Eating disorders are a family affair. Even though behaviors like bingeing and purging are conducted in secret, repercussions ripple throughout the family. Unsurprisingly, secrets prevent open communication, which harms interpersonal relationships. The nature of bulimia’s side effects can exacerbate this harm.

Bulimia’s Side Effects

Bulimia’s numerous side effects affect all family members as they struggle to comprehend what is happening. Some of these side effects, such as malnutrition, dehydration, and low blood pressure, are seen across multiple types of eating disorders. But there are several that are more prominent or unique to bulimia, including:

  • tooth enamel erosion
  • mouth sores
  • puffy cheeks
  • red or watery eyes
  • electrolyte imbalance
  • esophageal irritation and ulcers
  • lung problems due to aspiration of vomit
  • calluses or scarring on the knuckles (Russell’s sign)
  • injuries due to overexercise

An individual with bulimia may reduce the amount of time they spend with friends and family in an attempt to hide the most obvious outward signs. These signs include puffy cheeks caused by enlarged salivary glands, scarred knuckles due to using fingers to induce vomiting, and red and watery eyes caused by blood vessels that burst during vomiting.

Additionally, serious side effects may be missed altogether, or their cause may be misattributed. For example, an electrolyte imbalance may be chalked up to not maintaining hydration during exercise. The recommendation would likely be to drink more water or perhaps a sports drink. A healthcare practitioner may not recognize that the electrolyte imbalance is actually caused by repeated vomiting, diuretic or laxative abuse, or overexercise.

Impact on the Family

The existence of such troubling side effects can knock a family for a loop, as they are not sure where to turn or what to do to help their loved one. The isolation felt by the person with bulimia is mirrored by the family’s isolation. Because many people with bulimia do not have drastic weight changes, family may not notice a problem until the eating disorder is well-entrenched. They may even congratulate their loved one as they head to the gym more often, not realizing that overexercise is a form of purging.

Sometimes bulimia is not diagnosed until one of its side effects is observed by a third party. For example, a trip to the dentist may reveal tooth erosion and mouth sores. This can be shocking for a parent who did not suspect any issues beyond typical teenage body image concerns and dieting. It takes time for many of the negative side effects to develop. This highlights the breakdown in family communication, as parents realize the disordered eating behaviors have existed for a significant period of time.

For families impacted by bulimia and its side effects, it is not unusual to experience the following:

  • guilt
  • helplessness
  • isolation
  • anger
  • uncertainty
  • hopelessness
  • embarrassment
  • distrust
  • confusion
  • distance between family members

Bulimia lives in the shadows. Both bingeing and purging are done in secret, necessitating withdrawal from other people. The resulting isolation is multiplied over time, as the disorder wreaks havoc on personal relationships. And because bingeing and purging serve as a coping mechanism for difficult feelings and even past traumas, the need to distract and numb with food increases as personal connections wane. Ironically, the interpersonal connections that can help with recovery are specifically shunned by the person with an eating disorder.

This does not have to remain the case, though. If your family is affected by bulimia, there are effective treatments available. Seek out treatment programs as well as support for yourself. Recovery is worth it.

Barbara Spanjers, MS MFT is a therapist and wellness coach who helps people feel more attuned with food and their body. Learn more.