What are the long term effects of anorexia?

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In individuals with anorexia nervosa (AN), some may experience its effects in the long term. Some of those effects include low blood pressure, anemia, poor circulation, gastrointestinal (GI) problems, and more. It is important to understand how anorexia might be contributing to these difficulties.

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Long term effects of anorexia nervosa exist

Let’s take a look at a few of the long term effects of anorexia nervosa: 

1. Heart and blood vessels

With anorexia nervosa, some people may experience an irregular heartbeat, slow heart rate, and low blood pressure. In addition, some may experience poor circulation, anemia, and a constant feeling of being cold. (1)

When the body is starving, it will eventually begin to break down muscle tissue, including cardiac muscle, which makes up the heart. (2) This contributes to high rates of cardiac problems and sudden cardiac death in people with AN. (3)

2. Loss of menstrual cycle and fertility

For those who menstruate, absent or irregular periods often result from anorexia nervosa. (3) This occurs due to hormonal changes and the body’s attempts to conserve energy while experiencing malnutrition. It is important to note that some people with AN will continue having periods while engaging in severe eating disorder behaviors, and this is no longer part of the DSM criteria for an anorexia nervosa diagnosis. (4)

Most people who lose their periods due to AN will begin to menstruate regularly again after they begin eating adequately and make progress in recovery. It is usually possible to get pregnant and give birth after recovering, but challenges with conception and pregnancy complications are more common in people with a history of AN than those without. (2) Some people may also experience an irreversible loss of fertility due to suffering from AN. 

People who do not menstruate can also experience significant hormonal disruptions, including low testosterone and reduced bone density as a result of anorexia nervosa. In people of all genders, loss of bone mineral density due to hormonal changes from malnutrition can lead to osteoporosis, which may be irreversible. (2)

3. Your GI tract

A variety of gastrointestinal complications can result from anorexia nervosa, including constipation, gastroparesis, liver disease, bloating, abdominal pain, and stomach ulcers. (3) In addition, someone with anorexia nervosa may already have GI issues prior to dealing with their eating disorder. Most of these problems develop due to reduced energy availability causing digestion to slow down and the lack of nutrients necessary for cellular functions and repairs. 

Many people in recovery from AN experience digestive issues during the refeeding and recovery process as the body adjusts to processing more food and restoring digestive speed and function. (5) Most people will experience a reduction in digestive issues as they continue to eat consistently and adequately and their bodies readjust. In some cases, digestive problems may persist after recovery. (5)

4. Weakness, lack of energy, and fatigue

It is common for people with Anorexia nervosa to experience weakness, lack of energy, and fatigue. There are multiple factors which can contribute to this, including anemia, vitamin deficiencies, overall inadequate energy intake (resulting in decreased metabolic rate), and breakdown of muscle tissue during starvation. (3)

Working with a multidisciplinary treatment team can help to identify specific nutritional deficiencies and other abnormal lab values which may be contributing to these symptoms. While vitamins and other supplements can be a helpful piece of treatment, increasing strength and energy is dependent on eating enough food to meet the body's needs, restore metabolic functions, and enable cellular damage that occur during the eating disorder to be repaired. (6)

Identify that help is available

Using a multi-disciplinary perspective approach is one of the best things you can do to recover from Anorexia nervosa and reverse as many of the long term effects as possible. If you are able, it is beneficial to work with a team made up of dieticians, psychologists, and physicians who focus on helping those with eating disorders, and who will work with you to navigate the mental and physical health effects of the eating disorder.

Anorexia nervosa can cause a variety of serious long term effects, but healing is possible. Reaching out for support can be an important first step to recovering from this disorder.

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. Giovinazzo, S., Sukkar, S. G., Rosa, G. M., Zappi, A., Bezante, G. P., Balbi, M., & Brunelli, C. (2019). Anorexia nervosa and heart disease: a systematic review. Eating and weight disorders : EWD, 24(2), 199–207. https://doi.org/10.1007/s40519-018-0567-1
  2. Ekern, B. (2021, February 18). Long term & short term consequences of anorexia. Eating Disorder Hope. Retrieved August 16, 2022, from https://www.eatingdisorderhope.com/blog/long-term-short-term-consequences-of-anorexia 
  3. Cost, J., Krantz, M. J., & Mehler, P. S. (2020, June 1). Medical complications of anorexia nervosa. Cleveland Clinic Journal of Medicine. Retrieved August 16, 2022, from https://www.ccjm.org/content/87/6/361 
  4. Table 19, DSM-IV to DSM-5 anorexia nervosa comparison - DSM-5 changes. (n.d.). Retrieved August 16, 2022, from https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t15/ 
  5. Mack, I., Cuntz, U., Grämer, C., Niedermaier, S., Pohl, C., Schwiertz, A., Zimmermann, K., Zipfel, S., Enck, P., & Penders, J. (2016, May 27). Weight gain in anorexia nervosa does not ameliorate the faecal microbiota, branched chain fatty acid profiles and gastrointestinal complaints. Nature News. Retrieved August 16, 2022, from https://www.nature.com/articles/srep26752 
  6. Castro, J., Deulofeu, R., Gila, A., Puig, J., & Toro, J. (2004). Persistence of nutritional deficiencies after short-term weight recovery in adolescents with anorexia nervosa. International Journal of Eating Disorders, 35(2), 169–178. https://doi.org/10.1002/eat.10249

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