Eating disorders are among the major health problems most people experience globally. The reason most people do not know about them is that, unlike other diseases and conditions, most of the people affected are afraid of going public. This is because the disorders can seriously affect the person’s body, mind, and emotions. Most patients suffering from this spectrum of illnesses hardly find people they can relate to; therefore, they suffer from stigmatization alongside the disease. Being a spectrum of disorders, it constitutes several disorders. The most common disorders in the range are; anorexia nervosa, binge eating disorder, rumination disorder, avoidant food intake disorder, and bulimia nervosa. The symptoms of the eating disorder vary from one condition to the other. Anorexia nervosa, or simply anorexia, is most probably the commonest of the diseases. Research experts do not know its cause, but genetics, environment, trauma, culture, and biological factors are believed to play a significant role in the occurrence of the disorder. Patients suffering from this disorder have an abnormally low body weight, extreme fear of weight gain, and a very negative perception of weight. The patients may also refuse to eat sufficient food while struggling to maintain what they think is healthy body weight and function. Besides, most anorexic patients often see themselves as overweight, despite being of the proper weight. Most use this false belief to justify their extreme abstinence from food, which may lead to serious health complications for the patient. These, among other complications, may compromise a person’s health status and lead to severe problems. This paper aims to bring to light the physical and neurological effects anorexia nervosa impacts on its patients.
Physical effects of anorexia nervosa
The intentional restrain from taking food in anorexic patients has been known to subject anorexic patients to severe physical problems. The array of biological effects may be both significant and minor. Some of these problems may become complications that could severely affect the entire bodily system. These complications arise due to massive weight loss and nutritional deficiencies. The systems that may be affected by this disorder range from the gastrointestinal, muscular, skeletal, cardiovascular, respiratory, kidney and excretory, dermatological, ophthalmologic, and hematological systems. Some of these complications are reversible through better dieting and proper nutrition. Some system complications are, however, irreversible and long-term. This could easily lead to the patient’s death or damage to some organs. Below are the possible ways a person could be physically affected by anorexia nervosa through the individual’s different body systems.
Untreated anorexia nervosa could be detrimental to the patient’s cardiovascular system. The disorder has always been associated with adverse myocardial structural changes resulting in heart damage and failure (Sachs et al., 2021). This is the main reason why anorexics are hospitalized. Lack of essential body nutrients causes the patient’s body to slow down and lower its BMI to conserve energy. The heart, like other organs, is deprived of critical nutrients and grows weaker. Besides, studies show a significant reduction in heart mass, especially in the heart’s left ventricle (Sachs et al., 2021). Decreased left ventricular mass in anorexics leads to a significant reduction in cardiac output, reducing the amount of blood in circulation. The patients are also highly vulnerable to bradycardia due to weak heart muscles, leading to an abnormally slow heart rate. The shallow heart rate results from the parasympathetic nervous system’s efforts to conserve the little energy available. Low heart rate could also stem from the enlarging heart chambers and thinning heart walls, making pumping difficult.
Moreover, poor cardiac nutrition leads to bicuspid and tricuspid valve prolapse and a lower cardiac index. It could also lead to hypotension due to a slow heart rate, weak systole, and decreased cardiac preload (Sachs et al., 2021). Hypotension could also result from loss of cardiac reflex, which causes vasoconstriction, which raises blood pressure. Severe anorexics could also suffer from conditions such as purging through vomiting or laxatives. This often leads to dehydration, metabolic disturbances, low electrolyte levels, and deficient potassium and chloride serum levels. Hypokalemia affects the cardiac muscle contraction relaxation coupling, leading to an abnormal heartbeat (Sachs et al., 2021). Finally, to sustain blood circulation despite all odds, the heart works harder and strains, leading to heart failure. Heart problems, in turn, affect more than one system, which could compromise the physiology of multiple organs, causing detrimental effects on the patient’s health in general.
Restriction from food intake in patients suffering from anorexia nervosa also adversely affects the patient’s gastrointestinal system significantly. The restrained food intake in anorexics primarily results in problems in food digestion and regular stomach emptying, resulting in various stomach and gastrointestinal complications (Morgan & Jafar, 2022). These complications present with symptoms ranging from; vomiting, stomach bloating, heartburn, abdominal pain, intestinal blockage, abdominal distension, and regular fluctuations in blood sugar levels. Frequent vomiting incidents in anorexics have always been associated with swelling of parotid salivary glands in the mouth (Morgan & Jafar, 2022). It could also result in a hoarse voice and sore throat. Anorexia nervosa is also known to cause rare complications like acute gastric dilation, leading to necrosis since the stomach loses its retractability property. Gastric emptying is therefore hindered, resulting in obscured blood flow to the gastric and intestinal tissues (Morgan & Jafar, 2022). Necrosis leads to a dead gut and rupture of the gastric walls. Inadequate nutritional food intake may also reduce the bulk of food in the intestines leading to constipation.
