Dental problems & tooth decay

Purging in the form of vomiting is the most obvious reason for dental problems and tooth decay to occur in the context of an eating disorder. Stomach acid that is regurgitated can cause serious damage to the teeth, gums, and other tissues (such as the lining of the espohagus.)

However, nutritional deficiencies can also affect the integrity of the teeth. Lack of calcium, iron, and certain B vitamins can lead to gingivitis, canker sores, angular chelitis (inflammation at the corners of the mouth,) gingivitis, and dental erosion.

Dehydration may lead to impaired saliva production which can exacerbate dental erosion.

Finally, estrogen deficiency has been linked to receding gums due to bone loss in the jaw, heightened sensitivity, and the risk of infection (as estrogen plays an important role in the immune system of women.)

Other Complications associated with purging behaviours

Purging behaviours can take several forms, all of which can have many, serious consequences.


  • Electrolyte imbalances (particularly potassium) and possible sudden cardiac death

  • Dehydration

  • Dental erosion, gum irritation

  • Sore throat, swollen salivary glands

  • Stomachache, heartburn, and acid reflux

  • Barrett's esophagus and an increased risk for the development of cancer in the esophagus

  • Torn esophagus (Mallory-Weiss syndrome)

  • Ruptured esophagus (Boerhaave syndrome)

  • Scarring on the fingers and hands (Russell's sign)

  • Digestive problems

  • Disruption to the electrical and chemical signalling/feedback systems in the brain and digestive tract.


  • Electrolyte imbalances (particularly potassium) and possible sudden cardiac death

  • Dehydration (and related low blood pressure, fainting, etc.)

  • Lazy bowel, or loss of bowel function entirely, requiring medical assistance to pass fecal matter


  • Arrhythmias and potential sudden cardiac death

  • Injuries

  • Amenorrhea and the subsequent increased risk of osteopenia and osteoporosis

osteopenia & osteoporosis

Osteopenia ("pre-osteoporosis” or lower bone mass than is expected for a person’s age) and osteoporosis (serious loss of bone mass) are serious complications that can occur as a result of an eating disorder. 

Calcium, vitamin D, magnesium and other vitamins and minerals are crucial in the formation and maintenance of healthy bones. A lack of these critical nutrients can increase the risk of developing osteopenia and osteoporosis.

Furthermore, secondary amenorrhea due to impaired hormone production and function can lead to massive bone loss. The estrogen hormones that are involved in the menstrual cycle are crucial for bone health in cis-gendered females as these hormones "play a key role in regulation of bone mass and strength by controlling activity of bone-forming osteoblasts and bone-resorbing osteoclasts" (NCBI, 2009).

I imagine most people know about the basic impacts on reproductive health; in those with eating disorders reproductive is often disrupted due to hormone imbalances caused by malnutrition.

  • Anovulation and amenorrhea can impair or complicate sexual health, libido, and potential pregnancy.

  • Infertility and miscarriages are more common in the eating disorder population (Science Daily, 2013.)

  • Loss of pelvic musculature can increase the risk of uterine prolapse.

In a more detailed explanation, this article Jessica Baker points out that all eating disorders, including (using the DSM-5 definitions) anorexia, bulimia, otherwise specified feeding and eating disorders, and binge eating disorder can al cause damage to reproductive health, at any age.

While loss of one's period or irregularity is more common with anorexia, it can also strike people who struggle with bulimia or otherwise specified feeding and eating disorders.  Ovulation may cease for those actively struggling with an eating disorder of any kind.  Aside from potentially making conception difficult, eating disorders can also affect birth outcomes:

...women with AN have an increased risk of low weight babies, preterm birth, and a C-sections. Women with BED are at increased risk for maternal hypertension, large-for-gestational-age babies, and a longer duration of labor. 

In addition, the article cited above cites the effects on older women with eating disorders, noting:

...midlife women (age 40+ years) with an eating disorder have worse medical profiles compared with young adults.

Please take the time to have a look at the linked article:  Eating Disorder Can Do Real Damage to Gynecological Health - At Any Age .  


Gwyneth Olwen (a Canadian blogger) covers more extensively issues of fertility and pregnancy, restriction and fertility, two types of fertility, intervention to induce fertility, the un-recovered or partially recovered patient, all in great detail which includes what data we have on men and on fertility, pregnancy, and post-partum health during or after recovering from an eating disorder.  Check out her blog at Reproductive Health 1: Fertility and Pregnancy.

However, fertility and pregnancy are not the only two reasons to recover from an eating disorder: eating disorders also affect menstruation (which can, in turn, cause bone thinning, among other things) and implications for me, which she explains in Reproductive Health II: Kids or not, it's still important.

reproductive health issues

When we lose weight, we do not selectively lose weight from only certain stores. The body takes what it needs from various sources, as needed. Extensive and enduring malnutrition depletes the body of reserves and leads to the breakdown of even crucial organs (such as the brain, heart, liver, and kidneys.) Severe organ damage can result in death. Most of the changes that occur can be reversed with proper nourishment, but it takes time and we have to remember our bodies are all very different and thus tolerate severe stresses differently.


organ damage (with weight loss)





Premature death is the ultimate outcome of an untreated eating disorder.  All of the damages listed above finally come together, and death ensues, either due to medical complications or suicide.  In one meta analysis, 

...mortality rate of 5.0 – that is, they were five times more likely to have died over the study period than age-matched peers in the general population.

Mortality rates are age and treatment related.  The sooner a diagnosis and treatment occur, the higher the recovery rate.  

According to one study, the mortality rate for anorexia nervosa patients aged 25 to 44 followed after hospital discharge was 14 times that of age-matched non-eating disordered peers.

Read more here and never underestimate your risk of a catastrophic medical event.