Recurrent vomiting eventually leads to a significant and permanent loss of dental enamel, especially from lingual surfaces of the front teeth. These teeth may become chipped and appear ragged and "moth-eaten." There may also be an increased frequency of dental cavities. In some individuals, the salivary glands, particularly the parotid glands, may become notably enlarged. Individuals who induce vomiting by manually stimulating the gag reflex may develop calluses or scars on the dorsal surface of the hand from repeated trauma from the teeth. Serious cardiac and skeletal myopathies have been reported among individuals who regularly use syrup of ipecac to induce vomiting.
Menstrual irregularity or amenorrhea sometimes occurs among females with Bulimia Nervosa; whether such disturbances are related to weight fluctuations, to nutritional deficiencies, or to emotional stress is uncertain. Individuals who chronically abuse laxatives may become dependent on their use to stimulate bowel movements. The fluid and electrolyte disturbances resulting from the purging behavior are sometimes sufficiently severe to constitute medically serious problems. Rare but potentially fatal complications include esophageal tears, gastric rupture, and cardiac arrhythmias. Compared with individuals with Bulimia Nervosa, Nonpurging Type, those with the Purging Type are much more likely to have physical problems such as fluid and electrolyte disturbances.
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