Severe Anorexia Nervosa Complications
The serious medical consequences of prolonged starvation and malnutrition make anorexia nervosa the deadliest psychiatric disorder.
Unlike other psychiatric disorders, anorexia nervosa is often accompanied by a range of medical complications affecting every major bodily system. In general, these complications are a direct result of significant weight loss and sustained malnutrition and they worsen as body weight drops lower. Specifically, starvation causes the body’s fats and proteins to break down, which leads to a loss of cellular function and volume. This, in turn, causes atrophy of the heart, brain, liver, intestines, kidneys and muscles.
A healthy heart requires a balance of minerals such as potassium, calcium, magnesium and phosphate. These electrolytes are normally dissolved in bodily fluids; however, due to the dehydration that is often attendant to anorexia binge-purge subtype (AN-BP), the reduction of fluids and minerals can result in an electrolyte imbalance. Some of these electrolytes are essential to maintaining a normal heart rate and without them, an individual may develop irregular or slowed heart rhythms and be at risk for sudden cardiac death. As weight drops further and the flow of blood is reduced, the heart can become weakened and shrink in size.
Patients with anorexia may suffer neurological damage that can result in seizures and cognitive impairment marked by the inability to concentrate or engage in sustained reasoning. Brain scans can demonstrate that the brain endures structural changes; while most changes normalize with weight restoration, in severe cases, structural changes and cognitive disabilities may be permanent.
Individuals with anorexia often have reduced bone mineral density. Mild loss is termed osteopenia and severe loss of bone mineral density is termed osteoporosis. Patients who develop anorexia during adolescence are particularly at risk for these complications because bone accrual occurs through the early-20’s. As a result, young patients may never reach peak bone mass, bringing an increased lifetime risk of bone fractures and, particularly in male adolescents, stunted growth.
Patients often develop a digestive disorder that affects the stomach muscles and impedes the stomach from emptying properly. This is referred to as gastroparesis. Symptoms generally include bloating, early satiety and pain. Constipation is also a common gastrointestinal complication of anorexia nervosa.
As the body attempts to maintain core temperature and prevent the heat loss that results from drastic weight loss, multiple dermatological changes can occur. Patients may develop dry skin, which can crack and bleed, or they may develop painful and itchy skin lesions on the lower legs, hands, toes, feet, ears and face. In addition, the body may grow fine downy hair on the sides of the face and along the spine called lanugo hair. There may also be bluish or purple coloring of the hands and feet caused by slow blood circulation.
Anorexia nervosa can also adversely affect reproductive health and fertility, endocrine function and respiratory function. Research suggests that nearly all complications of anorexia nervosa can resolve with timely medically-supervised nutritional rehabilitation and weight restoration. However, many providers lack experience in addressing the complex medical complications of anorexia, some of which can be life-threatening. In certain cases, specialized medical stabilization may be necessary for severely compromised patients prior to beginning inpatient treatment.
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