Anorexia Nervosa and Its Long-Term Repercussions

Anorexia is a severe medical, physical, emotional, and mental disease. It affects all areas of the body both in the short and long term.

Your treatment team and medical provider can work with you to reverse the physical and psychological damage caused by anorexia.

How Anorexia Affects the Body

Anorexia affects all parts of the body. The longer the illness stays in place, the more likely you’ll deal with the long-term effects of anorexia after recovery.

Mental Health

Anorexia is an illness where the person is obsessed with extreme thinness, has a significant fear of gaining weight or being fat, and even with low body weight, they have a distorted view of their body weight and shape. In addition, co-occurring mental health issues are common, including these:

• Anxiety disorder
• Obsessive-compulsive disorder (OCD)
• Depression

Researchers say that 94% of people hospitalized for eating disorders have a co-occurring mental health issue [1]. Some develop the problem first and change their eating habits to cope. But others develop mental health challenges due to the distress caused by an eating disorder.

Skeletal System

Anorexia changes the density and strength of bones. The body constantly breaks down bone and develops replacement tissue. Anorexia breaks the building process, resulting in thin bones prone to breaking.

Those with the purging subtype of anorexia tend to have an even higher risk of bone loss due to drops in estrogen levels that occur with anorexia. In addition, elevated levels of the stress hormone cortisol can also limit bone growth and affect height.

Researchers say people who have struggled with anorexia for almost six years have a bone fracture risk that is seven times higher than the risk seen in healthy women of the same age [2].

Cardiovascular System

As the body loses muscle mass from significant weight loss and malnourishment, the heart muscle will become smaller and weaker.

It can further weaken with the stress of exercise, as the pulse rate increases and blood pressure lowers. People with anorexia often visit the hospital due to chest pain, but some may not notice the damage until much later [3].

One of the most common effects is bradycardia, where the heart beats at less than 60 beats per minute and an average beat per minute is 60 to 100 [4]. When this happens, it can reduce blood flow and weaken the heart.

This increases the risk of death in those with anorexia. When the heart is not working correctly due to this disease, it can disrupt the normal functioning of minerals such as potassium, calcium, magnesium, and phosphate. When dehydration occurs from starvation, it can create an electrolyte imbalance.

Immune System

Researchers debate how the immune system changes in people with long-term anorexia [5]. Some say that people with eating disorders have more infections, and others say they have fewer.

But researchers know that people with anorexia have increased rates of illness and death from infections. They may be too weak to fight off a simple sickness like a cold, and that could leave them open to more serious illnesses.

Reproductive System

Difficulties or inability to conceive and bear children is another consequence of anorexia. Many individuals would rather seek fertility treatment than eating disorder treatment.

Women who do get pregnant while struggling with anorexia may experience the following [6]:

• Anemia
• Cesarean section
• Preterm birth
• Low birth weight

Long-Term Effects of Anorexia After Recovery

Studies on the duration of anorexia show that the average length of AN is typically eight years, but some struggle for even longer [7.] The path to recovery can wind, as some people move through healing and relapse multiple times.

People who struggle with long-term anorexia may face these issues after treatment.

Low Body Weight

Reduced body weight and composition is also a long-term effect of anorexia. When a person has recovered, they may remain thin even while following a physician-directed meal plan.

Fat deposition tends to be in the truncal area, with weight restoration in the short term. When weight is gained in the central part of the body, it can increase the risk of insulin resistance and diabetes [8].

Continued Skeletal Problems

With weight restoration, restored bone development does not always occur. The longer a person struggles with anorexia and irregular periods, the more likely that bone loss is permanent.

Neurological Issues

Neurological damage can also affect other issues, such as seizures, disordered thinking, tingling, or numbness in the hands and feet. Brain structural changes also occur with anorexia and may discontinue as weight restoration occurs, but some damage is also permanent.

What Does All of This Mean?

When someone is struggling with anorexia nervosa, they must be under the supervision of a physician specializing in eating disorders and their physical and biological effects.

We know that body changes start to occur quickly with anorexia, even before a person looks severely thin or underweight. We also know that the longer a person struggles with the illness, the more lasting many of the damaged areas and functions of the brain will be.

Seeking treatment quickly is essential for recovery and reversal of most of the consequences of this disorder.

An anorexia treatment program typically involves the following:

• Refeeding: People with anorexia often enter treatment in a state of starvation. Existing electrolyte imbalances can worsen if they eat too much too quickly. A balanced refeeding program that replaces missing nutrients can help people gain weight safely and carefully.
• Supplementation: People with anorexia often need calcium, vitamin D, and other critical elements. Doctors may provide these nutrients with shots or pills.
• Counseling: It’s challenging for people with anorexia to sit and eat a full meal. Counselors use each meal and snack as a treatment opportunity. People discuss their feelings as they eat and slowly learn that the foods they ingest can help them feel better, not worse.
• Medication: Some people with anorexia benefit from antidepressants and other therapies to address underlying mental health challenges.

Researchers say close to half of all people with anorexia make a full recovery, and another 33% improve significantly [7]. Treatment makes a huge difference in the lives of people with anorexia. The sooner care begins, the better.

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References

1. Anxiety, Depression, and Obsessive Compulsive Disorder. (2022). National Eating Disorders Association. Accessed September 2022.
2. Legroux I, Cortet B. (2019). Factors influencing bone loss in anorexia nervosa: assessment and therapeutic options. Rheumatic and Musculoskeletal Diseases, 5(2):e001009.
3. Acute Center for Eating Disorders & Severe Malnutrition. (2015). Low Heart Rate (Bradycardia) and Anorexia. Denver Health. Accessed September 2022.
4. The Significance of Bradycardia in Anorexia Nervosa. International Journal of Angiology. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3709923/. June 2013. Accessed September 2022.
5. Yahalom M, Spitz M, Sandler L, Heno N, Roguin N, Turgeman Y. (2013). The significance of bradycardia in anorexia nervosa. International Journal of Angioly, 22(2):83-94.
6. Pan JP, Li TY, Tucker D, Chen KY. (2022). Pregnancy Outcomes in Women with Active Anorexia Nervosa: A Systematic Review. Journal of Eating Disorders, 10(25).
7. Statistics for Journalists. (n.d.). Beat Eating Disorders. Accessed September 2022.
8. 8. Mayer L, Walsh BT, Pierson RN Jr, Heymsfield SB, Gallagher D, Wang J, Parides MK, Leibel RL, Warren MP, Killory E, Glasofer D. (2005). Body fat redistribution after weight gain in women with anorexia nervosa. Am J Clin Nutr, 81(6):1286-91.

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The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published on January 1, 2023 and reviewed by Jacquelyn Ekern, MS, LPC on January 1, 2023.
Published on EatingDisorderHope.com