Laxative abuse in eating disorders occurs when an individual attempts to bypass the absorption of calories and nutrients in order to lose weight through the frequent use of laxatives. Laxative abuse often results in a variety of serious health complications and can cause potentially life-threatening conditions.
By: Valisha Barclay
What are Laxatives?
Laxatives are a type of medication used to treat constipation. They soften stools and help the body eliminate waste more easily. They are not recommended for long-term use. Prolonged laxative use compromises the normal function of the large intestine and may lead to laxative dependency. This may necessitate an increased dosage of the laxative which can cause serious health consequences and laxative abuse. Laxative abuse is of concern in those without eating disorders. Therefore, in those with eating disorders, its impact can be more pronounced since there is little to no replenishing of nutrients.
Eating Disorders and Laxative Abuse
For many with eating disorders, particularly anorexia and bulimia nervosa, laxatives are often used in an attempt to bypass the absorption of calories and lose weight. It is important to note that laxatives stimulate the large intestine and most nutrients from food are absorbed in the small intestine. The body’s water content is partially regulated in the large intestine. Using a laxative, therefore, has an effect on fluid levels in the body and does not change your actual weight. Laxative abuse can result in serious health consequences such as:
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Gastrointestinal issues
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Impaired function of the intestines
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Electrolyte abnormalities and dehydration. [1,2,3]
Gastrointestinal Issues
Using laxatives regularly can lead to diarrhea, blood in the stool, nausea, vomiting, and gas. These issues can cause someone to live an uncomfortable life where these effects take over, impacting their social and personal lives.
Impaired Function of Intestines
Prolonged use of laxatives can lead to permanent damage of the intestines. Because the laxative is constantly stimulating the intestines, the nerves of the intestines can lose normal function, resulting in a colon that cannot successfully eliminate stool, leading to bloating and cramping. Risk of infection also increases. Laxatives strip the mucus that naturally coats the large intestine. This mucus protects the large intestine from infection and irritation.[2]
Electrolyte Abnormalities and Dehydration
Since stimulant laxatives stimulate the colon to release water, the body’s water content changes. We have different electrolytes in our body such as potassium and sodium. Changing the amount of water continuously without rehydrating can lead to a change in the concentration of electrolytes in the body and often causes dehydration. This shift leads to severe metabolic disturbances. Loss of too much sodium can cause hypotension, tachycardia, dizziness, and fainting. Hypokalemia, or low levels of potassium, can result in cardiac arrhythmias, skeletal muscle paralysis, rhabdomyolysis, kidney problems, and nerve issues.[2]
Laxative Abuse and Mental Health
Laxative abuse has been associated with a history of depression and anxiety, borderline personality disorder, and self-injurious behaviors. Studies have shown that low self-esteem and body dissatisfaction are also associated with laxative abuse.[4] It is important to seek help and find a treatment team that caters to all aspects of care. This is why a multidisciplinary team is important. Although the recovery time for laxative abuse differs, recovery is possible.
At BALANCE eating disorder treatment center, our compassionate, highly skilled team of clinicians is trained in diagnosing and treating the spectrum of eating disorders, including anorexia, bulimia, binge eating disorder, compulsive overeating, and other disordered eating behaviors and body image issues.
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This post was written by BALANCE Dietetic Intern, Valisha Barclay.
Valisha is a dietetic intern at NYU who is currently working on her Masters in Clinical Nutrition. She completed her undergrad at Hunter College and works as a Care Coordinator at Memorial Sloan Kettering Cancer Center with patients undergoing bone marrow transplants. She has also worked with patients with gynecological cancers including ovarian, uterine and cervical cancers for three years. She has a passion for learning and providing support and care. She also has a passion for food, nutritionally and culturally. Outside of school and work, she enjoys cooking with her toddler and hopes to travel and explore the world through food.
Resources
1. Health C. Laxative Use: What to Know. 2020. https://health.cornell.edu/sites/health/files/pdf-library/LaxativeUse.pdf.
2. Baker ME, Sandle MG. Complications Of Laxative Abuse. Annual Review of Medicine. 1996;47(1):127-134. doi:10.1146/annurev.med.47.1.127.
3. Laxative Abuse. National Eating Disorders Association. https://www.nationaleatingdisorders.org/learn/general-information/laxative-abuse.Published February 22, 2018.
4. Tozzi F, Thornton LM, Mitchell J, et al. Features Associated With Laxative Abuse in Individuals With Eating Disorders. Psychosomatic Medicine. 2006;68(3):470-477. doi:10.1097/01.psy.0000221359.35034.e7.
