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Eating Disorders: Anorexia and Bulimia


An in-depth report on the treatment and prevention of eating disorders.

Alternative Names

Anorexia; Bulimia

Complications of Anorexia

Anorexia nervosa is a very serious illness that has a wide range of effects on the body and mind. It is also associated with other problems ranging from frequent flus and general poor health to life-threatening conditions. Some experts believe that it should be not be approached as a simple eating disorder but as a serious condition requiring staging according to severity.

At this time no treatment program for anorexia nervosa is completely effective. Recovery rates vary between 23% and 50%, and relapses range from 4% to 27%. Even for those who recover, one study indicated that recovery took between four and nearly seven years. Depending on the duration of the study, anorexic patients have reported death rates ranging from 4% to 25%. Even after treatment and weight gain, many patients continue to display characteristics of the disorder, including perfectionism and a drive for thinness, that could keep them at risk for recurrence. In spite of these very serious findings, this condition has received very little research attention.

According to different studies, the risk for early death is higher for people with the following conditions or characteristics:

  • Being younger.
  • Having bulimia anorexia. (The mortality rate is twice as high in this group than in the anorexic-restrictor types.)
  • Being severely low in weight at the time of treatment.
  • Being sick for more than six years.
  • Having been previously obese.
  • Having personality disorders.
  • Having an accompanying severe psychological disorder.
  • Having a dysfunctional marriage.
  • Being male. (The higher risk for life-threatening medical problems in males may be due to their tendency to be diagnosed with anorexia later than women.)

Hormonal Changes

One of the most serious effects of anorexia are hormonal changes, which can have severe health consequences:

  • Reproductive hormones, including estrogen and dehydroepiandrosterone (DHEA), are lower. Estrogen is important for healthy hearts and bones. DHEA, a weak male hormone, may also be important for bone health and for other functions.
  • Thyroid hormones are lower.
  • Stress hormones are higher.
  • Growth hormones are lower. Children and adolescents with anorexia may experience retarded growth.

The result of many of these hormonal abnormalities in women is long-term, irregular or absent menstruation (amenorrhea). This can occur early on in anorexia, even before severe weight loss. Over time this causes infertility, bone loss, and other problems. Low weight alone may not be sufficient to cause amenorrhea. Extreme fasting and purging behaviors may play an even stronger role in hormonal disturbance.

Psychologic Effects and Suicide

Adolescents with eating behaviors associated with anorexia (fasting, frequent exercise to lose weight, and self-induced vomiting) are at high risk for anxiety and depression in young adulthood. Some studies estimate that between 12% and 18% of people who are anorexic also abuse alcohol or drugs. Even worse, suicide has been estimated to account for as many as half the deaths in anorexia. In one study, suicide rates occurred in 1.4% of women with anorexia. The study, however, only looked at female death records. Such records may not have always recorded anorexia as an accompanying condition, so the incidence of suicide in anorexia may be much higher.

Heart Disease

Heart disease is the most common medical cause of death in people with severe anorexia. The effects of anorexia on the heart are as follows:

  • Dangerous heart rhythms, including slow rhythms known as bradycardia, may develop. Such abnormalities can show up even in teenagers with anorexia.
  • Blood flow is reduced.
  • Blood pressure may drop.
  • The heart muscles starve, losing size.
  • Cholesterol levels tend to rise.

A primary danger to the heart is from abnormalities in the balance of minerals, such as potassium, calcium, magnesium, and phosphate, which are normally dissolved in the body's fluid. The dehydration and starvation that occurs with anorexia can reduce fluid and mineral levels and produce a condition known as electrolyte imbalance. Electrolytes (e.g., calcium and potassium) are critical for maintaining the electric currents necessary for a normal heartbeat. An imbalance in these electrolytes can be very serious and even life threatening unless fluids and minerals are replaced. Heart problems are a particular risk when anorexia is compounded by bulimia and the use of ipecac, a drug that causes vomiting.

Long-Term Outlook on Fertility

After treatment and an increase in weight, estrogen levels are usually restored and periods resume. In severe anorexia, however, even after treatment, normal menstruation never returns in 25% of such patients.

  • If a woman with anorexia becomes pregnant before regaining normal weight, she faces a higher risk for miscarriage, cesarean section, and for having an infant with low birth weight or birth defects. She is also at higher risk for postpartum depression.
  • Women with anorexia who seek fertility treatments have lower chances for success.

Long-Term Effect on Bones and Growth

Almost 90% of women with anorexia experience osteopenia (loss of bone minerals) and 40% have osteoporosis (more advanced loss of bone density). Up to two-thirds of children and adolescent girls with anorexia fail to develop strong bones during their critical growing period. Boys with anorexia also suffer from stunted growth. The less the patient weighs, the more severe the bone loss. Women with anorexia who also binge-purge face an even higher risk for bone loss.

Bone loss in women is mainly due to low estrogen levels that occur with anorexia. Other biologic factors in anorexia also may contribute to bone loss, including high levels of stress hormones (which impair bone growth) and low levels of calcium, certain growth factors, and DHEA (a weak male hormone).Weight gain, unfortunately, does not completely restore bone. Only achieving regular menstruation as soon as possible can protect against permanent bone loss. The longer the eating disorder persists the more likely the bone loss will be permanent.

Testosterone levels decline in boys as they lose weight, which also can affect their bone density. In young boys with anorexia, weight restoration produces some catch-up growth, but it may not produce full growth.

Neurological Problems

People with severe anorexia may suffer nerve damage that affects the brain and other parts of the body. The following nerve-related conditions have been reported:

  • Seizures.
  • Disordered thinking.
  • Numbness or odd nerve sensations in the hands or feet (a condition called peripheral neuropathy).

Brains scans indicate that parts of the brain undergo structural changes and abnormal activity during anorexic states. Some of these changes return to normal after weight gain, but there is evidence that some damage may be permanent. Still, the extent of the neurologic problems is unclear, and some studies have been unable to determine specific mental problems associated with anorexia.

Blood Problems

Anemia is a common result of anorexia and starvation. A particularly serious blood problem is pernicious anemia, which can be caused by severely low levels of vitamin B12. If anorexia becomes extreme, the bone marrow dramatically reduces its production of blood cells, a life-threatening condition called pancytopenia.

Gastrointestinal Problems

Bloating and constipation are both very common problems in people with anorexia.

Multiorgan Failure

In very late anorexia, the organs simply fail. The main signal for this is elevated levels of liver enzymes, which require immediate administration of calories.

Complications in Diabetic Adolescents

Eating disorders are very serious for young people with type 1 diabetes. The complications of anorexia that affect all patients are even more dangerous in this group of patients. Hypoglycemia, or low blood sugar, for example, is a danger for anyone with anorexia, but it is a particularly dangerous risk for those with diabetes. One study found that 85% of young women with diabetes and eating disorders had retinopathy, damage to the retina in the eye, which can lead to blindness.


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