Skip to main content

Advertisement

SpringerLink
Log in

Medical complications of anorexia nervosa and their treatments: an update on some critical aspects

  • Review
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Anorexia nervosa has the highest mortality rate of any psychiatric disorder. Many of the deaths are attributable to medical complications which arise as the malnutrition and weight loss worsens. Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients. Herein, we will describe the medical complications of anorexia nervosa and their treatments.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Arcelus J, Mitchell AJ, Wales J, Nielsen S (2011) Mortality rates in patients with anorexia nervosa and other eating disorders. A meta-analysis of 36 studies. Arch Gen Psychiatry 68:724–731. doi:10.1001/archgenpsychiatry.2011.74

    Article  PubMed  Google Scholar 

  2. Hoang U, Goldacre M, James A (2014) Mortality following hospital discharge with a diagnosis of eating disorder: national record linkage study, England, 2001–2009. Int J Eat Disord 47:507–515. doi:10.1002/eat.22249

    Article  PubMed  Google Scholar 

  3. Miller KK, Lee EE, Lawson EA, Misra M, Minihan J, Grinspoon SK, Gleysteen S, Mickley D, Herzog D, Klibanski A (2006) Determinants of skeletal loss and recovery in anorexia nervosa. J Clin Endocrinol Metab 91:2931–2937. doi:10.1210/jc.2005-2818

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  4. Fazeli PK, Klibanski A (2014) Anorexia nervosa and bone metabolism. Bone 66:39–45. doi:10.1016/j.bone.2014.05.014

    Article  CAS  PubMed  Google Scholar 

  5. Lucas AR, Melton LJ 3rd, Crowson CS, O’Fallon WM (1999) Long-term fracture risk among women with anorexia nervosa: a population-based cohort study. Mayo Clin Proc 74:972–977

    Article  CAS  PubMed  Google Scholar 

  6. Faje AT, Fazeli PK, Miller KK, Katzman DK, Ebrahimi S, Lee H, Mendes N, Snelgrove D, Meenaghan E, Misra M, Klibanski A (2014) Fracture risk and areal bone mineral density in adolescent females with anorexia nervosa. Int J Eat Disord 47:458–466. doi:10.1002/eat.22248

    Article  PubMed Central  PubMed  Google Scholar 

  7. Milos G, Hauselmann HJ, Krieg MA, Ruegsegger P, Gallo LM (2014) Are patterns of bone loss in anorexic and postmenopausal women similar? Preliminary results using high resolution peripheral computed tomography. Bone 58:146–150. doi:10.1016/j.bone.2013.09.016

    Article  PubMed  Google Scholar 

  8. Biller BM, Saxe V, Herzog DB, Rosenthal DL, Holzman S, Klibanski A (1989) Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa. J Clin Endrocrinol Metab 68:548–554

    Article  CAS  Google Scholar 

  9. Trombetti A, Richert L, Herrmann FR, Chevalley T, Graf JD, Rizzoli R (2013) Selective determinants of low bone mineral mass in adult women with anorexia nervosa. Int J Endocrinol 2013:897193. doi:10.1155/2013/897193

    Article  PubMed Central  PubMed  Google Scholar 

  10. Bredella MA, Fazeli PK, Daley SM, Miller KK, Rosen CJ, Klibanski A, Torriani M (2014) Marrow fat composition in anorexia nervosa. Bone 66:199–204. doi:10.1016/j.bone.2014.06.014

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  11. Sabel AL, Rosen E, Mehler PS (2014) Severe anorexia nervosa in males: clinical presentations and medical treatment. Eat Disord 22:209–220. doi:10.1080/10640266.2014.890459

    Article  PubMed  Google Scholar 

  12. Mehler PS, Sabel AL, Watson T, Andersen AE (2008) High risk of osteoporosis in male patients with eating disorders. Int J Eat Disord 41:666–672. doi:10.1002/eat.20554

