What Is Laxative Misuse?
It’s fairly common for people who struggle with bulimia nervosa or other eating disorders to misuse or abuse laxatives. In fact, one study found as many as 56% of people with purging-type conditions misuse these medications. [1]
While there’s no hard and fast definition of “laxative misuse,” the term refers to using these medications improperly or on an unnecessarily regular basis. If this type of use continues, it’s even possible to develop laxative dependence.
The idea has become popular as a way to quickly move food through the body, bypassing the digestive process in order to avoid absorbing calories. For many people with BN, laxative use can also be expressed as compensatory behavior—an attempt to clear out the system after a binging episode.
But these beliefs are based on a misunderstanding about how digestion and laxatives actually work. The medications cannot meaningfully help a person lose weight, nor do they meaningfully reduce the amount of food, fat, or calories that the body is absorbing.
How Do Laxatives Work?
Laxatives are a type of medication designed to make bowel movements easier. If a person struggles with constipation, laxatives offer a legitimate way to help treat the problem.
However, when misused or abused, laxatives can have serious or dangerous side effects. In the worst-case scenarios, these effects can even be life-threatening.
Regardless, there are four different types of laxatives, which impact the body in different ways. [2]
Bulk-forming laxatives work by increasing the “bulk” of stool. The added weight in the digestive tract can help stimulate bowel movement.
These types of laxatives don’t work right away, and it may take between 2-3 days to see an effect.
Osmotic laxatives work by drawing water into the stool, helping to soften it and make passing it easier.
These types of laxatives also take several days to make an impact, typically showing results in 2-3 days.
Among the fastest-acting laxatives, this version of the medication stimulates the muscles in the gut, physically helping move stool along its path. They typically take effect within 6-12 hours.
Stool softeners, as implied by the name, can make stool softer and easier to pass. Generally producing results within 12-78 hours, these types of laxatives are typically recommended for a person who has issues with unusually hard stool, or a blockage.
Why Do Some People With Bulimia Misuse Laxatives?
There are many reasons why someone struggling with bulimia nervosa or other eating disorders may turn to laxatives.
Misunderstood Science
Many people turn to laxatives to help lose or control weight.
Like all myths, this concept has some kernel of truth to it. Laxatives can result in a small reduction in weight. But this weight is made almost entirely of water, electrolytes, minerals, and any indigestible fiber or waste in the large intestine.
Any weight loss seen from laxative use exclusively does not represent a loss of fat. And generally, the effect is only temporary, with someone regaining the difference as soon as they eat again or rehydrate. [3]
Negative Body Image
Nearly all eating disorders, including bulimia nervosa, are driven, in some part, by negative body image and low self-esteem. These unfortunate mindsets can also contribute to laxative misuse.
One study found that, among a group of women who all experienced eating disorders, those who abused laxatives demonstrated more features of perfectionism and avoidant personality disorder, a condition that involves chronic feelings of inadequacy. [4]
In the same study, women who abused laxatives while struggling with bulimia nervosa showed the highest scores for a number of concerning attitudes, including: [4]
- Desire for thinness
- Dissatisfaction with their bodies
- Feelings of uselessness
- Lack of interoceptive mindfulness
- Characteristics of both passive-aggressive and borderline personality disorders.
Compensatory Behavior
Purging-type disorders, in general, and bulimia nervosa specifically, also revolve around a disordered behavioral pattern of binging and purging. In these cases, a person will look for a way to compensate for what they consumed during a binging episode.
For many people struggling with BN, laxatives offer a fast and easy option for compensation.
10-60% of those with eating disorders misuse laxatives.
A 2010 review noted that anywhere from 10-60% of people with eating disorders reported engaging in laxative abuse or misuse. Laxatives in the stimulant class were found to be the most frequently misused, likely because they work faster than other types of laxatives. [5]
The review also suggested that part of the reason patients engaged in this behavior was the belief that the medications would meaningfully reduce how many calories they absorb from their food. [5]
Potential Complications of Laxative Misuse
Unfortunately, laxative misuse can result in a number of health complications, with some being potentially dangerous.
Somewhat paradoxically, constipation is one of the most common effects of misusing laxatives. This is because overusing the medication can cause the intestines to lose nerve and muscle response, which is an important part of the bowel movement process. [6]
Laxative misuse can also lead to: [6]
- Cycles of constipation and diarrhea
- Bloating
- Passing unusual amounts of gas
- Dehydration
- Thirst
- Dry mouth
- Headaches
Results of Chronic Laxative Misuse
Over time, laxative misuse may cause more serious health concerns.
Prolonged laxative misuse can irritate the colon enough that it bleeds, resulting in bloody stools. Some people may also experience rectal prolapse as a result of the chronic, severe diarrhea laxative misuse can cause.
Impaired function of the intestines may also occur to the point where it becomes very difficult to evacuate stool normally. This issue is not only dangerous but can be difficult and slow to reverse.
Perhaps most seriously, laxative misuse can result in electrolyte abnormalities. This can cause weakness, irregular heartbeat, and even death.
Electrolyte abnormalities are also notoriously difficult to detect at times. They may cause a person who otherwise seemed fairly fine to suddenly experience severe, or even deadly, health complications.
Seeking Help for Bulimia and Laxative Abuse
If you or a loved one are showcasing signs of struggling with body image, purging, undereating, or using laxatives to try to lose weight, it may be time to seek help.
Bulimia nervosa, other eating disorders, and laxative abuse are all associated with a number of health complications, so it’s important to seek treatment as quickly as possible.
A mental health professional can help you significantly improve not just your physical health but your mental health, making a positive impact on the way you feel about your body and your overall outlook on life.
And it’s never too late to seek help. Making the first step can be difficult, but it can lead you to a path of healing and a healthier and happier future.
Resources
- Tozzi, F., Thornton, L., Mitchell, J., Fichter, M.M., et al. (2006, May). Features Associated With Laxative Abuse in Individuals With Eating Disorders. Psychosomatic Medicine; 68(3):470-7.
- Laxatives. (2019, June 10). UK NHS. Retrieved September 15, 2022.
- Laxative Abuse. (2022). National Eating Disorders Association. Retrieved September 15, 2022.
- Pryor, T., Wiederman, M. W., & McGilley, B. (1996). Laxative abuse among women with eating disorders: an indication of psychopathology? The International journal of eating disorders; 20(1):13–18.
- Roerig, J. L., Steffen, K. J., Mitchell, J. E., & Zunker, C. (2010). Laxative abuse: epidemiology, diagnosis and management. Drugs; 70(12):1487–1503.
- Laxative Use: What to Know. (2019, October). Cornell Health. Retrieved September 15, 2022.