Medical Dangers of Anorexia Nervosa
Anorexia nervosa has a multitude of medical complications ranging from mild to severe. In fact, it is believed that 5-20% of anorexics die, usually from complications associated with self-starvation, such as: heart, kidney, or multiple organ failure, or illnesses like pneumonia, which may be due to an inability to fight infection—all ultimately due to the anorexia. Studies show that the longer one has anorexia, the higher the mortality rate. Someone who has been anorexic for five years has about a 5% chance of mortality, but the rate increases to 18% in individuals who suffer chronically for 30 years (Zerbe p. 250).
Let’s take a closer look at some of the complications that can arise during the course of anorexia:
Starving, bingeing, and purging all lead to electrolyte imbalances. Electrolytes, which are chemicals like sodium, potassium, and chloride, help regulate heart beat. When dehydration occurs, electrolytes such as potassium are lowered, which may result in cardiac arrhythmia, an irregular heart beat—too fast, too slow, or lacking the proper rhythm. While it is true that some arrhythmia are not dangerous and may even subside once the body is restored to health, others are extremely dangerous and can lead to cardiac arrest. Like Russian Roulette, there are no guarantees as to who develops an arrhythmia or other severe consequence.
In addition to affecting the heart’s rhythm, anorexia can affect its size. When people starve and lose weight, they do not lose only fat, they also lose muscle mass. Since the heart itself is a muscle, starvation can lead to decreases in both mass and chamber size.
Also, in order for the heart to beat, lungs to work, and blood to travel through our veins, the body requires energy. Starving causes an energy crisis, in response to which the body literally slows down to conserve what little energy it has left in order to perform the basic functions required to sustain life. In addition to the metabolism slowing down, the heart rate also slows down, a condition called “bradycardia.” Most women’s hearts average approximately 80 beats per minute, but some anorexics have had heart rates as low as 25 beats per minute (Kaplan 1993, p. 73).
One of the most common problems experienced by those struggling with anorexia is delayed gastric emptying, which essentially means that food leaves the stomach slower than it would if the body were healthy. Many anorexics complain that they feel unduly bloated and “stuffed” after consuming only a modest meal, some feel full after only a few bites. While this discomfort is founded in a real physical condition, it does tend to subside once eating is normalized.
Anorexics who vomit are at risk for internal bleeding, ulcers, and gastritis, a painful inflammation of the stomach lining. Vomiting can cause a painful swelling of the esophagus, and places undue stress on the stomach, both of which are at risk of rupturing, a condition which is fatal unless immediate medical attention is available. Vomiting also causes enlarged salivary glands sometimes described as “chipmunk cheeks,” loss of the gag reflex, and has been linked to the development of hiatal hernias.
Constipation is a common condition resulting from inadequate fiber and food intake. Some individuals have such reduced intestinal motility that medical attention is required. Laxative abuse and overly aggressive refeeding both pose a risk for bowel perforations, which may call for surgical intervention. The small intestine also frequently becomes ineffective in absorbing nutrients and minerals.
MORE RISKS AND COMPLICATIONS
• amenorrhea—due to decreased estrogen production, which causes females to cease ovulation and menstruation
• anemia—a blood disorder characterized by either a decrease in the number of red cells, or a reduction in hemoglobin; the body’s ability to carry oxygen from the lungs to its tissues is reduced; often caused by an iron deficiency
• bingeing—an effect of starvation
• decreased testicular function—some studies reveal a decrease in testosterone and certain male hormones
• dental decay and discoloration
• depressed immune system
• dry skin; brittle hair and nails
• edema—water retention, most commonly in the ankles and feet
• endocrine abnormalities
• high cholesterol—an effect of starvation, not necessarily warranting a low cholesterol diet
• increased risk of osteoporosis—bones lose density and fracture easily
• ketosis—the excessive accumulation of ketone bodies in the blood and urine, which is indicative of the body digesting its fat stores as a sole source of energy
• kidney damage/failure—usually due to dehydration; may be worsened by the use of diuretics
• lanugo—the growth of fine hair on the body, which is the body’s attempt to keep itself warm when fat stores are depleted
• liver damage—a condition that is usually irreparable
• loss of hair on the head
• low blood pressure
• low body temperature—causes anorexics to feel cold
• muscle cramps and weakness—usually due to electrolyte imbalances
• pancreatitis—the painful swelling of the pancreas evidenced by severe abdominal pain, distention, and fever
• sensitivity to light and sound
• yellow skin—also called hypercarotinemia
Reprinted with permission from Anorexia: A Guide to Recovery
By Lindsey Hall and Monika Ostroff
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