Anorexia nervosa (AN) is a dangerous eating disorder with severe short-term and long-term health consequences if left untreated. While drastic weight loss is a visible symptom, many health consequences of anorexia nervosa may be more difficult to spot. Thinning bones, heart disease, and neurological issues are just some of the health risks of anorexia nervosa that can fly under the radar. This article provides a detailed look at the short-term effects of anorexia nervosa, its potential long-term complications, and available treatments.
Introduction to Anorexia Nervosa
Anorexia nervosa, often called anorexia, is a treatable eating disorder where people maintain a low body weight based on personal weight history. People with anorexia have a strong fear of gaining weight and may think they're overweight, even when they're thin. To prevent weight gain or continue to lose weight, they often limit the amount or type of food they eat. Anorexia can cause changes in the brain due to malnutrition. If left untreated, weight loss can get to a point where people with anorexia are at high risk of serious physical harm or death. Anorexia has the second-highest death rate of any mental illness, surpassed only by opioid overdoses. Anorexia, like other eating disorders, can take over people's lives and be very hard to overcome. Because it's related to changes in the brain, anorexia behaviors are not choices, and the illness is not really about food or looking a certain way.
The Immediate Physiological Response: "Starvation Mode"
The short-term health effects of anorexia nervosa begin almost immediately. Once someone starts regularly restricting their diet, their body will adjust to the change, going into “starvation mode.” This can be considered a biological contingency plan, during which time the body redirects vital materials to continue functioning. Starved for nutrients and energy, the body will begin to look for these essential ingredients in other sources. This could mean breaking down muscle mass, siphoning nutrients out of bones, or redirecting energy or nutrients from other processes to fuel the essential centers of the brain, heart, and lungs. To aid this shift, the brain releases a cascade of hormones, which could negatively affect the body, organs, and internal functions. After a sustained time in this state, the issues caused by this hormonal influx can become chronic.
Key Short-Term Effects
Some of the first short-term effects of these changes include:
- Digestive upset
- Weight loss
- Hair loss (and growth)
- Loss of menstrual periods
- Inability to get warm
- Anemia
- Having dry skin and hair
- Feelings of being nauseous
- Becoming dehydrated
- Feeling fatigued
- Feeling faint or passing out
- Not sleeping well or insomnia
- Feeling dizzy
Detailed Examination of Short-Term Effects
Weight Loss
Severe weight loss is a common sign of AN and the most visible effect of anorexia nervosa. Indeed, a refusal to gain weight is often at the heart of this mental illness. While experts say weight loss of even 5% of body weight could be significant if paired with mental health issues, many people with AN lose much more than that. A body weight that’s 85% or less of what is considered normal for a person, based on their age, height, and other factors, is generally considered to be criteria for AN diagnosis.
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Hair Loss (and Growth)
There are several reasons why people with AN may see changes in their hair over the short term. Hair is primarily composed of protein, a vital building block used for many bodily functions. When the body goes into starvation mode, it will likely stop sending protein to these areas and redirect it to more vital functions. Yet, almost paradoxically, severe anorexia nervosa can also lead to hair growth. Many people struggling with this condition notice fine hair, called lanugo, growing all over their bodies. Continued weight loss leaves someone vulnerable to hypothermia, and, in response, the body may grow more hair in an attempt to stay warm.
Loss of Menstrual Periods
The endocrine system is responsible for creating and distributing the hormones that dictate the countless chemical processes in the body and brain. The system is extremely delicate, relying on a complex interplay of brain signals, fat stores, and stress triggers to operate. Thanks to the body’s adjustments to a severely limited diet, it is often damaged or otherwise thrown off in the early stages of AN. For people with uteruses, one of the most important functions of the endocrine system is regulating the menstrual cycle. When this system is not functioning correctly, it’s very common for someone to lose their menstrual cycle completely. The body may also pick up on other signals, such as a low level of body fat, which tells it that it is not a good time to conceive. In response, it may direct resources away from menstrual cycle maintenance. For those who menstruate, absent or irregular periods often result from anorexia nervosa. This occurs due to hormonal changes and the body’s attempts to conserve energy while experiencing malnutrition.
