8 Medical Complications of Anorexia

Anorexia nervosa (AN) is one of the most prevalent eating disorders in the United States, affecting individuals of all ages, races, and genders.

Unfortunately, it’s also one of the most dangerous eating disorders, associated with an overall increased mortality risk.¹

While anorexia nervosa is counted among mental health disorders, the significant impact the condition has on the physical body can lead to a number of severe medical complications, which can further complicate the recovery process for those struggling with this condition.

What is Anorexia Nervosa?

Anorexia nervosa is a serious mental health disorder characterized by a distorted body image and an extreme fear of or aversion to gaining weight.²

The condition can manifest in a number of ways, including extreme exercise, self-induced vomiting, or other maladaptive attempts at weight control. But most frequently, it appears as extreme restriction of food intake, leading to dangerous weight loss and malnourishment.²

There is likely no single cause of AN, but rather a combination of factors that affect certain individuals to produce these disordered thoughts and behaviors. Indeed, a number of genetic, psychological, and environmental considerations have all been linked to the development of anorexia nervosa, or identified as risk factors.³

As with other eating disorders, treatment for the condition is typically multifaceted, to address these various underlying issues. It focuses on weight restoration and psychotherapy.^2,3 

8 Anorexia Nervosa Medical Complications

Anorexia nervosa can impact an individual’s physical health in numerous ways. And severe anorexia nervosa can have an even more devastating effect.

Still, there are some conditions that more frequently occur with or are caused by this condition.

Endocrine Changes

The endocrine system carries out some of the most important functions in the body. It works to oversee the production and management of hormones that play a role in metabolism, growth and development, and reproduction.⁴

Since these functions are so central to how the rest of the body operates, issues with the endocrine system can be far-reaching and particularly dangerous. AN is tied to multiple endocrine abnormalities.

Metabolic Issues

The severe limitation of food intake can lead the body to switch into so-called “starvation mode.” This represents an entirely new set of internal priorities, as the body turns to alternative energy sources to maintain functioning.⁵

These changes are, in part, dictated and, in part, supported by the endocrine system. Once they take place, they can be difficult to reverse. Those with severe anorexia nervosa often require medically-assisted nutritional rehabilitation at first, as overwhelming the body with too much sustenance after a period of starvation can lead to serious complications (known as “refeeding syndrome”).^3,6

Menstrual Issues

A common symptom in female patients with AN is hypothalamic amenorrhea, or the loss or disturbance of the menstrual period. The condition is caused by changes in hormone production brought on by limited food intake, and it impacts a large number of biological women and girls who struggle with AN.⁶

Although hypothalamic amenorrhea is not typically life-threatening, the loss of the menstrual cycle is linked to a number of other health risks, including lower bone density, vision problems, and a risk of heart and blood vessel disorders. If left untreated, prolonged amenorrhea can have long-term consequences on reproductive health.⁷

Osteoporosis

Osteoporosis is a medical condition that happens if bone mineral density and bone mass decrease, or the structure and strength of bone change. It can increase the risk of fractures.⁸

There are several factors linking anorexia nervosa and osteoporosis.⁹ 

Malnutrition contributes to osteoporosis. In states of starvation, the body may pull calcium from bones, weakening them and raising the risk of osteoporosis. A lack of vitamin D can also weaken bones.¹⁰

The starvation from anorexia also causes the body to release stress hormones such as cortisol. These can accelerate bone absorption and raise the risk of osteoporosis.⁹

Malnutrition in biological female patients with anorexia can lead to low estrogen levels, which may also cause osteoporosis. Estrogen is vital for maintaining bone density in women, and low estrogen levels can increase the risk of osteoporosis.^8,9

Gastrointestinal Complications

Individuals with AN often experience gastrointestinal complications throughout their entire digestive tract.¹² These varied conditions can have a number of causes, but many of them are tied to the limited and/or irregular use of the digestive system during anorexia nervosa.

Gastroparesis is one of the most common gastrointestinal complications in anorexia patients. This condition affects the normal movement of food through the stomach, resulting in nausea, vomiting, and abdominal pain. The disrupted food movement through the digestive system due to gastroparesis can also contribute to constipation.³

Fortunately, individuals with this medical complication can resolve it through refeeding.¹³

Cardiovascular Complications

Perhaps the most notorious—and dangerous—of the medical consequences tied to AN are the cardiovascular complications brought on by the condition.