Moreover, constipation in anorexics could also result from damage to peripheral nerve innervating the rectal and anal mucosa and muscles, decreasing the bowel movements essential for proper egestion (Morgan & Jafar, 2022). It could also stem from the weakening of intestinal muscles weakening the propulsion of digested food (Morgan & Jafar, 2022). Severe constipation sometimes leads to further complications like bowel prolapse, where there is a rectal protrusion in the patient’s anal opening. Finally, bowel problems in patients with anorexia are a known cause of intestinal obstruction and inflammation of the pancreas, among other problems.
Anorexia nervosa is also known to affect the endocrine system, which is responsible for releasing various hormones in the body. This can occur because of not one but several reasons. When a person restrains themselves from taking food, this could result in depletion of the lipid and cholesterol stores in the body. With depleted lipid and cholesterol stores, hormones are reduced since fats and cholesterols are essential for synthesizing most hormones (Stevens, 2022). The fall in hormone levels leads to the depletion of glycogen stores in the body since hormones are required to convert glucose to glycogen in glycogenesis. The fall in hormone levels and starvation may also lead to abnormal glucose metabolism, which leads to hypoglycemia (Baskaran et al., 2017)
Hypoglycemia could lead to a spectrum of problems in the person’s body. These problems include severe headaches, slow thinking, seizures, and irregular changes in mood. To conserve the little glucose in the body, the body usually lowers its resting metabolic rate. If this continues for very long, the patient could suffer from hypothermia since there is inadequate glucose to facilitate hyperthermic reactions in the body.
Furthermore, anorexia nervosa is a known cause of musculoskeletal problems in patients. This is because when one is deprived of food, they have inadequate access to essential nutrients like calcium and vitamins for bone growth. Insufficient calcium and phosphorus reserves in the body lead to many skeletal problems. Some of these include reduced bone mass density, weakening of the bones, osteoporosis, osteopenia, and increased risk of fractures since the bones are brittle. Osteoporosis results from bone loss due to the breakdown of calcium stores in the trabecular bone (Baskaran et al., 2017). This may weaken the patient’s skeletal system making them feel pain in the back, lose breath and height, and change their posture.
Moreover, nutrient deficiency from anorexia leads to the breakdown of muscle protein to provide energy (Stevens, 2022). This weakens the patient’s muscles and makes them weak and exhausted, leading to a significant loss in muscle tone (Stevens, 2022). The disorder could also lead to the loss of electrolytes that are essential for the motor action of muscles, thus, causing a lot of pain and muscle spasms since nerve signals are not transmitted well at neuromuscular junctions.
Nevertheless, anorexia nervosa affects the integumentary and dermatological systems in several ways. These ways are the most common and easily recognizable effects this disorder has on its patients. Nutritional deprivation experienced by most anorexics physically changes the patient’s skin, hair, and nails in several ways. Anorexics often suffer from bluish discoloration of their fingertips and ears (Stevens, 2022). This occurs because, with less food intake for energy provision, the blood flow rate is slowed; thus, in cold places, the fingertips and ears turn bluish. It also results in the development of fine lanugo-like hair on the body to conserve the little heat the body can produce.
Moreover, anorexics are prone to thinning and falling out of hair on the scalp due to malnutrition (Stevens, 2022). Other frequent cutaneous manifestations of anorexia include xerosis, nail fragility, hyperpigmentation in a few people, self-induced dermatitis, scurvy, and acrodermatitis. Caroternoderma could also result from a deficiency in the ingestion of carotenoid-rich vegetables. Purging-type anorexia nervosa is also primarily associated with Russell’s sign. This sign is mainly characterized by the development of knuckle calluses and lesions on the planter aspect of the patient’s hand due to the frequent introduction of the patient’s hands into their mouth. Finally, anorexics are also vulnerable to acne development (Stevens, 2022). The worst part about acne development in anorexics is that the acne could risk the anorexic more to starvation. Most anorexic patients adopt several mechanisms to control acne development, and most involve their dieting behavior. These dieting behaviors may worsen the condition, leading to more acne and severe weight loss.