Inability to Get Warm
Low levels of body fat can lead to other issues and short-term effects of AN. Without an insulating layer of fat, people with AN feel cold much more quickly and easily. Many may visibly shiver and shake throughout the day or find it impossible to feel warm, even when dressed in warm layers. In addition, some may experience a constant feeling of being cold.
Anemia
Diet restriction naturally leads to insufficient critical vitamins, minerals, and nutrients, including iron. Anemia describes the condition of a body low on iron, and this can lead to a number of negative effects, including:
- Fatigue
- Weakness
- Irregular heartbeat
People with anemia may also bruise easily, experience internal bruising, or take longer to heal. This condition is also widespread among people who struggle with anorexia nervosa, with an estimated 17% of AN patients experiencing anemia. A lacking of enough healthy red blood cells to properly operate.
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Digestive Upset
Gastrointestinal (GI) issues are common among people struggling with anorexia nervosa and other eating disorders. Studies have found that up to 58% of people with all types of eating disorders experienced GI symptoms of some type, compared to just 5% of healthy people. Some of the most common GI issues related to anorexia nervosa include:
- Bloating
- Gassiness
- Nausea
- Constipation
- Cramping
- Diarrhea
These issues can be severe and perpetuate a negative feedback cycle, making people feel even less compelled to eat. A variety of gastrointestinal medical complications can result from anorexia nervosa, including constipation, gastroparesis, liver disease, bloating, abdominal pain, and stomach ulcers. Most of these problems develop due to reduced energy availability, causing digestion to slow down and causing a lack of nutrients necessary for cellular functions and repairs.
Other General Side Effects
- Having mood swings
- Depression and anxiety, which can bring even more side effects such as: irritability, insomnia, depressed mood, social withdrawal, lowered interest in activities once loved, to name a few
- Having a low self-esteem and/or self-worth
- Performing poorly in school or work activities
- Relationships that suffer
- Avoiding or missing activities you normally enjoy
Long-Term Side Effects of Anorexia
While many of the short-term effects of AN are unpleasant and uncomfortable, the long-term effects of the condition can be dangerous or potentially even deadly. Generally, the longer someone struggles with this disorder, the more damage they inflict on their bodies and the more difficult it will be to fully heal. Some of the most common long-term effects of AN include:
- Neurological disease
- Heart damage
- Complications with blood pressure
- Early-onset osteoporosis
- Developing anemia
- Having weak or thinning bones, known as osteoporosis
- Getting seizures
- Developing issues with your thyroid
- Lacking enough vitamins and minerals for your body to function properly
- A lowering of potassium levels in your blood
- A lowering of testosterone in males
- Decrease in white blood cells, which can increase your risk of developing a serious infection
- A lack of menstruation in females, also known as Amenorrhea
- Suffering from poor teeth health such as tooth decay
- Lowering of muscle, causing a patient to feel weak
- Losing hair - significant hair loss can occur
- Potential heart failure caused by abnormally low blood pressure and heart rate
- Problems with your kidneys
- Anxiety and Depression worsening
- Taking one’s life (suicide)
- Dying from health complications
Heart Damage
While AN impacts all the muscles in the body, it may be most dangerous for the heart. Without proper nutrition, the heart’s electrical system will get out of whack, causing issues like arrhythmia and leaving someone more vulnerable to heart disease or heart failure. The lack of energy consumed can also make the heart work harder, producing tiny tears that can lead to big problems if continuing for too long. Overall, the heart damage caused by AN can be significant and lead to sudden cardiac death. Lesser symptoms of this damage may include dizziness or a sense of fluttering in the chest. With anorexia nervosa, some people may experience an irregular heartbeat, slow heart rate, and low blood pressure. When the body is starving, it will eventually break down muscle tissue, including cardiac muscle, which makes up the heart. This contributes to high rates of cardiac problems and sudden cardiac death in people with AN.
