• To treat eating disorders
• Questions and answers

What are the medical risks and complications of eating disorders?

A person with a severe eating disorder such as anorexia or bulimia develops a number of medical problems that disappear when the eating behaviour has been normalized.  

• Anxiety.
• Depression.
• Obsessive thoughts, such as repeated hand washing, showering, clothes washing, food washing and washing household utensils.
• Repeated dressing and undressing.
• Repeated jumping exercises.
• Long runs.
• Suicidal thoughts – approximately 25% have attempted to commit suicide, usually with the help of an overdose of medication or by cutting themselves.
• Extreme mood swings.

• An anorexic patient has low blood pressure (<90/60 mm Hg) and low pulse (<60 beats/min), a situation that leads to exhaustion and dizziness.  
• Hands and feet feel cold due to decreased blood circulation. 
• Patients with anorexia are usually dehydrated.
• If the patient has potassium deficiency there is a risk of heart arrhythmia. 

• Tooth decay due to contact with stomach acids during vomiting.
• Enlarged salivary glands and decreased salivary flow.
• Sores in the corners of the mouth.  
• Throat Injuries from the use of fingers to induce vomiting.

• Patients with eating disorders frequently have stomach pains.  
• Anorexics develop a small stomach, which is emptied slowly, giving the patient a strong feeling of satiety and a sense of the food ‘’getting stuck in the throat’’.
• The patients often suffer from constipation since only small amounts of food pass through the intestine at any time. The concomitant lack of ingested fluids and potassium also impair the digestive process.
• Bleeding oesophagus and stomach ulcers can develop in anorexics.
• Constipation and the extreme use of laxatives can cause fissures in the rectum.
• Reduced liver function.
• A yellow complexion caused by the inability of the liver to remove a yellow pigment called bilirubin from the blood. 
• The patient generally drinks too little, vomits and becomes dehydrated, which diminishes the amount of urine, thereby increasing the risk of kidney stones.  

• Anaemia is common, but is often hidden because the patient is dehydrated.
• Patients with anorexia may have normal or even high haemoglobin levels, but a more detailed analysis often shows deficiencies of iron, folic acid and vitamin B12.
• Low concentrations of sodium and potassium can be seen in patients who vomit repeatedly.

• General weakening of the muscles, and in certain cases, muscle injuries with subsequent disability is seen during extended periods of starvation.  
• Fatigue, concentration difficulties, and learning difficulties are common due to low blood sugar levels.    
• Cerebral function disorders can develop.
• Patients with bulimia who are treated with anti-depressants may develop epileptic seizures.

• Osteoporosis is regularly seen in patients with severe starvation. It is caused by nutritional and oestrogen deficiency. The skeleton is not just a support system for the body; it is also the reserve for calcium, magnesium, phosphorus, zink, and selenium. The amount of calcium in the skeleton is maximal approximately at the age of 22 years. The lack of these minerals leads to a softer, more brittle skeleton. The risk of bone brittleness and fractures increases the longer the feed deprivation has been present and the longer the gonadal hormone production has been suppressed. Absence of menses is a sign of suppressed gonadal axis.
• Those who develop anorexia prior to puberty risk becoming short in stature. The levels of the most important minerals and vitamins, as well as oestrogen, must be measured carefully and supplements must be given to these patients.

• The skin becomes dry. 
• The growth of hair on the head becomes thinner.
• Soft, downy hair begins to grow on the face, arms, legs and back.

• Hypothermia is a sign of anorexia but patients with bulimia also can suffer from low body temperature when they do not binge.  
• Anorexia patients often compensate for feeling cold by increasing their physical activity.
• The low body temperature is most easily seen in your hands and feet and the resulting feeling of being cold often affects your ability to sleep.
• Bulimia patients often sleep badly and wake up very early.

• Absence of menses is a criterion of the diagnosis of anorexia. It can take several months until the menstruation returns even after the patient has regained normal weight.
• In anorexia and bulimia, the gonadal axis is suppressed at all levels, including the hypothalamus, the pituitary and the ovaries. The ovaries stop producing eggs, sperm and the anabolic (growth and strength promoting) hormones estrogens and androgens.
• During the period when the gonadal axis is suppressed, ovarian cysts may develop. The cysts disappear when the eating behaviour is normalized.

• A starving patient can develop severe vitamin deficiencies. Vitamin A can be stored in the liver for up to a year, but after that time, a deficiency can develop with continuing food restriction. Vitamin C deficiency develops if you eat food lacking vitamin C for three months. Vitamin B12 and folic acid deficiency can also develop with prolonged periods of food restriction.
• Vitamin D deficiency leads not only to skeletal diseases, but also a range of symptoms such as stomach ache, depression, fatigue, and diffuse pain.
• Zink deficiency is also common.
• Vitamin deficiencies can also lead to cramps, seizures paralyses, and memory disorders.