The disease of bulimia and its consequences in the oral cavity

While bulimia nervosa has been extensively documented in both academic and lay literature, consolidating and synthesizing its core characteristics can provide added value beyond merely reiterating well-established definitions. Bulimia nervosa represents a complex eating disorder centered on dysfunctional eating patterns and an obsessive preoccupation with body weight regulation. A hallmark feature is the recurrence of *binge-eating episodes*—periods during which individuals consume abnormally large quantities of food within a discrete timeframe, accompanied by a perceived loss of control. These episodes are invariably followed by compensatory behaviors aimed at mitigating the physical consequences of overeating, particularly weight gain. The disorder predominantly affects adolescents and young adult women, with diagnostic criteria (e.g., DSM-5) requiring symptom persistence for at least three months, occurring at a frequency of no fewer than twice weekly. Two primary subtypes are recognized: *purging-type bulimia* (involving self-induced vomiting, laxative abuse, or enemas) and *non-purging-type bulimia* (characterized by restrictive dieting, excessive exercise, or fasting as compensatory mechanisms). The etiology of bulimia is multifactorial, encompassing biological components (e.g., neurotransmitter dysregulation), psychological factors (e.g., low self-esteem, perfectionism), and environmental influences (e.g., sociocultural pressures regarding body image, adverse childhood experiences). The disorder frequently co-occurs with other mental health conditions, including major depressive disorder, anxiety disorders, and obsessive-compulsive disorder.

In addition to the known symptoms of bulimia, such as: periods of overeating and ingestion of unhealthy food; loss of control of food intake during seizures; provoking vomiting, exercising and cleansing to avoid becoming obese, there are also symptoms that are not apparent at first glance. This is because bulimia patients hide these symptoms and usually have a normal or slightly higher body weight. The characteristic symptoms of this group are definitely changes in the stomach, namely inflammation of the intestines, which can lead to an increase in the amount of stomach and intestines.

Beyond its psychological manifestations, bulimia nervosa induces severe physiological disruptions primarily driven by chronic deficiencies in key electrolytes—sodium, potassium, and chloride. These imbalances may precipitate cardiac arrhythmias, congestive heart failure, or sudden episodes of syncope and vertigo. Individuals with bulimia frequently exhibit peripheral edema due to fluid retention—a compensatory response to recurrent self-induced vomiting, which the body previously adapted to as a metabolic baseline. Gradual restoration of hydroelectrolytic equilibrium through monitored fluid intake is critical to prevent abrupt electrolyte shifts. Equally perilous are the gastrointestinal complications: persistent vomiting erodes the gastric mucosa, elevating the risk of perforation—a life-threatening condition. Excessive laxative use further contributes to colonic atony, chronic constipation, and the development of hemorrhoids. Despite often being concealed (as body weight may remain within normal ranges), bulimia reveals itself through distressing behaviors such as binge-eating episodes alternating with restrictive fasting, or an obsessive preoccupation with weight. Disregarding these red flags exacerbates deterioration in both mental and physical health—including enamel erosion, gingival inflammation, and oral mucosal ulcerations. Timely medical and psychotherapeutic intervention is essential to avert irreversible organ damage.