Blood Pressure Complications
The impact of AN on the heart can cause a cascade effect throughout the body and ultimately impact someone’s blood pressure, as well. Since the heart may be struggling to beat as hard or fast as it needs to, it’s not uncommon for someone with anorexia nervosa to experience low blood pressure or blood pressure drops. Malnutrition can also cause blood pressure issues, as the body loses certain nutrients, vitamins, and minerals that help regulate it.
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Early-Onset Osteoporosis
The body breaks down and rebuilds bones throughout its lifespan. During adolescence, someone’s body makes more bone mass than it loses. But as people age, they naturally begin to lose bone mass. The malnutrition brought on by anorexia nervosa can significantly speed up this process or disrupt it in other ways. The specific consequences vary by age, including:
- Adolescence: People who struggle with this eating disorder in their formative years may never develop the solid bones they were meant to have. If they reach the point of severe anorexia nervosa, their body may begin breaking down the bone material they do have for nutrients, as well.
- Middle age: Older people who struggle with AN may already be at an age where their bones are naturally getting thinner. The stress and other issues brought on by AN can greatly speed up and exacerbate this process. A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures.
Neurological Disease
The nervous system is essentially the electrical wires that run throughout the body. To function properly, it relies on nutrients absorbed through the diet. Starvation may impact these delicate tissues in several ways, which can lead to symptoms like:
- Muscle weakness
- Nerve-related pain
- Headaches
- Seizures
- Fainting
- Movement problems
Some of these symptoms can compound other issues, for example, making it more difficult for someone to drive or serving to worsen certain forms of anxiety.
Loss of Menstrual Cycle and Fertility
For those who menstruate, absent or irregular periods often result from anorexia nervosa. This occurs due to hormonal changes and the body’s attempts to conserve energy while experiencing malnutrition. It is important to note that some people with AN will continue having periods while engaging in severe eating disorder behaviors, and this is no longer part of the DSM criteria for an anorexia nervosa diagnosis. Most people who lose their periods due to AN will begin to menstruate regularly again after they begin eating adequately and making progress in recovery. It is usually possible to get pregnant and give birth after recovering. Still, challenges with conception and pregnancy complications are more common in people with a history of AN than those without. Some people may also experience an irreversible loss of fertility due to suffering from AN. People who do not menstruate can also experience significant hormonal disruptions, including low testosterone and reduced bone density as a result of anorexia nervosa. In people of all genders, loss of bone mineral density due to hormonal changes from malnutrition can lead to osteoporosis, which may be irreversible.
Weakness, Lack of Energy, and Fatigue
It is common for people with anorexia nervosa (and disordered eating habits in general) to experience weakness, lack of energy, and fatigue. Multiple factors can contribute to this, including anemia, vitamin deficiencies, overall inadequate energy intake (resulting in decreased metabolic rate), low body weight, and breakdown of muscle tissue during starvation.
Treating the Short-Term and Long-Term Effects of Anorexia
Thankfully, most of the short- and long-term health risks of anorexia nervosa are reversible. Through proper care and diet restoration, the body will receive the nutrients it needs to heal itself. Still, it’s extremely important for someone with AN to make this transition back to a regular diet with proper medical guidance, especially in severe cases.
Anorexia Recovery and Refeeding Syndrome
When the body has been in a state of starvation for an extended period of time, it will have fully adjusted to the hormonal shifts and other changes involved to survive. Introducing too much nutrition in this state too quickly can throw the new balance off. And as unhealthy as it is to live in a chronic state of starvation, changing things too quickly can cause severe consequences. The issues related to this change are referred to as refeeding syndrome. Left unchecked, it can lead to dangerous shifts in bodily fluids and electrolytes that can lead to respiratory issues, seizures, or even death. Still, these scary consequences can be avoided through careful planning and care. A team of medical professionals can help ensure a patient in early recovery from anorexia is receiving the right amount of nutrients and that their fluid and electrolyte levels are balanced.
