Eating Disorders - Complications of Anorexia

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Effect on Fertility and Pregnancy

After treatment and an increase in weight, estrogen levels are usually restored and periods resume. In severe anorexia, however, even after treatment, normal menstruation never returns in some patients.

• If a woman with anorexia becomes pregnant before regaining normal weight, she faces a higher risk for miscarriage, cesarean section, and for having an infant with low birth weight or birth defects. She may also be at higher risk for postpartum depression.
• Women with anorexia who seek fertility treatments have lower chances for success.

Effect on Bones and Growth

Almost 90% of women with anorexia experience osteopenia (loss of bone calcium), and 40% have osteoporosis (more advanced loss of bone density). Up to two-thirds of children and adolescent girls with anorexia fail to develop strong bones during their critical growing period. Boys with anorexia also suffer from stunted growth. The less the patient weighs, the more severe the bone density loss. Women with anorexia who also binge-purge face an even higher risk for bone density loss.

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Bone density loss in women is mainly due to low estrogen levels that occur with anorexia. Other biologic factors in anorexia also may contribute to bone density loss, including high levels of stress hormones (which impair bone growth) and low levels of calcium, certain growth factors, and DHEA (a weak male hormone). Weight gain, unfortunately, does not completely restore bone. Only achieving regular menstruation as soon as possible can protect against permanent bone density loss. The longer the eating disorder persists the more likely the bone density loss will be permanent.

Testosterone levels decline in boys as they lose weight, which also can affect their bone density. In young boys with anorexia, weight restoration produces some catch-up growth, but it may not produce full growth.

Neurological Problems

People with severe anorexia may suffer nerve damage that affects the brain and other parts of the body. The following nerve-related conditions have been reported:

• Seizures
• Disordered thinking
• Numbness or odd nerve sensations in the hands or feet (peripheral neuropathy)