Chronic complications of bulimia nervosa: a narrative review

Abstract

Background:
Bulimia nervosa is a serious eating disorder characterized by recurrent episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, or misuse of laxatives and diuretics. Although acute complications are well recognized, the long-term consequences of the disorder are discussed less frequently.

Objective:
This review aims to summarize the most important chronic somatic and psychiatric complications of bulimia nervosa and highlight their clinical relevance.

Methods:
This study was conducted as a narrative review of the literature, primarily using the PubMed database, focusing on publications addressing the long-term complications of bulimia nervosa.

Results:
Chronic complications of bulimia nervosa may affect multiple organ systems and often develop gradually over time. Gastrointestinal involvement may lead to persistent esophageal inflammation and Barrett’s esophagus. Cardiovascular complications, frequently associated with hypokalemia and other electrolyte disturbances, include arrhythmias and long-term cardiac dysfunction. Endocrine abnormalities may contribute to reduced bone mineral density, increasing the risk of osteopenia and osteoporosis. Chronic hypokalemia may also result in renal impairment. Psychiatric complications, including depression, anxiety, and substance use disorders, are also common and significantly impair quality of life.

Conclusions:
Bulimia nervosa is associated with a wide range of chronic complications that may remain unrecognized for prolonged periods. Early diagnosis and increased clinical awareness are essential to reduce long-term morbidity and improve patient outcomes.