Treatment Approaches
Treatment for anorexia nervosa is specific to the person being treated. The goals of treatment include:
- Restoring good nutrition
- Stabilizing weight loss
- Eliminating disordered eating behaviors
- Treating underlying psychological concerns
The biggest challenge in treating someone with anorexia is helping them recognize and accept that they have a serious illness. Many people with anorexia deny that they have an eating disorder and only seek help when it becomes life-threatening. This is why early recognition and treatment are so important.
A healthcare provider will design a custom treatment plan, which may include:
- Hospitalization may be necessary to treat severe malnutrition or other serious health complications. You may also stay in the hospital for severe mental health issues. Medications sometimes play a role in treating these complications. But the long-term treatment for anorexia nervosa is psychotherapy.
Therapy
Psychotherapy, or talk therapy, helps change thinking and behavior patterns associated with eating disorders. It can help you develop healthier attitudes toward food, weight and body image. It can also help you learn better coping mechanisms and techniques for dealing with stress and negative thoughts. Some people with anorexia have coexisting mental health conditions that contribute to their eating disorder. It’s important to treat these conditions alongside anorexia. But even if you don’t have another disorder, anorexia itself is a mental health issue. Treatment must address the root cause in your mind.
There are many types of psychotherapy, including:
- Acceptance and commitment therapy. This method focuses on developing the motivation to change your behaviors, regardless of your thoughts and feelings.
- Cognitive behavioral therapy (CBT). This method focuses on addressing distorted views and attitudes about weight, shape and appearance, and making behavioral changes.
- Cognitive remediation therapy. This method involves exercises and activities to help improve your cognitive and executive function and your ability to take charge of your life.
- Dialectical behavior therapy (DBT). Specific skills you’ll learn in DBT include building mindfulness, improving relationships, managing emotions and tolerating stress.
- Family therapy. Family support is very important to anorexia treatment success. Family-based therapy for anorexia (the Maudsley Method) puts your family in charge of your nutrition.
- Interpersonal psychotherapy (IPT). IPT involves improving your relationships and communication, which may reduce your eating disorder symptoms.
- Psychodynamic psychotherapy. This therapy involves looking at the root causes of anorexia as the key to your recovery.
Multidisciplinary Approach
Using a multi-disciplinary perspective approach is one of the best things you can do to recover from anorexia nervosa and reverse as many of the long-term effects as possible. If you are able, it is beneficial to work with a team made up of dietitians, psychologists, and physicians who focus on helping those with anorexia and other eating disorders and who will work with you to navigate the mental and physical health effects of the eating disorder. Working with a multidisciplinary anorexia treatment team can help to identify specific nutritional deficiencies and other abnormal lab values that may be contributing to symptoms of a serious eating disorder. While vitamins and other supplements can be a helpful piece of treatment, increasing strength and energy is dependent on your food intake. You need to eat enough food to meet the body's needs, restore metabolic functions, and enable cellular damage that occurs during the eating disorder to be repaired. This is all part of weight restoration and learning to be ok with gaining weight. In cases of severe anorexia nervosa, inpatient treatment options should be considered. Your treatment team can advise you of the best course of action.
The Role of Family
A person’s family can play a crucial role in treatment. They can encourage a family member with eating or body image issues to seek help and can provide support during treatment.
Prevention
There's no guaranteed way to prevent anorexia nervosa. Primary healthcare professionals, including pediatricians, family medicine professionals and internal medicine professionals, may be in a good position to see early signs that could lead to anorexia. For instance, they can ask questions about eating habits and satisfaction with appearance during routine medical appointments. If you notice that people have dieting habits that seem too rigid, or they're unhappy with their appearance, think about talking to them about these issues.