Anorexia nervosa can affect the cardiovascular system in a number of ways, due to chronic malnutrition and weight loss. In the most extreme cases, these issues can lead to sudden cardiac death, or sudden death related to the stopping of the heart.³

Another common cardiovascular complication in individuals with anorexia nervosa is bradycardia, which causes the heart muscle to shrink and produce a slower-than-normal heart rate. They may also develop abnormal heart rhythms and postural orthostatic tachycardia syndrome, which reduces the amount of blood returning to the heart when someone stands up.¹⁴

Kidney Damage

AN has been linked to dysfunction of the renal system, which operates primarily out of the kidneys and works to filter blood, creating urine as a waste byproduct.¹⁵

Anorexia nervosa can cause electrolyte imbalances, or imbalanced levels of vital minerals and nutrients that help power a number of essential movements in the body and its cells. Serious imbalances can lead to muscle weakness, abnormal heart rhythms, and seizures.^16,17

The frequent use of laxatives and diuretics, as well as self-induced vomiting, can also lead to increased rates of acute kidney injury, chronic kidney disease, and nephrolithiasis, or kidney stones.^16,18

Once the kidneys are no longer functioning properly, it opens the door to a host of other physical health issues, including high blood pressure, anemia, and bone disease.¹⁹

Immune System Dysfunction

Besides impacting the way the body functions, anorexia nervosa can also affect the way it protects itself, as the malnutrition connected to the condition can lead to widespread immune system dysfunction.

In general, the lack of vitamins and minerals within the body weakens the immune system, making someone more susceptible to infections and illnesses. As such, individuals with AN may experience more frequent infections, slow wound healing, and other immune-related health problems. 

Specifically, anemia, or a deficiency of iron in the blood, can cause several immune-related concerns. Low levels of this mineral can lead to fatigue and other complications that may impede the immune system’s response.²⁰

Mental Health Complications

As with other mental health disorders, anorexia nervosa is often accompanied by a number of comorbid, or co-occurring, mental health conditions.

Anxiety disorders of all kinds, depression, substance use disorders, certain personality disorders, and chronic low self-esteem are particularly common in patients with AN. Those with anorexia nervosa also often have suicidal ideation.²¹

In fact, suicide is one of the leading causes of death in anorexia nervosa patients.²²

Even in less extreme cases, the mental health complications tied to anorexia nervosa can have a significantly negative impact on someone’s health and well-being. And depression, anxiety, and substance use can worsen the physical symptoms of anorexia nervosa, as well as complicate recovery efforts.

Blood Disorders

Hematological abnormalities and complications are conditions that impact the quality of the blood. One such condition is anemia, in which there aren’t enough red blood cells to carry oxygen to the body’s tissues. This can lead to fatigue, weakness, shortness of breath, or heart complications.²³

Anemia is a malady afflicting patients with AN, but there are other hematologic complications of anorexia nervosa, including:

• Leukopenia: A condition characterized by a low white blood cell count. It leads to an increase in the risk of infections.²⁴
• Thrombocytopenia: A condition in which the blood has too few platelets, leading to excessive bleeding and bruising.²⁵

Finding Help for Anorexia Nervosa

Anorexia nervosa is a severe psychiatric disorder that can manifest as myriad physical and mental complications. If left untreated, this can lead to long-term consequences or even death, in the worst-case scenario.

Fortunately, many effective treatments can help individuals with AN recover and improve their quality of life. Care for AN typically involves a multidisciplinary approach, including:

• Psychotherapy
• Medical monitoring
• Nutritional counseling. 

Depending on the severity of the illness, treatment may occur in a hospital, an outpatient program, or a residential treatment center. Still, there can be no help at all without action.

The first step in finding help for anorexia nervosa is often talking to a healthcare professional. These experts can provide an accurate diagnosis and refer you to the most suitable treatment options.

A number of eating disorder hotlines can also help people access information and resources. These services are often free and allow people to discuss these issues anonymously and confidentially.

Regardless of where it’s done, seeking help for anorexia nervosa is a courageous step toward recovery. With the proper treatment and support, it is possible to overcome this illness and lead a happy and healthy life.