    Article  PubMed  Google Scholar 

  13. Behre HM, Kilesch S, Leifke E, Link TM, Nieschlag E (1997) Long-term effect of testosterone therapy on bone mineral density in hypogonadal men. J Clin Endocrinol Metab 82:2386–2390

    Article  CAS  PubMed  Google Scholar 

  14. Mehler PS, Mackenzie TD (2009) Treatment of osteopenia and osteoporosis in anorexia nervosa: a systematic review of the literature. Int J Eat Disord 42:195–201. doi:10.1002/eat.20593

    Article  PubMed  Google Scholar 

  15. Moyer VA, Lefevre ML, Siu AL (2013) Vitamin D and calcium supplementation to prevent fractures in adults: US Preventive Services Task Force recommendation statement. Ann Intern Med 159:691–696. doi:10.7326/0003-4819-158-9-201305070-00603

    Google Scholar 

  16. Golden NH, Iglesias EA, Jacobson MS, Carey D, Meyer W, Schebendach J, Hertz S, Shenker IR (2005) Alendronate for the treatment of osteopenia in anorexia nervosa: a randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab 90:3179–3185. doi:10.1210/jc.2004-1659

    Article  CAS  PubMed  Google Scholar 

  17. Fazeli PK, Wang IS, Miller KK, Herzog DB, Misra M, Lee H, Finkelstein JS, Bouxsein ML, Klibanski A (2014) Teriparatide increases bone formation and bone mineral density in adult women with anorexia nervosa. J Clin Endocrinol Metab 99:1322–1329. doi:10.1210/jc.2013-4105

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  18. Misra M, Klibanski A (2014) Anorexia nervosa and bone. J Endocrinol 221:R163–R176. doi:10.1530/JOE-14-0039

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Katzman DK, Misra M (2013) Bone health in adolescent females with anorexia nervosa. What is the clinician to do? Int J Eat Disord 46:456–460. doi:10.1002/eat.22102

    Article  PubMed  Google Scholar 

  20. Mcclung MR, Grauer A, Boonen S, Bolognese MA, Brown JP, Diez-Perez A, Langdahl BL, Reginster JY, Zanchetta JR, Wasserman SM, Katz L, Maddox J, Yang YC, Libanati C, Bone HG (2014) Romosozumab in postmenopausal women with low bone mineral density. N Engl J Med 370:412–420. doi:10.1056/NEJMoa1305224

    Article  CAS  PubMed  Google Scholar 

  21. Eisenberg DF, Placzek H, Gu T, Krishna A, Tulsi BB (2015) cost and consequence of noncompliance to oral bisphosphonate treatment. J Manage Care Spec Pharm 21:56–65

    Google Scholar 

  22. Miller KK, Grinspoon SK, Ciampa J, Hier J, Herzog D, Klibanski A (2005) Medical findings in outpatients with anorexia nervosa. Arch Intern Med 165:561–566

    Article  PubMed  Google Scholar 

  23. Sabel AL, Gaudiani JL, Statland B, Mehler PS (2013) Hematological abnormalities in severe anorexia nervosa. Ann Hematol 92:605–613. doi:10.1007/s00277-013-1672-x

    Article  PubMed  Google Scholar 

  24. Osgood E, Muddassir S, Jaju M, Moser R, Farid F, Mewada N (2014) Starvation marrow - gelatinous transformation of bone marrow. J Community Hosp Intern Med Perspect 4(4). doi:10.3402/jchimp.v4.24811

    PubMed Central  PubMed  Google Scholar 

  25. Rafiullah Islam R, Mahmood R, Sitwala KV (2013) Gelatinous bone marrow transformation secondary to unusual eating habits and drastic weight loss. BMJ Case Rep. doi:10.1136/bcr-2013-200243

    Google Scholar 

  26. Vende Zande VL, Mazza JJ, Yale SH (2004) Hematologic and metabolic abnormalities in a patient with anorexia nervosa. WMJ 103:38–40