Another physical effect of the manifestation of anorexia nervosa in patients is the adverse complications the disorder causes on the kidney and excretory systems. Most of the difficulties caused are very serious, though some are fully treatable. Patients suffering from anorexia often suffer from vitamin deficiency, low minerals level, electrolyte imbalance, and dehydration due to starvation, binging, and purging (Marumoto et al., 2020). These deficiencies are the leading causes of kidney complications since they keep the kidney from functioning as it should. The difficulties range from acute kidney injury, long-term kidney disease, development of kidney stones, hyponatremia, and hypokalemia. The most common of these complications is kidney stones. They develop due to the accumulation of waste and toxins like ammonium urate and calcium oxalate, due to poor flushing system of the kidney, in cases of dehydration due to anorexia nervosa. These toxins and waste products of excretion crystalize after accumulation leading to a build-up of stones. Kidney stones in patients with anorexia subject them to sudden flank pain radiating from the groins, pain when urinating, and production of bloody or brown urine, among other complications. This condition is, however, treatable and reversible. Acute kidney injuries are a common characteristic of patients suffering from anorexia nervosa. This complication leads to a sharp decline in kidney function and could lead to death if the condition goes unattended (Marumoto et al., 2020). It stems from other issues like dehydration, urine obstruction in patients with kidney stones, irregular blood pressure, and low nutrient intake.
Moreover, if anorexia goes unchecked, it could worsen the kidney condition and lead to chronic kidney disease. This condition is permanent and more severe than other kidney complications due to AN (Marumoto et al., 2020). The disease results from low potassium serum levels, high calcium levels in the blood, chronic dehydration, and long-term kidney inflammation, among other causes. Finally, electrolyte imbalance is another kidney complication associated with anorexia—the imbalance of delicate electrolytes like potassium and sodium results from excessive vomiting, leading to hypokalemia (Marumoto et al., 2020). The kidneys change the sodium and magnesium serum concentration to compensate for the decrease in potassium serum levels. This imbalance affects the kidneys and other systems in the body, including the heart.
Besides, anorexia nervosa has been deduced to cause several reproductive complications. The disorder is known for its ability to disrupt the hormonal cycle in women due to drastic drops in fat levels. These disruptions in the hormonal process lead to menstrual complications and other reproductive issues in anorexic subjects. If left untreated, these disruptions could cause permanent damage to the reproductive system, and the subject may never have a normal reproductive cycle again (Guverich, 2019). Furthermore, women whose menstrual cycles have been disrupted due to anorexia are highly susceptible to infertility and pregnancy complications. Some of the most typical complications anorexic women experience are amenorrhea and oligomenorrhoea (irregular periods) (Guverich, 2019). These complications in the menstrual cycle mean the woman’s ovulation cycle is also at stake; this is what makes it hard for anorexic women to get pregnant. Abnormal hormone levels lead to shrinkage of the ovaries and uterus of some women with anorexia nervosa upon pelvic ultrasound studies (Guverich, 2019). During childbirth and pregnancy term, anorexic women are prone to miscarriages, preterm delivery, and an increased risk of birthing underweight children. In men, anorexia affects male fertility since abnormally low-fat levels lead to deficient testosterone and androgen levels, leading to an imbalanced sperm count and erectile dysfunction (Guverich, 2019). Some of these conditions could be reversed by proper dieting.
Finally, breathing and other respiratory complications are other common physical manifestations of anorexia. The extreme nutritional deficit in anorexics is a known cause of the weakening of some functional respiration muscles, like the diaphragm (Stevens, 2022). Emphysema is also a common respiratory complication of anorexia. Voluntary starvation, leading to human caloric malnutrition, produces emphysematous lung structure changes. Long-term caloric malnutrition in anorexic subjects leads to loss of lung tissue and decreases surfactant production. This destabilizes the alveoli and reduces the number of alveoli and surface area for gaseous exchange. Malnutrition in anorexic patients could also lead to other respiratory complications, including; bronchiectasis, where there is an excessively thick mucous membrane in inflamed airways, and spontaneous pneumothorax (Stevens, 2022). Pulmonary edema could also result from a reduction in surfactant production; thus, the alveoli are not kept dry.
