Anemia, Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart failure, Bone loss (osteoporosis), Increased risk of fractures, Muscle loss, In women, missed period, In men, decreased testosterone, Gastrointestinal problems, such as constipation, bloating or nausea. Functional gastrointestinal disorders and epigastric pain are also common GI complications in anorexia nervosa, often presenting as significant abdominal discomfort and requiring specific clinical attention. Acute gastric dilation, though rare, is a serious complication that can occur in severe cases. Adolescent females are particularly vulnerable to impaired bone development and osteoporosis due to malnutrition. In anorexia nervosa, decreased bone formation, in addition to increased bone resorption, contributes to the marked loss of bone mineral density and increases fracture risk. Severe osteoporosis is a major complication of anorexia nervosa, resulting in increased fracture risk even after weight restoration.
The structural cardiac hallmark of this disease is myocardial atrophy, characterized by a reduction in the mass index and volume of the left ventricle, which commonly results in mitral valve prolapse. Myocardial atrophy, the structural hallmark of this disease, is characterized by a reduction in the mass index of the left ventricle and a concomitant decrease in left ventricular volume. Mitral valve prolapse is common in AN.
Although its mechanism has not been fully clarified, it is believed to be a consequence of myocardial atrophy and reduction in the size of the left ventricular chamber, leading to relative valve laxity even in the absence of myxomatous valve degeneration. This theory of “valvular-ventricular disproportion” suggests that excess mitral valve tissue or improper size of the left ventricular cavity causes prolapse. This theory is supported by the observation that prolapse disappears in patients after weight regain, but reappears when patients lose weight again. 9 In a cohort study10, the authors observed mitral valve prolapse in most of their patients with severe AN, but found no significant correlation between ventricular dimension and prolapse.
In contrast, a low heart rate was significantly correlated with mitral valve prolapse. Therefore, the cause of prolapse is probably multifactorial and may also be mediated by an increase in underlying vagal tone and the resulting bradycardia. Pericardial effusion can develop with progressive weight loss, but usually subsides with restoration of weight and simultaneous normalization of serum triiodothyronine levels (T, 11). People with anorexia usually have a low level of red blood cells, which can cause fatigue, shortness of breath, dizziness, and heart rate - all signs of anemia. In severe malnutrition, changes in bone marrow such as serous fat atrophy and loss of normal marrow fat can occur, leading to further hematologic abnormalities.
Individuals who develop anorexia, especially during adolescence, are at risk for long-term health issues including bone and hormonal complications. Complications of anorexia nervosa can be serious and cause death. In fact, anorexia nervosa has one of the highest mortality rates compared to other mental health conditions, second only to opioid overdose. Numerous general medical complications affect nearly all major organ systems in anorexia nervosa, and increased mortality risk is closely linked to these complications. Medical complications account for a large proportion of deaths in anorexia nervosa. Anorexia nervosa is a disease with very serious psychological and medical complications. With a mortality rate of around 10%, anorexia deaths are due to starvation, cardiovascular complications and suicide. Anorexia nervosa is classified as both a mental illness and a mental disorder, and is associated with significant mental health complications such as anxiety disorders, personality disorders, and substance abuse, which frequently co-occur and worsen outcomes. Marked weight loss is a key feature of anorexia nervosa and is associated with the severity of medical complications. Patients with anorexia nervosa are at high risk for medical and obstetric complications, including refeeding syndrome and cardiac problems.
According to the National Association for Anorexia Nervosa and Associated Disorders (ANAD), eating disorders are among the deadliest mental illnesses, second only to opioid overdose. Disorder patients, including those with anorexia nervosa, may experience pulmonary complications such as lung-related risks. Eating disorder patients are at risk for pulmonary complications like emphysema and pneumothorax due to malnutrition and restrictive behaviors. This review analyzes these complications, many of which are resolved with effective nutritional therapy and weight gain. However, the encouraging message is that the vast majority of these, often serious medical complications, are reversible with weight gain and nutritional rehabilitation, as will be described in the third segment of this series. Sufficient weight gain is necessary for recovery from certain GI complications, and achieving ideal body weight (approximately 95% of ideal) is important for clinical improvement and the resumption of normal physiological functions. In more severe cases, it can cause a number of secondary complications, such as renal failure, hypovolemic shock (low blood volume), electrolyte imbalances, and orthostatic hypotension.
