Eating disorders are very serious illnesses that have wide range of effects on the body and mind. They are frequently associated with a number of other medical problems, ranging from frequent infections and general poor health to life-threatening conditions.
Purging can cause extensive damage throughout the digestive tract. Complications include:
- Frequent use of laxatives can cause dehydration, bloating, and electrolyte imbalances, which can lead to many other medical complications. Laxative abuse can cause colon damage that may result in chronic constipation.
- Acid and bile from frequent forced vomiting can cause inflammation and damage to the lining of the esophagus, stomach, and entire gastrointestinal tract. Resulting complications include gastroesophageal reflux disease (GERD), gastritis, and esophagitis. In severe cases, the esophagus can rupture.
Heart disorders are the most common medical causes of death in people with severe anorexia nervosa. The effects of anorexia on the heart include:
- Dangerous heart rhythms, including slow rhythms known as bradycardia. These rhythm abnormalities are triggered by dehydration and electrolyte imbalances.
- Blood pressure may drop.
- The heart muscles starve, losing strength and size.
- In extreme cases, the heart stops (cardiac arrest).
Starvation, binge eating, and purging can cause damage to many of the body’s organs including the kidneys, lungs, and liver. Severe anorexia nervosa can cause multi-organ failure.
Starvation can cause serious hormonal changes, which may have severe health consequences. Hormones affected include:
- Reproductive hormones, including estrogen and dehydroepiandrosterone (DHEA)
- Thyroid hormones
- Stress hormones
- Growth hormones
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 and pregnancy complications, bone density loss (osteoporosis), and other problems.
In children and adolescents with eating disorders, hormonal abnormalities can interfere with normal bone development and growth.
Nearly all women with anorexia experience osteopenia (loss of bone calcium), and many 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 density loss. Patients who binge-purge face an even higher risk for bone density loss.
Bone density loss in women is mainly due to low estrogen levels that occur with anorexia. Other biologic factors in anorexia also may contribute to bone density 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 density loss. The longer the eating disorder persists the more likely the bone density loss will be permanent.
Testosterone levels decline in boys as they lose weight, which also can affect their bone density. In boys with anorexia, weight restoration produces some catch-up growth, but it may not produce full growth.
Anemia (reduced number of red blood cells) is a common result of malnutrition and starvation. A particularly serious blood problem is 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.
Teeth and Skin Complications
Tooth erosion, cavities, mouth sores, and gum problems are common in people who purge. The stomach acid caused by forced vomiting erodes tooth enamel and dries out the saliva glands.
Dehydration affects people with bulimia nervosa and anorexia nervosa. It can cause dry, flaky skin and brittle hair. Patients may lose hair on the scalp, but grow a layer of downy hair elsewhere, which is the body’s attempt to try to stay warm.
Neurological conditions associated with severe anorexia nervosa include:
- Disordered thinking
- Numbness or odd nerve sensations in the hands or feet (peripheral neuropathy)
Imaging scans indicate that parts of the brain physically shrink (atrophy) during anorexic states. Weight gain helps many patients recover brain function, but some damage may be permanent.
Anxiety disorders and depression are common in people with eating disorders. Patients are also at higher risk for substance abuse including smoking (to help prevent weight gain), alcohol, and drug abuse. In addition to illicit drugs, people with eating disorders often abuse over-the-counter laxatives, diuretics, appetite suppressants, and drugs that induce vomiting (such as ipecac). Some patients with anorexia nervosa are at risk for suicidal behavior. .
Eating disorders are particularly serious for people with either type 1 or type 2 diabetes.
Low blood sugar (hypoglycemia) is a danger for anyone with anorexia, but it is a particularly dangerous risk for patients with diabetes, especially those who take supplemental insulin. If patients do not take their insulin, dangerous high blood sugar (hyperglycemia) can occur. Unfortunately, patients with eating disorders may skip or reduce their daily insulin in order to decrease their body’s utilization of calories.
Extremely high blood sugar levels can cause life-threatening complications. They include diabetic ketoacidosis, a condition in which acidic chemicals (ketones) accumulate in the body. This condition can lead to coma and death.