The Health Risks of Eating Disorders
What are the Health Complications of Disordered Eating?
Eating disorders are associated with poor physical and mental health. They can lead to serious life-threatening complications.
Information about the health consequences of eating disorders has come from a variety of sources including studies of the effects of famines and food insecurity, as well as research studies in which research participants have adhered to a restricted diet for a period of time (e.g., The Minnesota Starvation Experiment).
The health consequences of anorexia nervosa, purging disorder, avoidant and restrictive food intake disorder (ARFID), bulimia nervosa and binge eating disorder have also been described in the research literature and in the personal accounts of people with lived and living eating disorder experience. Consistent findings have been observed and documented.
The Effects of Undereating
Cognitive + Mood Changes: Thinking is affected by undereating. This is hardly surprising since the brain requires a lot of energy (i.e., calories) to function properly.
Thinking becomes inflexible when undereating occurs with the result that it becomes difficult to switch rapidly from topic to topic. It also becomes difficult to make decisions.
Concentration is almost always impaired although people may not be aware of this since they force themselves to focus on what they are doing. In part the concentration impairment is due to the presence of recurrent thoughts about food and eating (secondary to under-eating) since these interfere with the ability to focus on other things. Some people find that they even dream about food and eating.
The almost constant thinking about food and eating affects behavior too. It leads some people to become particularly interested in cooking and thus they keep reading recipes and watching TV food + cooking programs, and they may also do a lot of cooking and baking. At the same time they tend to become less interested in other things. They often give up old interests and hobbies.
A side effect of undereating is a generally somewhat low mood and people are prone to get irritated rather easily.
Behavior Changes: One of the most prominent changes is heightened "obsessiveness". This term refers to the tendency to be inflexible and rigid in one's routines.
Some people may also become very particular about cleanliness and tidiness. Often this is accompanied by difficulty being spontaneous. The obsessiveness is often particularly striking when it comes to eating.
People may eat in a very particular way. Eating may become like a mini “ceremony” which has to be conducted alone.
Some people eat very slowly, chewing each mouthful a certain number of times; others eat in a ritualized way always eating from a certain plate, or cutting food into small pieces.
Hoarding objects is yet another feature although not everyone shows it. The hoarding may be of food or other things. Often people cannot explain why they are doing this.
Undereating has a profound effect on social functioning. There is a tendency to become inward-looking and self-focused. This is exaggerated by the heightened need for routine and predictability, and difficulty being spontaneous. As a result people withdraw socially and get used to this way of living. Also there is a loss of sexual desire due to hormonal changes and this too can contribute to the social withdrawal.
Heart Issues: When a person rapidly loses weight, the size and strength of their heart decreases.
As a result, their heart is not able to pump blood around their body as efficiently as it should which can result in feeling dizzy, light-headed, chest palpitations, or heart attack.
Blood pressure drops and the heart rate (pulse) declines.
There is heightened risk of heart beat irregularities (arrhythmias).
Hormonal Changes: Hormones that regulate metabolism, fertility, pregnancy, and bone health are particularly affected by eating disorders.
Low levels of the hormones oestrogen, progesterone, thyroid, hormones and testosterone and high levels of cortisol can result in a reduction of fertility or infertility in individuals with an eating disorder and a variety of other symptoms.
Symptoms include low libido (sexual desire), absence of menstrual periods (amenorrhoea), irregular menstrual periods, loss of early morning erections, loss of nocturnal emissions (“wet dreams”), constipation, dry skin, sleep problems, depression, anxiety, or panic (e.g., increased heart rate), changes to appetite, puberty, and growth.
Sleep is impaired when undereating occurs. Sleeps tends to be less refreshing and there is a tendency to wake early.
Many hormonal changes occur when a body has insufficient reserves of fat and muscles. These include changes to sex hormones (testosterone and oestrogen) as well as high levels of cortisol, low levels of IGF-1 and Leptin. Changes in these hormones can slow bone development and even cause bone loss and bone mineral deficiencies which lead to osteoporosis. If osteoporosis develops, bones become fragile and are likely to break from the slightest injury or fall. Bone fractures, chronic pain, disability, and loss of stature may also occur.
Eating disorders can impact reproductive hormones. People who become pregnant while they are experienced disordered eating are at higher risk of complications during pregnancy. Effects may include high blood pressure, gestational diabetes (especially in binge eating disorder), anaemia, and increased risk of miscarriage or complicated delivery. There can also be complications for the fetus, such as premature birth, low or high birth weight, feeding difficulties, and respiratory distress.
Hair, Skin, + Body Temperature Effects
A downy hair (called lanugo) may start to grow on the body especially on the on the face, abdomen, back and arms.
There may also be hair loss from the scalp.
Often the skin becomes dry and it can develop an orange tinge.
Temperature regulation is is altered with there being a decrease in body temperature. People feel profoundly cold.
Health Risks of Anorexia by the Eating Recovery Center
The Consequences of Binge Eating
Hormonal Changes: Binge eating can cause an increase in hormone levels that increases the retention of body fat.
