Far beyond the desire to lose a few pounds, people with anorexia nervosa or AN have a life-threatening mental health disorder that causes a refusal or inability to eat, despite the increasingly negative effects this lack of nutrients has on the individual’s health and well-being. Anorexia nervosa can cause many long-term complications affecting both the body and the mind.

Brain Shrinkage

Seven separate studies indicate that people with anorexia nervosa are likely to have reduced gray and white brain matter. The research also shows reductions in the size of various regions of the brain, particularly those involving appetite, weight loss, hormone normalization, and reward. Some of the brain damage may be permanent, but fortunately, recent studies show that post-recovery weight gain can reverse this shrinkage. However, some research suggests the gray matter changes in the brain may persist after recovery.

Mental Health Issues

Anorexia nervosa has a high comorbidity rate with other mental illnesses, including depression, anxiety, obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD, and bipolar disorder. Often, another mental illness is the underlying cause of the eating disorder or vice versa. In many cases, people who have recovered from anorexia continue to experience depression, anxiety, OCD, or body dysmorphic disorder.

Substance Abuse

Substance abuse is quite prevalent among people with anorexia nervosa; up to 50% of individuals with AN abuse alcohol or drugs, compared to only 9% in the general population. A study published in the International Journal of Eating Disorders found that participants with AN make up the greatest number of cases of lifetime history of alcohol abuse or dependence (35%), a risk three times that of other eating disorders. Those with AN also had the highest rate of drug abuse in all drug categories, although one study found that the highest rate of drug abuse was in people with binge eating disorder. Experts have various theories for this correlation: stimulants such as cocaine can suppress appetite, and alcohol can help individuals cope with the depression and other feelings that lead them to limit food. Substance abuse can also replace the addiction to not eating when a person is recovering from AN.

Cognition and Memory

Research shows long-term anorexia can cause significant deficiencies in cognitive ability and memory. One study showed that the lower a person with anorexia’s body mass index (BMI), the more impaired their memory and cognitive function. Another 2019 study found that the longer a person has AN, the more severe the impairments in “verbal reasoning and non-verbal, serial, spatial planning, cognitive flexibility, new rule learning, cognitive inhibition and answer perseverance.” Even eighteen years post-recovery, the subjects showed more problems with attention, executive function, mentalizing, and a range of other cognitive abilities when compared to participants with bulimia or no eating disorder.

Heart Problems

Severely restricting food intake puts tremendous pressure on the cardiac and muscular systems. Researchers estimate that at least one-third of deaths from anorexia nervosa are due to cardiac complications, including sudden death from an irregular heart rhythm or heart failure. Electrolytes, such as calcium and potassium, help keep the heart beating. Most people with AN have severe deficiencies in these vitamins and minerals, which can lead to heart attacks, irregular heart rhythm, and even death. This lack of electrolytes affects other muscles as well, causing cramping and even paralysis.

Organ Failure

Most people with anorexia show symptoms of dehydration, a temporary condition that has various side effects, including kidney trouble, from kidney stones to complete organ failure. Sudden, acute kidney failure can be corrected if caught in time, but people with long-term AN who develop chronic kidney failure may never recover full function of the organs. Additionally, dehydration may result in tachycardia or abnormally high heart rate, which places additional stress on the heart. Prolonged dehydration causes all the organs to shut down.

Low Birth Weight

Because a nutritious diet is a cornerstone of a healthy pregnancy, if a woman with anorexia nervosa becomes pregnant, her unborn child may be affected by her disorder. The UCL Institute of Child Health (ICH) conducted a meta-analysis of over two million women. The results show that babies born to women with a history of anorexia nervosa have a lower birth weight than those born to mothers with no history of the disorder. Low birth weight is also linked to an increased risk of infant mortality.

Weakened Immune System

Surprisingly, people with anorexia nervosa often do not develop viral or bacterial infections, as their immune system temporarily adapts. However, over time, 50% of individuals with AN experience dysfunction in their white blood cells, the cells responsible for fighting infection. This impairment results in a weakened immune system, eventually leaving the individual more susceptible to infections and disease. Leukopenia (low white blood cells), anemia (low iron), and thrombocytopenia (low platelets) are common secondary conditions people with AN develop.

Infertility

Anorexia nervosa has lasting repercussions on the reproductive system, beyond the irregular or missing periods many women with AN experience. Even in recovery, individuals may face fertility issues because the communication between the hormones and reproductive organs has been interrupted. As a result, people who have had AN have a higher risk of miscarriage, obstetric complications, and post-partum depression. Some studies estimate that 18% of women seeing a doctor for infertility have or have had an eating disorder. According to the Mayo Clinic, men with AN may also develop issues with fertility due to decreased testosterone levels.

Death

Whether due to starvation, cardiac disease, natural causes, or suicide, people with anorexia nervosa who do not recover are at risk of premature death. Statistics show that women diagnosed as teenagers have a life expectancy of 25 years less than the average population. Both men and women have a mortality rate five times higher than those without an eating disorder. AN has the highest rate of completed suicides of all mental health disorders. An estimated 20 to 40% of anorexia-related deaths are caused by suicide, while most are a result of the devastating damage anorexia has on the person’s body.