are frequently seen with those suffering from eating disorders or who have had a history of an eating disorder a vast array
of physiological complications and health risks. No two individuals are the same. Their bodies may respond and react differently
to the abuse which they succumb to under eating disorder behaviors. Very rarely can someone who "dabbles" in eating
disorders (no matter which Anorexia, Bulimia, or Compulsive Overeating) simply walk away from the behavior alone. Additionally,
it is not uncommon to experience a switching of behaviors from one to the other or to additional self destructive behaviors
like self injurious behavior, compulsive spending, gambling, substance abuse, and stealing behavior to state a few.
As a therapist I have to be very in tuned with the possible complications more now than ever since insurance companies
are not very helpful in providing the right levels of care an individual may need. For the most part to date insurance companies
are dictating treatment and eating disorders are Illnesses they decline adequate treatment for very frequently. Individuals
suffering from eating disorders and their family members need help in understanding the serious ramifications of these destructive
behaviors on the body, soul, and mind of the individual.
Minerals make up the electrolyte system. They are essential for the balanced chemistry of the body and its ability to
function correctly. They ensure healthy nerve and muscle impulses, kidneys and heart, blood sugar levels and the delivery
of oxygen to the cells of the body. When this system is disrupted the results can be devastating including heart attacks
and stokes. You will see Electrolyte Imbalances especially with behaviors associated with purging, (vomiting, abuses of
diuretics and laxatives) as well as in drowning the body by binging on large quantities of fluids such as water, milk, soda.
This is caused by the depletion (frequently seen with purging behaviors)
or lack of intake of fluids into the body. Restricting, vomiting, laxative and diuretic abuse, and extended exercise without
appropriate hydration are the primary causes. Symptoms include: Possible dark circles under eyes, a "drawn" look
to the face itself, dizziness, weakness, and darkening of urine. In extreme cases it can lead to kidney failure, heart failure,
Can be caused by significant under eating and in some cases overeating
to the point of flooding the body and its systems. It can also be seen with binging and purging behavior especially when
the individual is purging following everything eaten. The body requires fuel (food) as its primary energy source and when
deprived of that it can result in respiratory infections, kidney failure, blindness, heart attack and death.
NutriQuest - Body of Evidence
A flooding of the system with water. (Drinking more than eight
8 ounce glasses of water a day.) **One client I worked with drank 5 gallons of water per day** Often seen with those who
binge on fluids. This is a very serious condition which requires immediate medical attention. Due to the influx of water
the body cannot balance its sodium level adequately and can cause fluid in the lungs, the brain to swell, nauseousness,
vomiting, severe confusion and even death. It can also appear as a drug overdose to medical personal because of an enormous
amount of strength an individual may experience in conjunction with some psychotic and delusional orientations.
A wasting away of muscle tissue and a decrease in muscle mass due to the
body feeding off of itself. Usually accompanies restricting.
soft downs hair on the face, back or arms. This is caused by the body's protective mechanism in malnutrition to help keep
the individual warm. It is a result of hormonal imbalances. It may take an extended period of time for this to go away after
the individual begins eating appropriately due to the body's need to protect itself.
This is a swelling of the soft tissues as a result of excess water accumulation and retention. Pitting Edema
is the type of swelling which when you apply pressure to the swollen area an indentation is left. It is most common in the
legs, feet and fingers of all three eating disorders. For Bulimics and Anorexics it can also be present in the abdominal
area. Can be caused by laxative and diuretic abuse.
serious condition which requires medical supervision. It usually occurs during the time the individual who has been depriving
themselves of sustenance and begins to eat again. Generally one of the causes of this edema is the lack of Protein in the
system. Patients or clients who resume normal eating should be monitored for this because it is a natural reaction of the
body to the reintroduction of food.
Impaired Neuromuscular Functioning
Inability to be able to move in a normal fashion. Due to vitamin and mineral deficiencies.
An extreme weakness of the muscles which may disable the individual to move at all.
Frequently caused by low levels of potassium but also by the degeneration of nerve cells in the spinal cord or in the brain
which have been deprived of essential nutrients. After onset they may occur more frequently and more severely and may lead
to permanent muscle weakness and possible death.
