People can learn about these tools, and how to use them effectively while working toward anorexia recovery. With malnutrition and a reduction of social support, eating disorders greatly increase the risk of the development of depression and anxiety. In many cases, these conditions can also trigger the start of disordered eating behaviors as a way to cope. Therefore, it can be difficult to know which condition came first, but there is no doubt these co-occurring medical problems compound each other.
Clients need treatment for both eating disorders and all co-occurring mental health problems to become fully recovered. Treating all conditions ensures clients can build a solid foundation on which to become and remain recovered. As people with eating disorders restrict their food intake, the brain fails to receive an adequate amount of nutrients. This often causes difficulties in concentrating that can make it hard to perform well at work or school.
As their performance tanks, stress levels may rise, resulting in an increased reliance on maladaptive coping mechanisms, including disordered eating behaviors. Care at eating disorder treatment centers can help people get back on the right track and avoid damaging their career or education.
Engaging in disordered eating behaviors often leaves people feeling guilty and ashamed. They may withdraw from their social circle as a result of these feelings. Their isolation also gives them a way to conceal their habits and avoid confrontation as well. As isolation worsens, they do not have any outside perceptions or insights to consider.
Anorexia treatment centers help clients rebuild their social networks to overcome this difficulty. With disordered thoughts often comes an urge to engage in dysfunctional behaviors that initially may feel soothing. Within a short time, however, these behaviors cause increased difficulties and stressors that make life even harder.
Only by replacing these disordered behaviors with healthy coping skills can people effectively work on becoming recovered. As eating disorders take a toll on the mind, symptoms tend to increase. Physical health complications also increase in tandem, resulting in a sharp decline in well being until these individuals seek anorexia nervosa treatment. Eating disorders can have a negative effect on physical health long before weight rises or falls out of a healthy range. Here are some of the effects of eating disorders on the body.
Signs of dehydration tend to appear very quickly after people begin engaging in disordered eating habits. The most common signs include:. Without resolving the dehydration, it is possible to experience severe electrolyte imbalances that can affect the health of the heart.
Kidney damage and failure can also occur if the dehydration continues for an extended period of time. Within a short period of time, low food and water intake levels can cause problems by throwing off the balance of electrolytes. The main electrolytes used by the body include sodium, potassium and magnesium. These substances are all necessary to keep the heart and other internal organs in good health. Even the muscles cannot work properly when electrolytes are not present in the right concentrations.
Without an adequate intake of nutrients, vitamin and mineral deficiencies quickly develop. People need to quickly start anorexia nervosa treatment to avoid the physical consequences associated with continued nutrient deficiencies. A lack of vitamin D, for example, arises fairly quickly after beginning to engage in disordered eating habits.
Continuing on without this nutrient can result in loss of bone mass and a higher risk of fractures as a result of osteoporosis. With all the stress and medical complications that come with eating disorders, it is no surprise headaches often arise. These headaches leave people searching for helpful coping skills they can use to ride out the pain.
If the individual does not know truly adaptive coping skills, they may rely on disordered behaviors that only serve to make the head pain worse. A fast resting heart rate is a classic warning sign of anorexia nervosa and other eating disorders.
This problem arises as the heart struggles to function due to electrolyte imbalances and a lack of nutrients. Without looking into anorexia treatment options and acquiring care, the heart muscle could experience lasting damage. A fast heart rate not only damages the heart but also worsens feelings of stress and anxiety.
By restricting their food intake, people also inadvertently leave the heart without any fuel. Blood pressure numbers tend to start to decline, eventually to dangerous levels, without the fuel the heart needs to function.
Dehydration can also cause low blood pressure to develop. In , Watanabe et al 58 reported the first autopsy case of fatal gastric dilatation without rupture. Severe congestion was observed in the intestine and cecum, suggesting that bulimia nervosa together with anorexia nervosa resulted in rapid gastric dilatation. The authors suggested that the cause of death was acute circulatory failure from hypovolemic shock that occurred following compression of the inferior vena cava and superior mesenteric vein, and loss of circulatory volume to the third space.
Fatal gastric rupture due to a bulimic attack was discovered after death in a young woman suffering from anorexia nervosa. Autopsy revealed an acute gastric dilatation and rupture without commonly observed ischemic damage of gastric wall structures.
In this case, the death as a consequence of neurogenic shock accounted for all the results of gross examination and histologic analyses. The other severe presentation of gastric dilatation is gastric infarction, which has been reported in several ED cases, sometimes with a fatal outcome.
These shifts result from hormonal and metabolic changes and may cause serious clinical complications. The hallmark biochemical feature of refeeding syndrome is hypophosphatemia. In addition, other abnormalities can be found eg, hypokalemia, hypomagnesemia. As a result, disturbances in the electrochemical membrane potential can result in arrhythmias and cardiac arrest. Besides the changes in potassium and magnesium levels, in refeeding syndrome phosphorus depletion occurs, which in turns leads to widespread dysfunction of cellular processes affecting almost every physiological system.