In addition, some of the complications can have permanent adverse effects even after there is a successful nutritional rehabilitation and weight restoration program. Unlike other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications that commonly occur as part of their eating disorders. The reported incidence of these medical complications varies depending on the individual patient and also depending on the severity of the episode of anorexia nervosa. Body mass index is a key metric used to classify disease severity and guide diagnosis and treatment.
Despite the above-mentioned cardiovascular complications observed in AN, an exact mechanism underlying the increased risk of cardiovascular mortality in this disorder has not been firmly established. Factors influencing QT prolongation, such as electrolyte imbalances and structural heart changes, contribute to arrhythmia risk and can lead to sudden death in these patients. In a later article, definitive medical treatment for these complications will be presented in a clinically practical manner. Tako-tsubo cardiomyopathy complicated by recurrent torsade de pointes in a patient with anorexia nervosa. Multiple concomitant medical complications occur throughout the body and become more pronounced as the severity of the disease increases. Multiple endocrine abnormalities are common in anorexia nervosa and contribute to its complications.
Anorexia nervosa and bulimia are intrinsically associated with many different medical complications. Beyond bradycardia, more subtle arrhythmias can create significant complications for patients with anorexia nervosa. The second part of this series will be devoted to the medical complications associated with bulimia nervosa, and the third article will discuss currently available treatments for the medical complications of anorexia nervosa and bulimia. In fact, anorexia nervosa has the highest mortality rate of any psychiatric disorder, probably due to these medical complications. Growth hormone resistance is a common endocrine abnormality in anorexia nervosa, characterized by elevated growth hormone and low IGF-1 levels. Euthyroid sick syndrome is a reversible thyroid abnormality seen in anorexia nervosa.
Here is a summary of the medical complications of anorexia and what makes it one of the deadliest diseases. Female patients with anorexia nervosa are at increased risk for hypothalamic amenorrhea, low estrogen, and osteoporosis. Restrictive type anorexia nervosa is a subtype characterized by severe food restriction without binge-eating or purging. Self induced vomiting is a maladaptive behavior in some patients with anorexia nervosa, leading to electrolyte imbalances and other complications. Severe anorexia nervosa is associated with significant medical complications, including metabolic, gastrointestinal, and cardiovascular risks. Risk factors for developing anorexia nervosa and its medical complications include genetic, psychological, and environmental contributors. The eating recovery center is a facility involved in the treatment and research of eating disorders. It is important to consult a healthcare professional for diagnosis, treatment, and ongoing care of anorexia nervosa.
Introduction to Eating Disorders
Eating disorders are complex mental health conditions that involve unhealthy relationships with food, body image, and weight. The most common eating disorders include anorexia nervosa, bulimia nervosa, and binge eating disorder. These disorders are characterized by abnormal eating habits, such as extreme restriction of food intake, episodes of binge eating, or cycles of bingeing and purging. Individuals struggling with eating disorders often experience a distorted body image and an intense fear of weight gain, which can lead to dangerous behaviors and severe health consequences.
According to the National Eating Disorders Association, eating disorders affect millions of people in the United States, cutting across age, gender, and cultural backgrounds. The impact of these conditions extends beyond physical health, as they are also associated with significant mental health challenges, including anxiety, depression, and an increased risk of sudden cardiac death. Early recognition and intervention are crucial, as eating disorders can result in numerous medical complications and even be life-threatening. Comprehensive treatment typically involves medical monitoring, nutritional counseling, and psychotherapy to address both the physical and psychological aspects of the disorder.
Three Major Complications of Anorexia Nervosa
Anorexia nervosa is a serious eating disorder marked by restrictive eating, significant weight loss, and a persistent fear of gaining weight. Among the many health risks associated with anorexia nervosa, three major complications stand out: cardiovascular complications, bone disease, and gastrointestinal problems.