Periodic Paralysis Association
This is a regurgitation of partially digested items in the
stomach, mixed with acid and enzymes. This can lead to damage in the esophagus, stomach, and larynx. This can be a precancerous
state to the esophagus and voice box and requires medical attention and medication often. Often seen in bulimics who purge
through vomiting, reflux can become so bad that food cannot be kept down at all and purging becomes involuntary for the
A condition associated with Cancer of the esophagus and
caused by reflux. It brings about a change in the cells of the esophagus.
Tears in the Esophagus
These are exactly what they sound like, rips or tears in the esophagus caused by the unnatural and consistent
purging of food. Keep in mind vomiting for the normal individual is only meant as a way of evacuating food from the stomach
when something is wrong. It is not meant to be done on any regular basis so when one purges one is forcing the body to do
something it is only meant to do under certain circumstances. As a result tears may occur and the individual may begin to
notice vomiting blood when purging.
Also associated with
purging through vomiting. It is a tear in the gastroesophageal junction.
The development of cancer cells of the throat and Larynx due to acid reflux. Seen in bulimics who purge.
Cancer of the Larynx
There can be two issues in this area. One is a deficiency
in digestive enzymes which leads to the bodies inability to properly digest food and absorb nutrients. This may lead to
malabsorption problems, malnutrition, and electrolyte imbalances. Additionally, When one purges one risks a change in the
signals from the stomach to the brain resulting in slowed digestion because the body has become accustomed to purging behavior.
For bulimics this can be disturbing because the small intestine does not send its signal to the brain to tell the individual
that they are full at the appropriate time. Additionally, the individual tends to feel full for a longer period of time.
Which is very uncomfortable for the individual trying to recover from an eating disorder.
Digestive enzymes attack the pancreas. This can be very painful.
It can be caused by the repeated stomach trauma of vomiting, alcohol consumption or the excessive use of laxatives or diet
Caused by increased stomach acids, high consumption of caffeine
as seen in some forms of diet pills or alcohol consumption.
Cramps, bloating, constipation, diarrhea,
Increased or decreased bowl activity. Many patients are treated for Irritable Bowel
Auto Immune System Weakening
Chronic Fatigue Syndrome is one eating
disorder patients complain of however other syndromes are very possible.
Weakness and Fatigue
Caused by insufficient nutrients or malnutrition, electrolyte imbalances, vitamin and mineral deficiencies,
increased depression, insomnia and heart problems.
Swelling in face
noticeable where the glands lie connecting the upper and lower jaws. Often follows purging by vomiting.
appearing eyes or tiny blood vessels torn on the face.
A direct result of violent purging by vomiting
A bleeding which occurs in the digestive
tract which primarily is seen through elimination or blood in the stool.
A sudden perforation or rupture in the stomach.
Hair Loss, Dry Skin, Brittle Lusterless
Hair, Brittle Nails
to dehydration there is an increased risk to anoretic and bulimic individuals of seizures (which are surges of electricity
within the brain). In these individuals lesions on the brain may develop as a result of long-term malnutrition which lack
the oxygen- carrying cells the brain requires to function adequately causing chemical imbalances.
Anorexia and Seizures
Low Blood Pressure, Hypotension
A condition brought about by malnutrition,
dehydration and a lowering of the body temperature. Can cause heart arrhythmias, shock or myocardial infarction.
This is seen as a sudden drop in blood pressure when changing
positions from sitting or laying down to the standing position. The individual may experience a momentary inability to see,
dizziness, blurred vision, passing out heart pounding and headaches.
High Blood Pressure, Hypertension
Seen primarily in compulsive overeaters the
blood pressure elevates beyond 140 over 90. It causes abnormal thickening of the heart muscle resulting in heart attacks,
additionally it may cause strokes fatal or brain damaging, and kidney failure.
A disturbance in blood sugar resulting in Low Blood Sugar especially
seen in anoretic or bulimic patients. Sweating and shakiness are symptomatic and can indicate problems with the liver or
kidneys which can lead to neurological and mental deterioration. Dietary attention is important.
Reactive Hypoglycemia home page
A high blood sugar as a result of an inadequate production of insulin.