Moreover, the introduction of carbohydrates to a diet leads to a rapid decrease in renal excretion of sodium and water. In this environment, patients may rapidly develop fluid overload with congestive cardiac failure, pulmonary edema, and cardiac arrhythmia. Some unusual deaths related to abnormal eating patterns polyphagia have been communicated with asphyxia as an unusual etiology.
A sudden subdiaphragmatic viscus expansion, with resultant lung volume displacement and impediment of venous return from the lower half of the body, and infraglottic asphyxia have been noted as the main causes of these deaths. In a study among severely malnourished patients, diaphragmatic contractility was severely depressed initially. This situation may cause acute respiratory distress and sudden death but is normally reversible with an adequate refeeding.
In addition to well-known electrolyte disturbances, anorexia nervosa nay be complicated by severe hypophosphatemia, which can cause muscle weakness and bulbar muscle dysfunction, resulting in aspiration pneumonia and cardiorespiratory arrest. Abuse of emetics such as ipecac can result in irreversible and potentially fatal cardiomyopathies.
Autopsy revealed pathological changes in the heart and skeletal muscles. Death can be the result, which is normally of cardiac origin myocarditis with arrhythmias. Other causes of death with the use of ipecac are myositis, gastroesophageal pathology including rupture , and metabolic abnormalities. In a case of longstanding bulimia nervosa subsequent to anorexia nervosa, death was caused by pneumonia and sepsis. Postmortem studies on the brain of a patient who died of acute anorexia nervosa showed a slim neuron type with one extremely long basal dendritic field.
In the neurons, the ramification pattern of single basal dendritic fields was found to be reduced and changes in the spine morphology, as well as reduction in spine density, were observed. The authors concluded that all anorexia nervosa deaths should be reported together with descriptions of causes and cerebral alterations.
Different severe acute inflammations such as pneumonia and peritonitis have been described in patients with anorexia nervosa. In another case, a sepsis with multiple organ dysfunction syndrome caused the death of the patient.
Investigations of sudden deaths by forensic pathologists have usually mentioned long QT syndrome as the main explanation. In addition, the absence of abnormal findings at postmortem examinations has highlighted the heritable nature of these sudden deaths. EDs, particularly anorexia nervosa, are life-threatening diseases with a high risk of death due to cardiovascular disturbances, which can also be present during refeeding.
Some of these alterations can lead to sudden death and a model of clinical monitoring of cardiovascular system should be developed carefully. It must be noted that risk of death is clearly linked to QT prolongation, mainly due to hypokalemia or to a starvation-derived anatomical remodeling of the heart. Despite some conflicting results mainly for methodological reasons about QT interval alterations, prolongation of the QT is usually associated with sudden ventricular arrhythmias and death.
Nevertheless, the main cardiovascular findings among patients with EDs are reversible by means of appropriate refeeding. As a result of this refeeding, increase in cardiac dimensions, ventricular mass, and cardiac output are reached. With respect to the above-mentioned causes of sudden death, many of them eg, protein-calorie malnutrition, ipecac toxicity, deficiencies of phosphorus and magnesium cause the sudden death by means of congestive heart failure.
Hypoglycemia, generally asymptomatic, is a usual finding among ED patients. Severe hypoglycemia is related to poor prognosis in ED patients. The pathophysiology of gastric dysfunction in ED is poorly understood. Several mechanisms, such as gastrointestinal smooth muscle atrophy, diminished release of cholecystokinin, abnormalities in the autonomic nervous system, and gastric rhythm abnormalities, have been considered.
Gastric infarction as a complication of acute gastric dilatation is an unusual associated circumstance. Nevertheless, both may be present in EDs, leading to perforation and death. It must be noted that the main results about sudden death in EDs are those related to anorexia nervosa.
In the case of bulimia nervosa, electrolyte disturbances are the main origin of sudden death by means of purging behaviors. With respect to EDs not otherwise specified, the search conducted yielded no results despite a recent study that has established that mortality rates for bulimia nervosa and EDs not otherwise specified seem to be similar. The most relevant conclusion of this review seems to be that the main causes of sudden death in EDs are those related to cardiovascular complications.
Thus, monitoring vital signs and performing electrocardiograms and serial measurements of plasma potassium are relevant. ED patients with severe cardiovascular symptoms should be hospitalized. The presence of purging behaviors increases the cardiovascular risk.
During refeeding, the adverse effects of hypophosphatemia include cardiac failure. Cardiac sequelae are secondary to and occur early in the cascade of events that arise during refeeding. In fact, no ED patients should start any treatment without full medical and nutritional explorations. National Center for Biotechnology Information , U. Vasc Health Risk Manag.