    Google Scholar 

  27. Cleary BS, Gaudiani JL, Mehler PS (2010) Interpreting the complete blood count in anorexia nervosa. Eat Disord 18:132–139. doi:10.1080/10640260903585540

    Article  PubMed  Google Scholar 

  28. Nishio S, Yamada H, Yamada K, Okabe H, Okuya T, Yonekawa O, Ono T, Sahara N, Tamashima S, Ihara M (2003) Severe neutropenia with gelatinous bone marrow transformation in anorexia nervosa: a case report. Int J Eat Disord 33:360–363

    Article  PubMed  Google Scholar 

  29. Mohamed M, Khalafallah A (2013) Gelatinoous transformation of bone marrow in a patient with severe anorexia nervosa. Int J Hematol 97:157–158. doi:10.1007/s12185-012-1255-y

    Article  PubMed  Google Scholar 

  30. Kennedy A, Kohn M, Lammi A, Clarke S (2004) Iron status and haematological changes in adolescent female inpatients with anorexia nervosa. J Paediatr Child Health 40:430–432

    Article  CAS  PubMed  Google Scholar 

  31. Karahmadi M, Layegh E, Layegh S, Keypour M (2011) High level increase in liver enzymes and severe thrombocytopenia in a male case of anorexia nervosa(*). J Res Med Sci 16:1378–1381

    PubMed Central  CAS  PubMed  Google Scholar 

  32. Yoshiuchi K, Takimoto Y, Moriya J, Inada S, Akabayashi A (2010) Thrombopoietin and thrombocytopenia in anorexia nervosa with severe liver dysfunction. Int J Eat Disord 43:675–677. doi:10.1002/eat.20762

    Article  PubMed  Google Scholar 

  33. Renthal W, Marin-Valencia I, Evans PA (2014) Thiamine deficiency secondary to anorexia nervosa: an uncommon cause of peripheral neuropathy and Wernicke encephalopathy in adolescence. Pediatr Neurol 51:100–103. doi:10.1016/j.pediatrneurol.2014.03.025

    Article  PubMed  Google Scholar 

  34. Altinyazar V, Kiylioglu N, Salkin G (2010) Anorexia nervosa and Wernicke Korsakoff’s syndrome: atypical presentation by acute psychosis. Int J Eat Disord 43:766–769. doi:10.1002/eat.20783

    Article  PubMed  Google Scholar 

  35. Bodell LP, Keel PK, Brumm MC, Akubuiro A, Caballero J, Tranel D, Hodis B, McCormick LM (2014) Longitudinal examination of decision-making performance in anorexia nervosa; before and after weight restoration. J Psychiatr Res 56:150–157. doi:10.1016/j.jpsychires.2014.05.015

    Article  PubMed Central  PubMed  Google Scholar 

  36. Fonville L, Giampietro V, Williams SC, Simmons A, Tchanturia K (2014) Alterations in brain structure in adults with anorexia nervosa and the impact of illness duration. Psychol Med 44:1965–1975. doi:10.1017/S0033291713002389

    Article  CAS  PubMed  Google Scholar 

  37. Boghi A, Sterpone S, Sales S, D’Agata F, Bradac GB, Zullo G, Munno D (2011) In vivo evidence of global and focal brain alterations in anorexia nervosa. Psychiatry Res 192:154–159. doi:10.1016/j.pscychresns.2010.12.008

    Article  PubMed  Google Scholar 

  38. Wagner A, Greer P, Bailer UF, Frank GK, Henry SE, Putnam K, Meltzer CC, Ziolko SK, Hoge J, McConaha C, Kaye WH (2006) Normal brain tissue volumes after long-term recovery in anorexia and bulimia nervosa. Biol Psychiatry 59:291–293

