Bulimia And Laxative Misuse 

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 (e.g., taking more laxatives than recommended) or on an unnecessarily regular basis. If this type of use continues, it’s even possible to develop laxative dependence.

Using laxatives 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 bingeing episode. 

But these beliefs are based on a misunderstanding about how digestion and laxatives actually work. The medications cannot help a person lose weight, and they do not reduce the amount of food, fat, or calories the body absorbs.

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. There are four different types of laxatives, which impact the body in different ways.²

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 because they mistakenly think laxatives will help them lose or control weight.

Like all myths, this concept contains some kernel of truth. 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. And body weight fluctuates daily, anyway.

Any weight loss from laxative use exclusively does not represent a loss of fat. 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 binge eating and self-induced vomiting. In these cases, a person will look for a way to compensate for what they consumed during a binge episode.

For many people struggling with BN, laxatives offer a fast and easy option for compensation.

The review also suggested that part of the reason patients engaged in purging behavior was the belief that taking laxatives would meaningfully reduce how many calories they absorbed from their food.⁵

Potential Complications of Laxative Misuse

Unfortunately, laxative misuse can result in a number of potentially dangerous health complications.

Somewhat paradoxically, constipation is one of the most common effects of misusing laxatives. 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 and severe eating disorder symptoms.

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 that 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

Eating disorders do not go away on their own and can have serious health complications if left untreated for too long. So it’s important to seek treatment from a qualified mental health professional or healthcare provider who specializes in eating disorders as quickly as possible. If you or a loved one is struggling with body image, purging, not eating enough food, or using laxatives to try to lose weight, it may be time to ask for help. 

You or your loved one may not realize you have a problem. Expressing your concern or talking to someone you trust can make it easier to ask for help. But help is available, and recovery is possible.