Chances for Recovery

Some studies have suggested that between 60% and 80% of patients are in remission within three months of treatment. However, relapse is common and up to half of women with bulimia continue to battle disordered eating habits for years, with bulimia itself persisting in 10% to 25% of patients. Medical


In general, there are few major health problems for bulimic people who maintain normal weight and do not go on to become anorexic. For example, one study comparing adolescents with anorexia and bulimia reported abnormal heart rhythms in patients with anorexia but not in those with bulimia. It should be noted, however, that in one study of bulimic patients undergoing therapy, after six years the mortality rate was 1%. Those who have both bulimia and anorexia, however, are in great danger.

And, the disorder, even without anorexia, is not without health problems and serious risks. The following are medical problems associated with bulimia:

Teeth erosion, cavities, and gum problems. Water retention, swelling, and abdominal bloating. Occasionally, fluid loss with low potassium levels. This occurs from excessive vomiting or laxative use. In severe cases it can cause extreme weakness, near paralysis, or lethal heart rhythms. Acute stomach distress.

Problems in swallowing. This is an area of possible concern because of repetitive assaults on the esophagus (the food pipe) from forced vomiting. It is not clear, however, if this problem is common.

Rupture of the esophagus, or food pipe. (Cases have been reported with forced vomiting but are not common.) Weakened rectal walls. In rare cases, walls may weaken to the extent that they protrude through the anus. This is a serious condition that requires surgery. Most pregnant women with a history of eating disorder have healthy pregnancies, although they face higher risks for a number of complications, including cesarean sections, postpartum depression, miscarriages, and complicated deliveries. Their babies may also have a higher risk for low birth weight, prematurity, and malformation. Irregular periods. (It should be noted that menstrual irregularities in patients with bulimia do not have the serious effects, particularly bone loss, as they do in patients with anorexia.)

Self-Destructive Behavior

A number of self-destructive behaviors occur with bulimia:

Smoking. Many teenage girls with eating disorders smoke because it is thought to help prevent weight gain. Impulsive Behaviors . Women with bulimia are at higher-than-average risk for dangerous impulsive behaviors, such as sexual promiscuity, self-cutting, and kleptomania. Some studies have reported such behaviors in half of those with bulimia. Alcohol and Substance Abuse. An estimated 30% to 70% of patients with bulimia abuse alcohol, drugs or both. This rate is higher than for the general population and in people with anorexia. It should be noted, however, that this higher rate of substance abuse may be a distortion, because studies are conducted only on diagnosed patients. Bulimia tends not to get diagnosed. And, reports of bulimia in the community (where the incidence of the eating disorder is higher than statistics suggest) indicate that substance abuse is actually lower than in people with anorexia.

Abuse of Over the Counter Medications. Women with bulimia frequently abuse over-the-counter medications, such as laxatives, appetite suppressants, diuretics, and drugs (e.g., ipecac) that induce vomiting. None of these drugs is without risk. For example, ipecac poisonings have been reported, and some people become dependent on laxatives for normal bowel functioning. Diet pills, even herbal and over-the-counter medications, can be hazardous, particularly if they are abused.

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