Eating disorders are serious psychiatric conditions characterized by high rates of comorbidity, relapse, chronicity, and mortality.
The two main eating disorders are anorexia nervosa and bulimia nervosa.
Anorexia nervosa is characterized by a dangerously low body weight and body image distortions with an obsessive fear of weight gain.
Bulimia nervosa, on the other hand is characterised by recurrent episodes of binge eating in combination with inappropriate compensatory behaviours and an overvaluation with weight and shape.
Both disorders have devastating and potentially life-threatening consequences.
In fact, eating disorders are associated with the highest mortality rate of any other psychiatric disorder and are associated with a 57-fold increase in suicidality relative to the general population.
Let’s take a closer look at the effects of both of these eating disorders and why they are so dangerous.
- Heightened sensitivity to cold
- Gastrointestinal symptoms, including constipation and bloatedness
- Dizziness (due to insufficient vitamin and mineral consumption)
- Amenorrhoea, low sexual drive, and infertility
- Poor sleep regime
- Emaciation; stunted growth and failure of breast development
- Dry or discolouration of the skin (partly due to vitamin and mineral deficiencies)
- Growth of unusually long hair down the back, forearms, and side of the face
- Swelling of parotid and submandibular glands (due to repeated purging behaviours)
- Erosion of inner surface of front teeth, primarily among those who vomit frequently
- Cold hands and feet; hypothermia
- Bradycardia; orthostatic hypotension; cardiac arrhythmias
- Dependent oedema (swelling in the lower body)
- Weak proximal muscles (e.g., shoulders, upper arm, pelvic area)
- Liver failure
- Polycystic Ovary Syndrome
Abnormalities on Physical Investigation
- Low concentration of leutenising hormone, follicle stimulating hormone, and oestradiol
- Low T3 and T4 in low-normal range, normal concentrations of thyroid stimulating hormone
- Mild increase in plasma cortisol
- Raised growth hormonal concentration
- Severe hypoglycaemia (i.e., when blood glucose level is too low)
- Low leptin
- ECG abnormalities, particularly in those with an electrolyte imbalance: conduction defects, especially prolongation of the Q-T interval (as a result of dehydration, malnutrition, low blood pressure)
- Delayed gastric emptying
- Decreased colonic motility (constipation, diarrhoea and intermittent abdominal cramping)
- Acute gastric dilatation (which the stomach becomes overstretched and rotated by excessive gas content)
- Moderate normocytic normochromic anaemia (form of blood disease)
- Mild leucopenia with relative lymphocytosis
- Thrombocytopenia (abnormally low platelets in the blood caused by nutrient deficiencies)
Other Metabolic Abnormalities
- Hypercholesterolaemia (high cholesterol caused by extreme dietary restriction in anorexia nervosa – the body tries to compensate by increasing its cholesterols for survival purposes)
- Raised serum carotene (due to excessive consumption of carotene-rich foods0
- Hypophosphataemia (abnormally low levels of phosphate, which can cause a seizure, coma, or softening of the bones.
- Electrolyte imbalance (can cause cardiac arrest and early death)
- Osteopenia and osteoporosis (partly due to loss of menstrual cycle and depletion of key minerals, such as calcium)
- Enlarged cerebral ventricles and external cerebrospinal fluid spaces
- Pancreatitis (caused by repeated stomach trauma like vomiting, or abuse of laxatives or diet pills)
- Increased suicidal thoughts and intent
- Mood and anxiety disorder
- Substance use and abuse
- Feelings of hopelessness
- Loss of interpersonal or romantic relationships
- Impaired sense of self-worth