Cardiovascular complications are among the most dangerous risks for patients with anorexia nervosa. Severe weight loss and malnutrition can lead to issues such as mitral valve prolapse, abnormal heart rhythms, and even sudden cardiac death. These complications arise from changes in heart muscle structure, electrolyte imbalances, and low blood pressure, putting individuals at a much higher risk of life-threatening events.
Bone disease is another significant complication, as chronic malnutrition and hormonal imbalances can severely impact bone health. Patients with anorexia nervosa often experience decreased bone mineral density, leading to osteoporosis and an increased risk of fractures. The loss of essential nutrients and low body weight disrupt normal bone metabolism, making bone disease a long-term concern even after weight restoration.
Gastrointestinal problems are also common in those with anorexia nervosa. Restrictive eating patterns and malnutrition can cause symptoms such as constipation, abdominal pain, and, in severe cases, conditions like superior mesenteric artery syndrome. These digestive system issues can further complicate recovery and contribute to ongoing discomfort and health risks.
Recognizing these major complications is essential for early intervention and effective treatment, as patients with anorexia nervosa are at a higher risk for serious, sometimes irreversible, health problems.
Risk of Developing Other Eating Disorders
Individuals diagnosed with anorexia nervosa face a significantly higher risk of developing other eating disorders over time, including bulimia nervosa and binge eating disorder. According to the National Eating Disorders Association, nearly half of those with anorexia nervosa may go on to develop bulimia nervosa, while about 20% may experience binge eating disorder. This overlap highlights the complex nature of eating disorders and the need for comprehensive, ongoing care.
Several factors contribute to this increased risk. Genetic predisposition plays a substantial role, as individuals with a family history of eating disorders or other mental health disorders—such as anxiety disorders or personality disorders—are more likely to develop multiple eating disorders. Environmental influences, including societal pressures to maintain a certain body weight or appearance, can also drive unhealthy eating behaviors and reinforce a distorted body image. Additionally, the presence of underlying mental health complications, such as depression or chronic stress, can make it more difficult for individuals to maintain a healthy relationship with food and body weight.
Recognizing the signs of other eating disorders is crucial for early intervention. Symptoms such as dramatic weight loss or weight gain, persistent preoccupation with food intake, and ongoing dissatisfaction with body image may signal the development of another eating disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) provides clear criteria for diagnosing anorexia nervosa, bulimia nervosa, and binge eating disorder, helping healthcare professionals identify and address these conditions promptly.
Comprehensive treatment for eating disorders involves more than just addressing physical symptoms or achieving weight restoration. Effective care requires a multidisciplinary approach, including nutritional rehabilitation, psychotherapy, and, when necessary, medication. In severe cases, hospitalization or residential treatment may be needed to manage medical complications and support recovery. Early recognition and intervention are essential to prevent the progression of eating disorders and reduce the risk of serious medical complications, such as bone disease, cardiovascular complications like mitral valve prolapse, and other long-term health risks associated with low body weight and malnutrition.
Ultimately, individuals with anorexia nervosa are at a higher risk for developing other eating disorders, making it vital to address both the physical and psychological aspects of these conditions. By promoting early intervention, comprehensive treatment, and ongoing support through mental health services administration, healthcare professionals can help individuals achieve a healthy weight, prevent further weight loss or gain, and improve overall mental health and quality of life.
Conclusion
Anorexia nervosa is a life-threatening eating disorder with far-reaching medical and psychological consequences. The risk of developing severe complications—such as cardiovascular issues, bone disease, and gastrointestinal problems—underscores the importance of early detection and comprehensive treatment. While the medical complications of anorexia nervosa can be profound, many are reversible with timely intervention, nutritional rehabilitation, and ongoing support from healthcare professionals. Raising awareness about the dangers of eating disorders and promoting access to mental health services are critical steps in reducing the impact of these serious mental illnesses and helping individuals achieve lasting recovery.
