The connection between anorexia and edema

Last updated on 
October 11, 2022
In this article

How are anorexia and edema linked?

Edema anorexia is common in patients with both subtypes of anorexia, with slightly higher rates in the restricting subtype (41.7%) than the binge-purge subtype (28%). (1) Edema is swelling, and it can be distressing for those with anorexia, who already have heightened body image issues.

Edema occurs as both a side effect of anorexia and in response to treatment. So it’s not unusual for people with anorexia to abandon treatment because they find the weight gain from edema so upsetting. 

What is edema?

Edema is swelling of any body part due to excess fluid accumulation. (2) The condition occurs when tiny blood vessels (capillaries) leak fluid, which builds up in the surrounding tissues.

Although edema can affect any part of the body, it’s more noticeable in feet, ankles, legs, arms, and hands. Symptoms of edema include: (3)

  • Puffiness or swelling directly under the skin, especially in the legs or arms
  • Skin that retains pits (or dimples) for several seconds
  • Stretched or shiny skin
  • Swollen abdomen
  • Extremities that feel heavy

Anorexia and edema

There are numerous causes for edema, including several diseases, conditions, and medications. It is also associated with the severe nutritional deficiency seen in people with anorexia. 

This is because malnutrition causes low levels of proteins in blood. (2) Proteins in blood draw water into blood vessels, so when protein levels are low, water may leak from blood vessels and collect in tissues.

Furthermore, purging behaviors, including self-induced vomiting and overuse of laxatives and diuretics, can contribute to the development of edema. Purging results in water loss, which prompts our bodies to release antidiuretic hormones that signal the body to hold on to as much water and minerals as possible. This leads to water retention and edema, usually in the extremities, and is called peripheral edema.

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Edema in anorexia recovery

Edema also occurs when purging behaviors stop. Many individuals with anorexia who stop self-induced vomiting and abruptly withdraw laxatives and/or diuretics will experience edema. 

Sudden cessation of purging results in a condition known as pseudo Bartter syndrome. This condition results when there is an increase in the production of aldosterone, an adrenal gland hormone that retains salt and water to prevent fainting from low blood pressure. (1) 

More salt and water is reabsorbed, without the usual expulsion of fluid via purging, which leads to rapid and severe edema formation. If there is no treatment or intervention, edema usually peaks between 4-10 days after purging stops and can last 2-4 weeks. (1,5)

Resolving edema

The best way to resolve issues with edema is to seek professional anorexia treatment. Yes, more severe edema can occur during anorexia treatment, when there is a long history of self-induced vomiting, and diuretic and laxative use.  

In these cases, a person can gain excessive water weight in a few days. (1) This is likely to be very distressing for those just starting their recovery from anorexia. But an experienced, compassionate treatment team will provide psychological support and reassurance that the edema is temporary and will be resolved as the body heals.

The treatment team will also do all they can to minimize edema formation, to avoid emotional distress. In inpatient treatment, the excess aldosterone production that causes edema can be resolved with the slow intravenous administration of saline. 

Since this can lead to further edema, spironolatione, a potassium-sparing diuretic that stops potassium levels from getting too low and prevents the body from absorbing too much salt, is typically administered. (5) This helps minimize edema caused by excessive aldosterone levels.

Significant weight gain from edema can prevent people with anorexia from completing treatment. However, the right treatment approach helps individuals  understand why the edema occurs and resolves it quickly. 

In anorexia patients who never or rarely engaged in purging behaviors, cases of edema are usually mild. These milder cases of edema may be resolved with intermittent leg elevation. (1)

Final words

For someone who struggles with or is recovering from anorexia and related body image issues, edema and the treatment required for this swelling can be distressing to experience. But it is a temporary symptom and short step in the journey to restoring well-being. Speak to our team today about compassionate care for eating disorders, attuned to your specific needs.

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Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Resources

  1. Eating Disorders Review. (2020, April 20). Causes and management of edema in patients with eating disorders. Eating Disorders Review. Retrieved March 11, 2022, from https://eatingdisordersreview.com/causes-and-management-of-edema-in-patients-with-eating-disorders/ 
  2. Mayo Foundation for Medical Education and Research. (2020, December 1). Edema. Mayo Clinic. Retrieved March 11, 2022, from https://www.mayoclinic.org/diseases-conditions/edema/symptoms-causes/ 
  3. Edema. Harvard Health. (2022, February 28). Retrieved March 11, 2022, from https://www.health.harvard.edu/a_to_z/edema-a-to-z 
  4. REMOVE
  5. Kant, S. (2019, February 9). What a nephrologist should know about eating disorders. Renal Fellow Network. Retrieved March 11, 2022, from https://www.renalfellow.org/2019/02/01/what-a-nephrologist-should-know-about-eating-disorders/ 
  6. Spironolactone: Uses, dosage, side effects. Drugs.com. (n.d.). Retrieved March 11, 2022, from https://www.drugs.com/spironolactone.html

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