Effects of bulimiaBulimia nervosa is characterized by purging habits, typically including vomiting, diuretic abuse, and laxative abuse. These behaviors can be incredibly painful and harmful to the body. The physical side effects of bulimia are sometimes difficult or impossible to treat. Many different organ systems in the body are affected by this eating disorder.

Physical Side Effects of Bulimia

Russell’s Sign

This is a tell-tale sign of self-induced vomiting, with scratches noted on the back of the hand caused by putting one’s finger into the throat to induce a gag reflex.

Tooth decay

The contents of the stomach are very acidic and repeated vomiting over time causes tooth enamel to break down. This can sometimes lead to the need for extensive and costly dental procedures.

Swollen salivary glands (sialadenosis)

Other physical side effects of bulimia are noticeable as well. For example, when someone has been vomiting on a daily basis for a time and stops suddenly, it’s very typical for the parotid salivary glands in front of the ears at the base of the jaw to swell, which makes the cheeks look swollen.

This can be very distressing to patients, but it gets better after a few weeks as long as the patient does not start vomiting again. If frequent vomiting continues, the patient is at high risk of developing this sign again, the next time he or she stops the practice

Acid reflux

physical side effects of bulimia and Oral_Manifestation_of_Bulimia.When vomiting, the lower esophageal sphincter, which acts as a doorway between the esophagus and stomach, must open to allow stomach contents to move back up through the esophagus. Over time, the sphincter gets weak and stomach acid starts to repeatedly splash up into the esophagus.

These physical side effects of bulimia cause an uncomfortable burning or chest pain sensation. In addition, acid reflux is very damaging to the lining of the esophagus and can lead to bleeding and scarring.

Sore throat and hoarse voice

Acidic stomach contents are damaging to the throat and the vocal cords, therefore hoarse voice and sore throat become common when someone has been repeatedly vomiting.


All forms of purging are likely to lead to dehydration. A large portion of perceived weight loss due to purging behaviors is actually from water losses in the body. If dehydration becomes severe enough, the patient is at risk for falls, loss of consciousness, confusion, or damage to the kidneys that can be permanent.

Electrolyte Abnormalities

Purging behaviors often override the body’s natural ability to keep electrolytes such as sodium, chloride, and potassium in normal balance. The side effects of low electrolytes can be extremely dangerous, with initial weakness progressing to cardiac arrest and death in the most severe cases.

Intestinal problems

Tension-headacheMore physical side effects of bulimia include intestinal problems. Purging with laxatives has may lead to a physical dependence on the medications and therefore constipation when the laxatives are stopped. Constipation resolves over time but can make it especially difficult for patients to stop abusing laxative medication.


Most of the problems highlighted here require treatment by a medical doctor, or dentist in the case of dental problems. Ultimately, recovery from bulimia nervosa is the only reliable method of preventing or healing these effects. For many patients, the occurrence of physical effects can serve as a wake-up call to the need for help and the importance of seeking treatment.

Article Contributed By: Carrie A. Brown, MD at ACUTE Center for Eating Disorders at Denver Health


  1. Brown, CA and Mehler, PS. Medical complications of self-induced vomiting. Eating Disorders. 2013;21(4):287-94.
  2. Brown, CA and Mehler, PS. Successful “Detoxing” From Commonly Utilized Modes of Purging in Bulimia Nervosa. Eating Disorders. 2012; 20(4): 312-20.
  3. Mehler, PS and AE Anderson. Eating Disorders. Baltimore: Johns Hopkins UP, 2010. Print.

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 a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Last Updated & Reviewed By: Jacquelyn Ekern, MS, LPC on January 5, 2021
Published on October 1, 2014