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Anorexia Nervosa

Medical Complications of Anorexia Nervosa

Cleveland Clinic Journal of Medicine
By Philip S. Mehler, MD, FACP, FAED, CEDS Jeana Cost, MS, LPC, CEDS

Cost J, Krantz M, Mehler PS. Medical Complications of Anorexia Nervosa. Cleveland Clinic Journal of Medicine. 87(6)361-366, 2020.


Anorexia nervosa is a mental illness characterized by self-starvation, marked weight loss, and malnutrition. As the illness worsens, numerous medical complications develop throughout the body. Some of these resolve with effective nutritional rehabilitation and weight gain, whereas others can lead to permanent damage.


  • The structural cardiac hallmark of this disease is myocardial atrophy characterized by a reduction in left ventricular mass index and volume, which commonly results in mitral valve prolapse.
  • Most female patients are amenorrheic and have low estrogen levels because they have reverted to a prepubertal state; male patients have low testosterone levels.
  • Marked loss of bone mineral density occurs, which can lead to early osteopenia and osteoporosis, even in adolescent patients, and this loss may be permanent.
  • Pulmonary complications include spontaneous pneumothorax, pneumomediastinum, and aspiration pneumonia.
  • Patients may also have generalized brain atrophy, damaged gray and white matter, and cognitive deficits that persist after treatment.

Anorexia nervosa (AN) is a common mental illness characterized by self-starvation, excessive weight loss, and malnutrition. Unlike in most other mental health disorders, in which physical health may be completely normal, compromised physical health is inextricably connected with this illness. Multiple concomitant medical complications occur throughout the body and become more pronounced as the severity of the illness increases. This review discusses these complications, many of which resolve with effective nutritional therapy and weight gain. Others can lead to permanent damage.

Written by

Philip S. Mehler, MD, FACP, FAED, CEDS

Dr. Philip S. Mehler began his career at Denver Health more than 35 years ago and was formerly its Chief of Internal Medicine and then Denver Health’s Chief Medical Officer (CMO) until he was promoted…
Written by

Jeana Cost, MS, LPC, CEDS

Jeana Cost is the Vice President of Operations and Clinical Services of the ACUTE Center for Eating Disorders & Severe Malnutrition. In her role, she is tasked with ensuring an excellent patient…

ACUTE Earns Prestigious Center of Excellence Designation from Anthem
In 2018, the ACUTE Center for Eating Disorders & Severe Malnutrition at Denver Health was honored by Anthem Health as a Center of Excellence for Medical Treatment of Severe and Extreme Eating Disorders. ACUTE is the first medical unit ever to achieve this designation in the field of eating disorders. It comes after a rigorous review process.

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