Pregnancy Complications: Effects may include high blood pressure, gestational diabetes, anaemia, and increased risk of miscarriage or complicated delivery. There can also be complications for the fetus, such as premature birth, low or high birth weight, feeding difficulties, and respiratory distress.
Gastrointestinal Problems: Symptoms include fullness after eating very small amounts, bloating, constipation, diarrhea, flatulence and abdominal pain. Food in the stomach takes much longer than normal to move into the small intestine which is why people have a heightened sensation of fullness even after eating relatively little. Taste may be impaired and so there may be increased use of condiments and spices to give food flavor. There may be persistent hunger.
Health Risks of Binge Eating Disorder by the Eating Recovery Center
Complications with Exercise
Heart Issues: Excessive exercise can lead to cardiovascular damage and vital organ dysfunction.
Bone Issues: Excessive exercise will deplete calcium resources which can lead to the bone loss, bone mineral deficiencies, bone fractures, and the osteoporosis noted above.
Hormonal Changes: Disordered eating and excessive exercise can disrupt hormone production and cause metabolic and reproductive issues.
Poor Healing: Excessive exercise especially when injured can result in injury relapse and delayed recovery.
Muscle Effects: Muscles waste and weakness can result. This is most obvious when walking up stairs or trying to stand up from a sitting or squatting position.
Compulsive and excessive exercise is bad for you
The Harms of Purging
Electrolyte Imbalance: Frequent vomiting can cause fluid loss which leads to fluctuations in the body’s electrolytes, and as a result cause an irregular heart beat and possible heart attack. Imbalances in the body’s electrolytes, such as potassium and sodium, can result in fainting, fever, digestive problems, confusion, blood pressure changes, heart palpitations, seizures, cardiac arrest and even death.
Hand Consequences: Fingers and knuckles can become calloused and burned by gastric acid.
Dental Issues: Vomiting causes gastric acid to enter the mouth and erode tooth enamel, which leaves teeth vulnerable to erosion, brittleness, and thermal sensitivity. Enamel erosion is not reversible. Expensive dental work can be needed to repair or replace the damaged tooth.
Mouth and Esophagus Issues: Parotid (salivary) glands can swell up and cause the cheeks to look enlarged and puffy. Ruptures and bleeding can occur in the oesophagus as objects used for purging, acid, and food pieces are forcefully used and ejected. If there is blood in your vomit this may indicate serious damage and you should contact a medical practitioner immediately.
Gastrointestinal Problems: Symptoms include fullness after eating very small amounts, bloating, constipation, diarrhea, flatulence and abdominal pain. Also, the ability to identify hunger and fullness is impaired.
Social Effects: People sometimes try to hide their vomiting, which can involve actions such as lying or vomiting in odd places. This can impact social relationships as well as functioning at work and other responsibilities.
Mood Impact: People may feel guilt, shame, anxiety or depression which can add to feeling worthless and out of control and these feelings can trigger a binge. This can lead to additional vomiting, beginning the vicious cycle over again.
Medical complications of bulimia shared by the Eating Recovery Center
Effects of Laxative Misuse
Fluid Loss: Any weight loss and change in body shape observed from laxative misuse is actually due to fluid loss from diarrhea and the complete emptying of the large intestine. Laxatives have minimal effect on calorie absorption because they work on the lower part of the bowel, whereas food is digested and absorbed higher up the gastro-intestinal (GI) tract in the small intestine.
Electrolyte Imbalance: The use of laxatives or diuretics can cause fluid loss which leads to fluctuations in the body’s electrolytes, and as a result cause an irregular heart beat and possible heart attack. Laxative misuse leads to large losses of body salts and water, which are vital in regulating electrical/nerve impulses in muscle, especially the heart. Electrolyte imbalance can cause muscle weakness, numbness, paralysis, seizures, irregular heartbeat, and even cardiac arrest.
Gastrointestinal Problems: Laxatives can worsen symptoms such as delayed gastric emptying, constipation and bloating, because after use the intestines have emptied and it may not be possible for a normal bowel movement to occur for several days. Laxatives can also increase swelling, pain and gas formation in the stomach, which contributes to feeling bloated. In extreme cases, it is possible to become so dependent on laxatives that your bowel will not function properly without them. Laxatives disrupt normal bowel function and can cause symptoms such as: loss of intestinal muscle tone, bloating, gas, colicky pain, appearance of mucus and blood in the stool, incontinence of feces, and in severe cases, paralysis of the bowel.
Kidney Issues: Additional risks of laxative misuse include kidney failure/ problems with kidney function through dehydration, rectal bleeding and urinary tract infections.
Laxative misuse is dangerous to your health
You deserve support
Many of these health complications are reversible when you start working on your eating disorder recovery. If you are looking for therapy for eating disorders in San Francisco, you can contact me here for a free 15 minute intro call to determine if we would be a good fit. I’m licensed in California, Oregon, and Arizona so can meet with clients virtually who reside in those states.
Resources + References
Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
Government of Western Australia. (2020). Break Free from ED Workbook.