Laxative abuse is the eating disorder that’s rarely talked about

Generally speaking, when we hear the term “eating disorder,” we usually think of either anorexia or bulimia. But laxative abuse is a prevalent disorder with grave risks that remains largely unspoken.

“One of the biggest misnomers with eating disorders is the myth that you can tell someone has a disorder because they’re so thin,” says Patti Perry, founder of Eating Disorders Clinic in Toronto and co-founder of the National Initiative for Eating Disorders. “That’s simply not true. There are people who are of so-called normal weight who stay that way through binging and purging with vomiting or laxative abuse.”

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It’s this misconception that adds to the shame that’s already piled on to an eating disorder, especially when it manifests itself in laxative abuse.

“Oftentimes, people who are purging in some way don’t look like they have an eating disorder and that’s even harder. Because people think, ‘Well, you’re not that skinny.'”

Laxative abuse, which can involve ingestion of anywhere from 30 to 100 laxatives in a day, is in fact quite common, with studies estimating that it occurs in 10 to 60 per cent of cases of anorexia or bulimia. The irony, however, is that the laxatives themselves don’t necessarily result in weight loss.

Laxatives work to push waste through the large intestine, but food is absorbed and digested in the small intestine. By the time the laxative takes effect and starts to move things through the large intestine, most of the fats and calories in food have been absorbed by the body.

What laxatives do accomplish is ridding the body of excess water, resulting in a loss of water weight and any consequent bloating. But this is temporary.

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“Within 24 hours, you’ll compensate for the water loss and regain it because the body craves being in equilibrium,” Perry says. “You’ll be thirsty, you’ll drink and you’ll possibly over-hydrate. You go back and forth.”

Like any other eating disorder, the dangers of laxative abuse can have dire consequences. It can cause dehydration, since the pills draw water into the intestines from other tissues, and could cause headaches, dizziness and fatigue, among other things. In addition, they’ll zap the body of much-needed electrolytes.

“Electrolytes include potassium, chloride and sodium, and they affect the electrical conduction of nerve impulses across the heart membrane. If you’re abusing laxatives, you could throw your body into electrolyte imbalance resulting in irregular nerve impulses across the heart. This can cause a heart attack and you could die.”

Laxative abuse has also been linked to rhabdomyolysis, the rapid deterioration of muscle tissue, gastrointestinal and liver damage, and kidney failure.

Furthermore, Perry says, overuse can lead to a sluggish digestive system that will cease to work on its own.

“If you just stop taking laxatives, you’ll end up extremely constipated and in order to get things working again, you’ll go back to taking laxatives. The recidivism rate of laxative abuse is very high as a result.”

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What’s even more alarming is that often, laxative abuse is used as a form of self-punishment. Researchers have found that the weight loss associated with this disorder is often only a surface consideration. Rather, people and especially teenagers, may use this as a way to decrease the fear of weight gain while focusing on the pain of self-punishment.

Knowing this, researchers believe, could help practitioners to focus less on laxatives as a gateway to weight loss and more as laxatives as a form of self-harm.

“An eating disorder has little to do with food or eating,” Perry says. “There are always significant underlying reasons for developing one.”