    Article  PubMed  Google Scholar 

  39. Roberto CA, Mayer LE, Brickman AM, Barnes A, Muraskin J, Yeung LK, Stefferner J, Sy M, Hirsch J, Stern Y, Walsh BT (2011) Brain tissue volume changes following weight gain in adults with anorexia nervosa. Int J Eat Disord 44:406–411. doi:10.1002/eat.20840

    Article  PubMed  Google Scholar 

  40. Holmes SR, Gudridge TA, Gaudiani JL, Mehler PS (2012) Dysphagia in severe anorexia nervosa: a case report. Int J Eat Disord 45:463–466. doi:10.1002/eat.20971

    Article  PubMed  Google Scholar 

  41. Olausson EA, Storsrud S, Grundin H, Isaksson M, Attvall S, Simren M (2014) A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol 109:375–385. doi:10.1038/ajg.2013.453

    Article  CAS  PubMed  Google Scholar 

  42. Sachs K, Andersen D, Sommer J, Winkelman A, Mehler PS (2015) Avoiding medical complications during the refeeding of patients with anorexia nervosa. Eat Disord 9:1–11

    Google Scholar 

  43. Mascolo M, Dee E, Townsend R, Brinton JT, Mehler PS (2015) Severe gastric dilation due to superior mesenteric artery syndrome in anorexia nervosa. Int J Eat Disord. 48(5):532–5334. doi:10.1002/eat.22385

  44. Smith RW, Korenblum C, Thacker K, Bonifacio HJ, Gonska T, Katzman DK (2013) Severely elevated transaminases in an adolescent male with anorexia nervosa. Int J Eat Disord 46:751–754. doi:10.1002/eat.22162

    Article  PubMed  Google Scholar 

  45. Harris RH, Sasson G, Mehler PS (2013) Elevations of liver function tests in severe anorexia nervosa. Int J Eat Disord 46:369–374. doi:10.1002/eat.22073

    Article  PubMed  Google Scholar 

  46. Krantz MJ, Mehler PS (2004) Resting tachycardia, a warning sign in anorexia nervosa: case report. BMC Cardiovasc Disord 4:10–13

    Article  PubMed Central  PubMed  Google Scholar 

  47. Galetta F, Franzoni F, Prattichizzo F, Rolla M, Santoro G, Pentimone F (2003) Heart rate variability and left ventricular diastolic function in anorexia nervosa. J Adolesc Heatlh 32:416–421

    Article  Google Scholar 

  48. American Psychiatric Association (2006) Treatment of patients with eating disorders. Third edition. Am J Psychiatry 163:4–54

    Google Scholar 

  49. Shamin T, Goden NH, Arden M, Filiberto L, Shenker IR (2003) Resolution of vital sign instability. An objective measure of medical stability in anorexia nervosa. J Adolesc Health 32:73–77

    Article  Google Scholar 

  50. Olivares JL, Vazquez M, Fleta J, Moreno LA, Perez-Gonzalez JM, Bueno M (2005) Cardiac findings in adolescents with anorexia nervosa at diagnosis and after weight restoration. Eur J Pediatr 164:383–386

    Article  PubMed  Google Scholar 

  51. Johnson GL, Humphies LL, Shirley PB, Mazzoleni A, Noonan JA (1986) Mitral valve prolapse in patients with anorexia nervosa and bulimia. Arch Intern Med 146:1525–1529

    Article  CAS  PubMed  Google Scholar 

  52. Docx MK, Gwellig M, Simons A, Vandenberghe P, Weyler J, Ramet J, Mertens L (2010) Pericardial effusions in adolescent girls with anorexia nervosa: clinical course and risk factors. Eat Disord 18:218–225. doi:10.1080/10640261003719484

    Article  PubMed  Google Scholar 

  53. Isner JM, Roberts WC, Heynsfield SB, Yager J (1985) Anorexia nervosa and sudden death. Ann Intern Med 102:49–52

    Article  CAS  PubMed  Google Scholar 

  54. Oflaz S, Yucel B, Oz F, Sahin D, Ozturk N, Yaci O, Polat N, Gurdal A, Cizgici AY, Dursun M, Oflaz H (2013) Assessment of myocardial damage by cardiac MRI in patients with anorexia nervosa. Int J Eat Disord 46:862–866. doi:10.1002/eat.22170

