The major neurological consequence for patients with anorexia is a decrease in brain volume. Brain volume deficits are reversible for adults, but might be irreversible for children and teens.

Neurological consequences

Bradycardia, or slow heart rate, is caused by significant parasympathetic nervous system control over the body., which can lead to heart problems. Those with bradycardia have a heart rate of <60 beats/minute. 

Bradycardia

Hypoglycemia occurs when a person has low blood sugar. Hypoglycemia causes dizziness and fainting due to low heart rate (bradycardia) and low blood pressure. 

Hypoglycemia

Osteopenia, or loss of bone density, is caused by low mineral intake. This results in weaker bones, which can cause injury. Osteopenia, if occuring in children and teens, has the potential to be irreversible, and inhibit growth.

Osteopenia

Follow-up with a cohort of female anorexia nervosa patients who underwent inpatient treatment indicate that the following factors being present in their lifespan predicts greater mortality compared to other severe anorexia nervosa patients: 


- Longer duration of eating disorder
- Lower minimum post-pubertal BMI
- More hospitalizations
- Previous suicide attempt(s)
- Diuretic use
- Self-induced vomiting
- Previous abortion(s)
- Pre-menarche onset of eating disorder
- Rumination

Anorexia Nervosa Predictive Factors of Mortality in Lifetime

Follow-up with a cohort of female anorexia nervosa patients who underwent inpatient treatment indicate that the following factors being present upon admission predicts greater mortality compared to other severe anorexia nervosa patients: 

- Older age
- Higher Eating Disorder index (EDI) score
- Lower desired Body Mass Index (BMI)

Anorexia Nervosa Predictive Factors of Mortality at Admission

In some cases of anorexia nervosa, sudden cardiac death may result, in which there is no atherosclerotic heart disease to explain it. Certain factors may predispose patients to this fatal outcomes:

- Hypokalemia
- Hypoglycemia
- Bradycardia
- Cardiac autonomic dysfunction
- Cardiac structural changes

Anorexia Nervosa Predictive Factors of Sudden Cardiac Death

Hyponatremia occurs when the blood contains too little sodium. Common causes of hyponatremia are a sodium-deficient diet, excessive water intake, or purging. Urine sodium-to-chloride ratios of >1.6 in combination with hypokalemia may indicate vomiting, while ratios <0.7 often indicate laxative use. Mild cases are often treatable through cessation of purging and oral hydration, but in serum sodium levels are <125mmol/L, the patient should be hospitalized and given saline, on a slow drip of 4-6mmol/L or less per 24hr to prevent central pontine myelinolysis. If serum sodium levels are <118mmol/L, intake into the intensive care unit with renal consultation should occur to determine if desmopressin, an antidiuretic, is required to restore sodium levels. 

Hyponatremia in Eating Disorder Patients

Hypokalemia occurs when the blood contains too little potassium. Common causes of hypokalemia are a potassium-deficient diet or purging of ingested food. Urine potassium-to-creatinine ratios of <13 are often indicative that hypokalemia is resultant from eating disorder behaviors. If serum potassium levels are 2.5 mmol/L or more and no symptoms of hypokalemia are present, it can be treated with oral potassium supplements and purging cessation in bulimia nervosa patients. However, if serum potassium levels are <2.5mmol/L, potassium supplementation must be provided both orally and intravenously in a saline solution drip at no greater than 50-75mL/hr to restore intravascular volume while preventing hyperkalemia. Severe hypokalemia can lead to QT prolongation, TdP, other arrhythmias, and rarely, acute renal failure via hypokalemic nephropathy. 

Hypokalemia in Eating Disorder Patients

A patient with a long-term history of severe dietary restriction presents with multiple health issues. Which of the following complications represents the most immediate, life-threatening risk requiring urgent medical intervention?

Anorexia nervosa leads to numerous severe health problems, making it one of the most lethal mental disorders. Significant negative outcomes include bone loss, heart failure, kidney failure, amenorrhea (the cessation of menstruation), and reduced function of the gonads. In extreme cases, these complications can result in death.

Grinnell College

Kalamazoo College

University of California, Berkeley

Google

Eating disorders, particularly conditions like bulimia nervosa and anorexia nervosa, are associated with a wide range of severe and adverse health consequences.

Adverse Health Consequences of Eating Disorders

The medical consequences of anorexia nervosa are primarily caused by severe starvation, as well as purging behaviors.

