The Psychology of Eating: From Healthy to Disordered Behavior

Eating Disorders 231

remaining 20 percent show great variability in their symptoms. Bulimia
nervosa has a range of physical and psychological problems associated with
it. Some of these are clearly consequences of the problem. For others it is
unclear whether they are causes, are consequences, or just co-occur. The
potential consequences of bulimia nervosa are illustrated in figure 10.4.

Physical complications

The mortality rate for bulimia is much lower than for anorexia and is
estimated at between 1 and 3 percent (Keel and Mitchell, 1997). Those
bulimics that do die from an eating-related disorder appear to have received
a diagnosis of anorexia at some time in their history (Herzog et al., 2000).
In the main, bulimia is not associated with mortality, but bulimics do
suffer a wide range of physical complications. Many complications parallel
those of anorexia and are due to nutritional deficits and the movement of
stomach acid caused by the binge–purge cycle. Such problems are exacer-
bated by the disturbance of bodily fluids caused by laxative and diuretic abuse.
For example, bulimics show cardiovascular problems such as palpitations,
irregular and missed heartbeats, hypotension, and sometimes heart failure.
They also suffer from gastrointestinal problems including dyspepsia,

Teeth

dental caries

abscesses

Skin

flaky skin

callouses

Bulimia

nervosa

Gastrointestinal

dyspepsia

constipation

diarrhea

pancreatitis

sore throats

Cardiovascular

palpitations

irregular heartbeats

hypotension

heart failure Psychological

neurotic symptoms:

guilt/worry/poor con-

centration/rumination

depression

suicide attempts

anxiety

alcohol and drug abuse

conduct disorder

multi-impulsivity

Figure 10.4 Possible consequences of bulimia nervosa.