    Article  PubMed  Google Scholar 

  55. Facchini M, Sala L, Malfatto G, Bragato R, Redaelli G, Invitti C (2006) Low-K+ dependent QT prolongation and risk for ventricular arrhythmia in anorexia nervosa. Int J Cardiol 106:170–176

    Article  PubMed  Google Scholar 

  56. Mehler PS, Krantz MJ (2005) QT dispersion in anorexia nervosa. Am J Cardiol 96:1034

    Article  PubMed  Google Scholar 

  57. Melanson E, Donahoo WT, Krantz MJ, Poirier P, Mehler PS (2004) Resting and ambulatory heart rate variability in chronic anorexia nervosa. Am J Cardiol 94:1217–1220

    Article  PubMed  Google Scholar 

  58. Biffl WL, Narayanan V, Gaudiani J, Mehler PS (2010) The management of pneumothorax in patients with anorexia nervosa: a case report. Patient Saf Surg 4:1–4. doi:10.1186/1754-9493-4-1

    Article  PubMed Central  PubMed  Google Scholar 

  59. Gardini GG, Boni E, Todisco P, Manara F, Borghesi A, Tantucci C (2009) Respiratory function in patients with stable anorexia nervosa. Chest 136:1356–1363. doi:10.1378/chest.08-3020

    Article  Google Scholar 

  60. Singhal V, Misra M, Klibanski A (2014) Endocrinology of anorexia nervosa in young people: recent insights. Curr Opin Endocrinol Diabetes Obes 21:64–70. doi:10.1097/MED.0000000000000026

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  61. Vyver E, Steinegger C, Katzman DK (2008) Eating disorders and menstrual dysfunction in adolescents. Ann N Y Acad Sci 1135:253–264. doi:10.1196/annals.1429.013

    Article  PubMed  Google Scholar 

  62. Miller KK, Wexler TL, Zha AM, Lawson EA, Meenaghen EM, Misra M, Binstock AB, Herzog AB, Klibanski A (2007) Andogen deficiency: association with increased anxiety and depression symptom severity in anorexia nervosa. J Clin Psychiatry 68:959–965

    Article  CAS  PubMed  Google Scholar 

  63. Misra M, Miller KK, Almazan C, Ramaswamy K, Lapcharoensap W, Worley M, Neubauer G, Herzbog DB, Klibanski A (2004) alterations in cortisol secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism. J Clin Endocrinol Metab 89:4972–4980

    Article  CAS  PubMed  Google Scholar 

  64. Mehler PS, Eckel RH, Donahoo WT (1999) Leptin levels in restricting and purging anorectics. Int J Eat Disord 26:189–194

    Article  CAS  PubMed  Google Scholar 

  65. Rich LM, Caine MR, Findling JW, Shaker JL (1990) Hypoglycemic coma in anorexia nervosa. Case report and review of the literature. Arch Intern Med 150:894–895

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Medicine and ACUTE at Denver Health, 777 Bannock Street, Denver, CO, 80204, USA

    Carrie Brown & Philip S. Mehler

  2. Eating Recovery Center, 7351 E Lowry Blvd, Suite 200, Denver, CO, 80230, USA

    Philip S. Mehler

Authors
  1. Carrie Brown
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Philip S. Mehler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philip S. Mehler.

Ethics declarations

Conflict of interest

Dr. Philip S. Mehler and Dr. Carrie Brown declare that they have no significant competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Brown, C., Mehler, P.S. Medical complications of anorexia nervosa and their treatments: an update on some critical aspects. Eat Weight Disord 20, 419–425 (2015). https://doi.org/10.1007/s40519-015-0202-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-015-0202-3

Keywords

Search

Navigation