Often seen in malnourished individuals as well as compulsive overeaters. For some this condition may be treated with dietary
changes. Some patients who develop diabetes which requires medical attention and medication during the eating disorder are
able as they recover more fully to be rid of the symptoms of diabetes, but need to be watched medically for a recurrence.
Some warning signs are frequent urination and inability to quench thirst, nervousness, weakness, trembling, weak rapid pulse,
seizures, and possible appearance of intoxication.
Eating Disorders and Diabetes
A state which involves high levels of acids which build up in
the blood caused by the body burning fat rather than sugar and carbohydrates to get energy. The shift from utilizing carbohydrates
as energy to fat results in the formation of ketoacids. Kidneys are overwhelmed by the continuous production of ketone bodies
resulting in profound acidosis. Common causes are alcohol abuse, starvation, excessive purging, dehydration and hyperglycemia.
Untreated diabetes can cause ketoacidosis (also known as DKA).
Kidney Infections and Potential Kidney
The function of the kidneys is to purify the poisons from the body, regulate acid concentration,
and maintain water balance. The risk to difficulties with the kidneys increases with dehydration, infection and low blood
pressure, and vitamin deficiencies. Untreated diabetes causes significant strain on the kidneys and can lead to kidney failure.
Loss of Menstrual Cycle because the hormone Oestrogen secreted by
the ovaries ceases to be produced. This can lead to Osteoporosis and Osteopenia.
A below normal bone mass indicating a calcium and Vitamin D deficiency which leads to Osteoporosis.
A thinning of the bones with a reduction in bone mass due to a depletion
of calcium and bone protein. This leaves bones vulnerable to fractures. A bone density test is helpful in evaluating damage
caused from eating disorder behaviors of restriction, binging and purging.
Osteoporosis and Related Bone Diseases
A form of degenerative arthritis within the tempero-mandibular
joint in the jaw. This is often seen in bulimic patients who purge through vomiting causing unnecessary strain on the joint.
There is often pain in the joint area, with difficulty chewing as a result, and headaches.
The TMJ Association
Stomach acids and enzymes from vomiting can cause erosion
of tooth enamel especially seen on the insides of the teeth where the tongue meets the teeth. This erosion ultimately leads
to severe decay and lays the ground work for gum disease. Vitamin D, calcium deficiencies, and hormonal imbalances can lead
to decalcification of the teeth.
Heart Attack, Cardiac Arrest, Dysrhythmia, Angina (chest pain)
and Irregular Heartbeat
Sudden heart attacks can cause permanent damage to the heart or death.
A cardiac arrest is sudden death. Electrolyte imbalances which include potassium deficiency, extreme orthostatic hypotension,
low blood pressure, slow heart rates, malnutrition, hormonal imbalances high blood pressure, high cholesterol, accumulations
of fat deposits around the heart muscle can all be contributing factors with involve complications with the heart. All eating
disorders have the potential for serious complications with the heart and even death.
Liver Disturbances and Failure
The liver is a very important organ of the
body. It works to eliminate waste from cells and works in conjunction with your digestive system. Some patients attempt
suicide through the use of acetaminophen which causes in some cases extreme liver damage and can ultimately lead to death.
Also the abuse of Ipecac Syrup also causes damage to the liver and cannot be eliminated from the body.
This is a condition which leaves an individual unable to have children. In eating disorders it may be caused
by the lack of menstrual cycle, and other hormonal imbalances. Malnutrition and various vitamin deficiencies can also make
it impossible to carry a child to full term. Additionally the lack of proper nutrition during pregnancy can lead to the birth
of a baby with birth defects.
International Council on Infertility
Problems During Pregnancy
Due to malnutrition, dehydration, vitamin and hormone
deficiencies pregnancies while actively involved in eating disorder behavior puts the unborn child at high risk of chronic
illness, still birth, and death.
CoMorbidities Seen Associated With Eating Disorders
Ultimately eating disorders which
are very self destructive in nature and can be view as slow attempts at suicide behavior can lead to heart attacks, strokes,
internal bleeding, gastric rupture, perforated ulcers liver failure, kidney failure, pancreatitis, and suicide.
Deborah J. Kuehnel, LCSW © 2002