There are numerous complications that can occur in patients with anorexia nervosa, which can sometimes be fatal. Most of the complications are associated with severe malnourishment, which can cause damage to every organ and system in the body.

In some cases, the damage may be permanent, even when the condition is being managed appropriately and is under control. Given the potential severity of complications associated with anorexia nervosa, it is important that anyone with signs or symptoms of the condition receives medical attention to help them on their path to recovery.

Psychological Complications

Anorexia nervosa is often associated with psychological disorders such as:

• Depression and anxiety
• Personality disorders
• Obsessive-compulsive disorder
• Alcohol and substance misuse

Further stemming from this, these disorders carry an increased risk of self-harm and suicidal behavior.

Hormonal Complications

There are a number of hormonal changes that can occur in individuals with anorexia nervosa, sometimes with severe and permanent effects. The changes may include:

• Reduced estrogen in women
• Reduced testosterone in men
• Reduced dehydroepiandrosterone (DHEA)
• Reduced thyroid hormones
• Reduced growth hormones
• Increased stress hormones

Estrogen, in particular, is important for the health of the heart and bones and a reduction in the level of the hormone can lead to related complications.

Resulting from these hormonal changes, affected individuals may experience a reduced sex drive and, in women, temporary loss of menstruation (amenorrhea) or permanent infertility.

Cardiovascular Complications

Complications of the cardiovascular system are the most common cause of death associated with anorexia nervosa. Arrhythmias and imbalances of electrolytes in the blood can both be fatal in severe cases, as they can affect the function of the heart and affect the normal rhythm of the heartbeat.

Other complications involving the heart include:

• Hypotension
• Anemia
• Bradycardia
• Arrhythmia
• Reduce heart muscle
• Imbalance of electrolytes (e.g. potassium, calcium, magnesium or phosphate)

Musculoskeletal Complications

Nearly 9 in 10 women with anorexia nervosa experience a loss of calcium in the bones, known as osteopenia. Likewise, 40% of patients go on to develop osteoporosis, which is a severe loss of bone density that is linked to a higher risk of bone fractures later in life.

This is closely linked to the changes in estrogen, as this hormone usually helps to strengthen the bone. However, other factors may also play a role, such as reduced DHEA, high stress hormone levels and lower dietary intake of calcium. The changes in DHEA and growth hormones can also affect the stature of children and adolescents with the condition.

Other Complications

Damage to any organ of the body can occur due to malnourishment and inability to sustain the function. This often includes damage to the kidney or liver, which can be permanent.

In some cases, anorexia nervosa can affect the central nervous system, which can lead to neurological disorders, such as seizures. Some individuals may also suffer from problems of concentration and memory.

Complications For Pregnant Women

For pregnant women who suffer or are recovering from anorexia nervosa, there are a number of additional risks. These include higher likelihood of:

• Miscarriage
• Premature birth
• Low birth weight
• Caesarean section

Additionally, the new mother will be more likely to suffer from postpartum depression.

Potentially Fatal Complications

Death associated with anorexia nervosa may occur suddenly, even when it is not immediately evident that the patient is severely underweight. Potentially fatal complications include:

• Arrhythmias (abnormal rhythm of the heart)
• Electrolyte imbalance of sodium, potassium or calcium ions
• Suicide

Given the severity of the complications associated with anorexia nervosa, it is essential that the condition is diagnosed and well managed as soon as possible to prevent adverse outcomes.

References

• http://www.mayoclinic.org/diseases-conditions/anorexia/symptoms-causes/dxc-20179513
• http://www.nhs.uk/Conditions/Anorexia-nervosa/Pages/Complications.aspx
• https://www.mccallumplace.com/health-risks-of-anorexia.html
• http://www.eatingdisorder.org/eating-disorder-information/anorexia-nervosa/

Further Reading

• All Anorexia Nervosa Content
• What is Anorexia Nervosa?
• Anorexia Nervosa Causes
• Anorexia Nervosa Treatment
• Anorexia Nervosa Diagnosis

Written by

Yolanda Smith

Yolanda graduated with a Bachelor of Pharmacy at the University of South Australia and has experience working in both Australia and Italy. She is passionate about how medicine, diet and lifestyle affect our health and enjoys helping people understand this. In her spare time she loves to explore the world and learn about new cultures and languages.