Neurological effects of anorexia nervosa
Besides impacting physical effects on its patients, anorexia nervosa is also known for the different neurological effects it has implications on them. Most of the known neurological impacts of this disease stem from malnutrition, decreasing the amounts of vitamins and minerals available for the normal neurological functioning of the body. Anorexia can lead to brain damage if left unchecked (England, 2022). Research shows that severe weight loss and insufficient levels of some vitamins and minerals could lead to deterioration in the brain’s gray and white matter amounts. This leads to an overall reduction in brain volume, and the results could be detrimental to the patient (England, 2022). Atrophy of brain matter could occur due to disruption in neurotransmitter release, initiating structural changes in the brain. Brain atrophy due to anorexia nervosa has been associated with other neurologic complications like dementia (memory loss that leads to problems in abstract thinking, learning, and planning), aphasia, addiction, depression, and schizophrenia in some cases (England, 2022). Depression and irritability result from the adverse effects this disorder have on the emotional centers, the limbic system, in the brain.
Hyponatremia and other electrolytic imbalance disorders due to malnutrition and vomiting in anorexic patients could also result in neurological complications like seizures. This is because sodium and other electrolytes are essential in initiating action potentials and nerve impulses. Low sodium levels and profound imbalance of other electrolytes could lead to irregular impulses leading to seizures in such individuals (Stevens, 2022). Sodium, potassium, calcium, and chloride deficiency, sure to severe dehydration, could also lead to muscle cramps since there are difficulties in impulse transmission at the neuromuscular junction. Irregular impulse generation could also affect multiple systems since nerve signals are required by all body parts of these organs’ typical motor and sensory functioning.
Severe complications such as Wernicke’s encephalopathy due to deficiency of vitamin B1 in severe malnutrition could also result from anorexia nervosa. This disease, due to Vitamin B1 deficiency, could cause other complications like; walking difficulties, confusion, amnesia, and visual disturbances (Stevens, 2022). It could also lead to permanent brain damage if not treated right (Stevens, 2022). This makes it a medical emergency. Anorexia could also contribute to the development of Wernicke’s encephalopathy since the body is deprived of essential minerals like magnesium, which is vital in converting vitamin B1 (thiamine) into its active form, pyrophosphate.
Finally, anorexia can lead to nerve-related conditions like peripheral neuropathies and numbness. These complications lead to general body weakness and reduction or absence of deep tendon reflexes. Other nerve-related complications, like bilateral peroneal nerve palsies, have also been diagnosed in anorexic patients. Odd nerve sensations in the hands and feet could also result from this disorder since there is an overall disruption in action potential generation and transmission.
In conclusion, anorexia nervosa can cause many health complications beyond the usual ones known to most people, like malnutrition. Therefore, healthcare personnel should manage patients suffering from this psychiatric disorder well since it puts them at a very high risk of suffering both physical and neurological health problems.
References
Marumoto, H., Sasaki, T., Tsuboi, N., & Ito. (2020, July). Kidney Disease Associated With Anorexia Nervosa: A Case Series With Kidney Biopsies. sciencedirect.com. Retrieved December 6, 2022, from https://www.sciencedirect.com/science/article/pii/S2590059520301059
Morgan, J., & Jafar, W. (2022). Anorexia nervosa and the gastrointestinal tract. fg.bmj.com. Retrieved December 6, 2022, from https://fg.bmj.com/content/13/4/316
Guverich, R. (2019, July 17). Anorexia, Bulimia, and Your Fertility. verywellfamily.com. Retrieved December 6, 2022, from https://www.verywellfamily.com/anorexia-bulimia-and-your-fertility-4688637
England, A. (2022, July 19). Anorexia Can Change Brain Structure. Very Well Mind. Retrieved December 6, 2022, from https://www.verywellmind.com/news-anorexia-can-actually-change-brain-structure-5441589
Sachs, K. V., Harnke, B., & Mehler. (2021, October 21). Cardiovascular complications of anorexia nervosa: A systematic review. ncbi.nlm.nih.gov. Retrieved December 6, 2022, from https://pubmed.ncbi.nlm.nih.gov/26710932/
Baskaran, C., Misra, M., & Klibanski, A. (2017). Effects of Anorexia Nervosa on the Endocrine System. Pediatric endocrinology reviews: PER, 14(3), 302–311. https://doi.org/10.17458/per.vol14.2017.BMK.effectsanorexianervosa
Stevens, A. (2022, July 18). What Does Anorexia Do to the Body? goodrx.com. Retrieved December 6, 2022, from https://www.goodrx.com/conditions/eating-disorders/side-effects-of-anorexia
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