Complications of Eating Disorders
Anorexia, Bulimia, and Binge Eating Cause Multiple Medical Problems
Dec 24, 2008
Eating disorders—anorexia nervosa, bulimia nervosa, and binge-eating disorder—are three times more likely to occur in women than in men, with lifetime prevalence rates from 0.6 to 2.8%. The median age of onset is between 18 and 21 years. (Hudson JI, et al. The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry. 2007;61(3):348-358)
Diagnosis of eating disorders is often delayed, since many patients don’t consult a physician for these conditions per se, and most don’t have obvious physical signs on routine examination. Instead, patients may complain of fatigue, constipation, insomnia, dizziness, palpitations, or any number of problems that may or may not be associated with the eating disorder.
It isn’t unusual for people suffering from eating disorders—particularly anorexia or bulimia nervosa—to exhibit serious complications at their first medical encounter. Stabilization of life-threatening medical complications takes precedence over treatment of the underlying psychological issues.
For individuals suffering from binge-eating disorder, issues associated with obesity may cause long-term medical problems, such as knee and hip arthritis, sleep apnea, coronary artery disease, or diabetes.
Most complications of eating disorders will resolve when healthy eating habits are resumed and the patient attains normal body weight. Others, like dental erosions or osteoporosis, remain problematic even when the eating disorder is successfully addressed.
Medical Complications of Eating Disorders
- Cardiovascular: Arrhythmias (abnormal heart rhythms); bradycardia (abnormally slow heart rate); low blood pressure; mitral valve prolapse; peripheral edema; heart damage due to ipecac; hypertension or palpitations due to diet pills; sudden death
- Endocrine: Amenorrhea (absent menstrual periods); increased cortisol levels (and other adrenal hormones); low blood glucose; infertility; neurogenic neurogenic diabetes insipidus; osteopenia/osteoporosis; impaired temperature regulation (often due to thyroid abnormalities)
- Gastrointestinal: Abnormal liver function tests; constipation; pancreatitis; acute gastric dilation; “cathartic colon” (overuse of laxatives and cathartics); erosion of teeth; esophagitis; esophageal tear (Mallory-Weiss syndrome) or esophageal rupture; gastroesophageal reflux; parotid gland swelling (salivary glands at angle of jaw hypertrophy in response to recurrent vomiting)
- Hematologic: Anemia; thrombocytopenia (decreased platelet count; may contribute to bruising or bleeding); decreased white blood cell count
- Metabolic: Dehydration; electrolyte imbalance; “refeeding syndrome” (abnormalities in multiple organ systems as a result of resuming nutrition in individuals who are severely malnourished); in binge-eating disorder, obesity
- Neurologic: Cognitive impairment; damage to peripheral nerves (numbness, tingling, inappropriate pain sensations); atrophy of brain cortex
- Pulmonary: Aspiration pneumonia (due to inhaling vomit); pneumothorax or rib fractures from severe vomiting; decreased lung capacity
- Renal: Kidney stones; increased blood urea nitrogen (indicates impaired kidney function)
- Skin: Carotenosis (yellowing of the skin due to excessive intake of vitamins or carrots in lieu of normal nutrition); Russell’s sign (calluses or sores on the backs of the hands or fingers from purging); dry skin; brittle nails; lanugo (overgrowth of fine body hairs, presumably an adaptation to poor thermoregulation); severe itching (“starvation pruritus”)
(Adapted from Williams PM, et al. Treating eating disorders in primary care. Am Fam Phys 2008;77(2):187-195)
Treatment of eating disorders is a multidisciplinary task. Medical management (stabilization of medical emergencies followed by long-term care of complications), behavioral intervention (cognitive behavior therapy, family counseling, and individual psychotherapy), medication, and education are partnered in an effort to provide people with eating disorders their best chance of recovery and a healthy life expectancy.