Published online Feb Author information Copyright and License information Disclaimer. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Eating disorders are usually associated with an increased risk of premature death with a wide range of rates and causes of mortality.
Keywords: sudden death, cardiovascular complications, refeeding syndrome, QT interval, hypokalemia. Introduction Medical manifestations of eating disorders EDs are not mere complications but relevant signs and symptoms of these pathologies. Results Cardiovascular complications and sudden death At least one-third of all deaths in patients with anorexia nervosa are estimated to be due to cardiac causes, mainly sudden death. Tako tsubo cardiomyopathy Tako tsubo syndrome apical ballooning syndrome , first described in Japan in , 31 is a reversible cardiomyopathy precipitated by acute and severe emotional stress mainly observed in postmenopausal women.
Table 1 Sudden death related to cardiovascular complications: main findings. This complication increases the risk of sudden death among those patients 35 , 36 Another mechanism of cardiovascular mortality and sudden death among eating disorder patients is the alteration in sympathovagal balance Open in a separate window.
Hypoglycemia and sudden death The presence of hypoglycemia is well-known in starvation, including in cases of anorexia nervosa. Gastric dilatation and gastric rupture EDs usually cause gastrointestinal disturbances, such as decreased gastric motility and delayed gastric emptying, which may rarely lead to acute gastric dilatation.
Other factors involved in sudden death among ED patients Some unusual deaths related to abnormal eating patterns polyphagia have been communicated with asphyxia as an unusual etiology. Discussion Investigations of sudden deaths by forensic pathologists have usually mentioned long QT syndrome as the main explanation.
Conclusion The most relevant conclusion of this review seems to be that the main causes of sudden death in EDs are those related to cardiovascular complications. Footnotes Disclosure The authors report no conflicts of interest in this work. References 1.
Birmingham CL, Beumont P. Medical Management of Eating Disorders. Cambridge: Cambridge University Press; World Health Organization. International Classification of Diseases. Geneva: World Health Organization; American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition. Text Revision. Katzman DK. Medical complications in adolescents with anorexia nervosa: a review of the literature.
Int J Eat Disord. Reversibility of cardiac abnormalities in adolescents with anorexia nerovsa after weight recovery. Stunting of growth in anorexia nervosa during the prepubertal and pubertal period. Isr J Med Sci. Short stature in anorexia nervosa patients. J Adolesc Health Care.
Decreased bone density in adolescent girls with anorexia nervosa. Neuroimaging in eating disorders. Neuropsychiatr Dis Treat. Electroencephalograpy in eating disorders. Gastrointestinal aspects of bulimia nervosa. In: Hay P, editor. Rijeca Croatia: In Tech; Mortality in eating disorders: a descriptive study. Emborg C. Mortality and causes of death in eating disorders in Denmark — a case register study.
Mortality and sudden death in anorexia nervosa. Characteristics of suicide attempts in anorexia and bulimia nervosa: a case-control study. Researchers refer to this as atypical anorexia nervosa.
People often think of anorexia nervosa in connection with females, but it can affect people of any sex or gender. Research suggests that the risk of eating disorders may be higher among transgender people than cisgender people. The reason for this is that males often receive a later diagnosis due to the mistaken belief that it does not affect them. Anorexia nervosa is different than anorexia. Anorexia means a loss of appetite or the inability to eat, and it can be a symptom of various diseases.
A person with anorexia nervosa will intentionally restrict their food intake as a way to help them manage emotional challenges. These often involve a fear of gaining weight or a desire to lose weight. Dietary restrictions can lead to nutritional deficiencies, which can severely affect overall health and result in potentially life threatening complications. The emotional and psychological challenges of anorexia nervosa can be hard for a person to overcome. Therapy includes counseling, nutritional advice, and medical care.
Some people may need treatment in the hospital. There are many myths about eating disorders. Learn more about the myths surrounding eating disorders and the real facts.
Anorexia nervosa is a complex condition. The main sign is significant weight loss or low body weight. In atypical anorexia nervosa, the person may still have a moderate weight despite substantial weight loss. The person may also demonstrate certain behaviors, such as :. The person may associate food and eating with guilt. They may seem unaware that anything is wrong or be unwilling to recognize their issues around eating.
Anorexia nervosa affects people differently. Not everyone with the condition will behave in the same way, and some individuals may experience atypical anorexia nervosa, meaning that they will not have a low body weight. Concerns about body weight and shape are often features of anorexia nervosa, but they may not be the main cause. Experts do not know exactly why the condition occurs, but genetic, environmental, biological, and other factors may play a role.
For some people, anorexia nervosa develops as a way of gaining control over an aspect of their life. As the person exerts control over their food intake, this feels like success, and so, the behavior continues. A person may also have a higher chance of developing an eating disorder if:.
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