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Mental health and physical medical complications of anorexia nervosa

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Individuals struggling with anorexia nervosa (AN) are in danger of developing a host of complications. These complications go beyond the stereotypical outward physical effects, impacting the psychological, emotional, and social aspects of their lives as well. It is important for the friends and loved ones of an individual with AN to realize that the disease can insidiously damage all aspects of a person, making it a very complicated condition. Successful treatment depends on treating all aspects of the disease, not just the physical.

Last updated on 
April 6, 2023
In this article

Physical complications

Anorexia nervosa involves the severe restriction of food intake, which causes a wide range of physical complications, affecting every body system. The body is systematically affected by malnutrition, which can cause it to slow down certain processes and make changes to conserve energy. 

The following are some of the physical or medical complications of anorexia nervosa as it progresses: (1)

  • Fatigue and fainting: due to low blood pressure and weakness
  • Slow heart rate: in an effort to slow down metabolism
  • Low blood pressure: due to dehydration and slow metabolism
  • Heart failure: causes swelling, shortness of breath, and fluid in the lungs.
  • Osteoporosis: reduction of bone density, leading to fragility and fractures
  • Muscle loss and weakness: the body breaks down available protein in the body to sustain life.
  • Dehydration: causes dull hair and skin, low blood pressure. 
  • Kidney failure: consequence of chronic dehydration and other organs beginning to fail. 
  • Lanugo: a layer of downy hair all over the body, in an effort to keep warm
  • Amenorrhea: the loss of menstruation in people who normally get periods 
  • Pregnancy complications due to lack of available nutrition

It is important to note that anorexia nervosa can affect people of all body sizes, and these complications may occur in individuals struggling with the disorder who are not at low body weights. Not every person with AN experiences all of these complications due to genetic differences in how different bodies respond to malnutrition. However, regardless of how many medical complications an individual is experiencing, AN is a serious illness and it is important to reach out for support. 

These physical complications can become increasingly serious over time, and can lead to death. In fact, anorexia nervosa is one of the deadliest diseases, with the highest mortality rate among eating disorders. (2) Because of this, it is especially important for those suffering from AN to seek professional treatment, involving a team of experienced professionals.

Mental health complications

Anorexia nervosa is considered a mental health disorder, closely related to anxiety disorders. This relationship makes analyzing the mental complications of AN somewhat of a “chicken and the egg” scenario, making it difficult to determine which issue came first. 

Risk factors for developing anorexia nervosa include: (3)

  • Being more worried about, or paying more attention to, weight and shape
  • Having an anxiety disorder as a child
  • Having a negative self-image
  • Having eating problems during infancy or early childhood
  • Having certain social or cultural ideas about health and beauty
  • Trying to be perfect or overly focused on rules

After the development of AN, these feelings listed above often intensify to the point of becoming obsessive-compulsive behaviors, such as food rituals, compulsive weighing and body checking, counting calories, and changing clothes often. Friends and loved ones may also notice personality changes that concern them, such as frequent lying to cover up eating behaviors. Depression is also a quite common issue among those dealing with AN. 

One common characteristic that researchers have found among people with AN is a tendency towards “black or white” thinking. For example, foods are either good or bad, and behaviors are either good or bad. There is no middle ground. As the disease progresses, this thinking tends to intensify, and feelings of adequacy become associated with maintaining these rigid rules. Many treatment modalities involve challenging these perceived rules, which is part of why recovery is such a difficult process. (4)

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Social complications

Individuals suffering from anorexia nervosa often find socializing difficult. AN disproportionately affects teens and young adults at a time in their lives when socializing with friends and dating is particularly important. (5) 

Those with anorexia nervosa typically withdraw from relationships and begin spending more time alone. This in turn may cause harmful thoughts and low-self esteem to worsen. Causes of social avoidance can be anxiety about the pressure to eat in front of others, avoiding questions about weight or appearance changes, and respite from the self-imposed pressure of comparing themselves to others. 

Romantic relationships and dating can be even more difficult, and low self-esteem often stops those with AN from pursuing dating. The fear of someone touching their body, the pressure to eat a meal together, and letting someone get to know them well is often daunting. Those who recover from eating disorders often list this as a major challenge and report a feeling of having “missed out” on social life and being “held back” in relationships due to the time they spent isolated during their illness. (4)

Emotional complications

Emotional changes in a person with AN are often closely related to the effects of malnutrition. As the body becomes malnourished, important neurotransmitters and hormones become imbalanced. That, paired with the mental health consequences of the disease, may lead to emotional instability that affects people around them as well. 

Some of the emotional effects of anorexia nervosa are:

  • Flat mood, or lack of emotion
  • Irritability
  • Mood swings
  • Anger
  • Rigidity in behaviors, and extreme anxiety if those are disrupted
  • Self-harm as reaction to emotional pain

Those with eating disorders are more likely to attempt suicide than their peers, and also more likely to turn to substance use to deal with emotions. (6) Alcohol, marijuana, cocaine, heroin, methamphetamines, and pills may be used to attempt to mask emotional distress and offer temporary escape. These emotional effects of anorexia nervosa can affect those around the individual, like family and friends, and can serve to isolate them even more from others. 

Treatment for AN includes careful attention to all of the ways that the disorder impacts an individual's life and body including physical, mental, social, and emotional components. Recovery is a challenging process, and pursuing it reflects an individual’s commitment to a life without the disorder. Support systems that understand the wide range of anorexia nervosa complications are invaluable and an important source of care and encouragement during the recovery process.

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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.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Anorexia nervosa. National Eating Disorders Association. (2018, February 28). Retrieved May 9, 2022, from https://www.nationaleatingdisorders.org/learn/by-eating-disorder/anorexia
  2. Anorexia nervosa – highest mortality rate of any mental disorder: Why? Eating Disorder Hope. (2022, March 13). Retrieved May 9, 2022, from https://www.eatingdisorderhope.com/information/anorexia/anorexia-death-rate 
  3.  MentalHealth.gov (2022). Anorexia Nervosa. Retrieved 18 March 2022, from https://www.mentalhealth.gov/what-to-look-for/eating-disorders/anorexia
  4.  Causes of Eating Disorders – Personality Traits and Skill Deficits. (2022). Retrieved 18 March 2022, from https://www.mentalhelp.net/eating-disorders/causes-personality-traits-and-skill-deficits/
  5.  Eating disorders (young people) - Social life and public places. (2022). Retrieved 18 March 2022, from https://healthtalk.org/eating-disorders/social-life-and-public-places
  6. Muhlheim, L. (2021, April 29). How to get help when you have an eating disorder and are suicidal. Verywell Mind. Retrieved May 9, 2022, from https://www.verywellmind.com/eating-disorders-suicide-4174291


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