Medical Consequences of Anorexia Nervosa

Chidiac, C. (2019). An update on the medical consequences of anorexia nervosa. Current Opinion in Pediatrics, 31 (4), 448-453. doi: 10.1097/MOP.0000000000000755.

An update on the medical consequences of anorexia nervosa

Bulimia nervosa. Johns Hopkins Medicine. (2023, January 31). https://www.hopkinsmedicine.org/health/conditions-and-diseases/eating-disorders/bulimia-nervosa 

Cleveland Clinic. (2022). Pica. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/22944-pica 

Mayo Foundation for Medical Education and Research. (2018, May 5). Binge-eating disorder. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/binge-eating-disorder/symptoms-causes/syc-20353627 

Mayo Foundation for Medical Education and Research. (2020a, October 14). Rumination syndrome. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/rumination-syndrome/symptoms-causes/syc-20377330 

Meczekalski, B., Podfigurna-Stopa, A., & Katulski, K. (2013). Long-term consequences of anorexia nervosa. Maturitas, 75(3), 215–220. https://doi.org/10.1016/j.maturitas.2013.04.014

References for Eating Disorders: Consequences

Mehler, P. S., Watters, A., Joiner, T., & Krantz, M. J. (2022). What accounts for the high mortality of anorexia nervosa? International Journal of Eating Disorders, 55(5), 633-636. https://doi.org/10.1002/eat.23664

What Accounts for the High Mortality of Anorexia Nervosa?

Spielman, R. M., Jenkins, W. J., & Lovett, M. D. (2020, April 22). Psychology (2nd ed.). OpenStax. https://openstax.org/books/psychology-2e/pages/1-introduction

OpenStax Psychology (2nd ed.) Textbook

While ARFID is similar to Anorexia-Nervosa in that it involves heavy food restriction, those with ARFID do not intend to lose weight, nor are they anxious about their body size or shape. Therefore, the dramatic weight loss exhibited by the disorder is unintentional. Some other consequences of the disorder are:
* Malnutrition
* Loss of appetite
* Stomach cramping
* Lanugo
* Heart failure as a result of malnutrition
* Loss of menstrual cycle
* Abnormal lab results

Avoidant/Restrictive Food Intake Disorder: Consequences

The consequences of Pica vary greatly as the non-food items ingested by those afflicted with Pica vary in their ingestability and toxicity. Depedning on what is eaten (ex: ice), Pica may even be harmless. However, some common and severe consequences are listed below:

* Damage to teeth by ingested matter
* Blockage of the digestive tract by ingested matter
* Contraction of illness/disease from ingested matter
* Death from toxic ingested matter

Pica: Consequences

Because Rumination Disorder is involuntary, it is difficult to prevent its consequences without receiving medical treatment. Some physical consequences of the disorder are:

* Malnutrition
* Unintended and/or unhealthy weight loss
* Bad breath
* Damage to teeth by regurgitated stomach acid 

Rumination Disorder: Consequences

Because binge eating disorder involves overconsumption of food, the consequences of binge eating disorder differ from other eating disorders, whose consequences occur due to lack of/restriction of food. Some possible consequences of binge eating disorder are:
* Obesity
* Type 2 Diabetes
* Heart disease
* Joint problems
* Gastroesophageal reflux disease (GERD)

Binge Eating Disorder: Consequences

Physical consequences of ARFID vary due to an individual's age. Common symptoms are:

-  Gastroenterological distress
- Inadequate or slowed growth
- Low weight
- Decreased appetite
- Abdominal pain when eating
- Nutrient deficiencies

Avoidant/Restrictive Food Intake Disorder (ARFID): Consequences

Bulimia nervosa is linked to numerous severe health problems. The compensatory behaviors associated with the disorder can lead to serious medical issues, including kidney failure, heart failure, and significant tooth decay.

Health Consequences of Bulimia Nervosa

Health Consequences of Anorexia Nervosa

Analyze the following clinical case. Based on the patient's symptoms, explain the likely underlying behaviors and the physiological mechanisms connecting those behaviors to each of the observed health issues.

Clinical Symptom Analysis

Based on the clinical summary, distinguish which of the patient's medical problems are most likely caused by the behavior of severe starvation versus those caused by the behavior of purging. Justify your reasoning for each.

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