What Specific Effects Can Eating Disorders Have on Your Health?
Eating disorders are a classification of psychiatric illnesses within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). These conditions are distinguished by their detrimental effects on patterns of thinking, eating and behavior surrounding food and self-image.
Individuals develop an unhealthy preoccupation with their bodies, often having a disproportionate viewpoint on appearance as it relates to self-worth. The disordered behaviors aren't the root of the problem but rather a way to cope with negative psychological issues. Consequently, these behaviors have a strong impact on psychological, sexual and biological health, and can become fatal if left unchecked.
Of all the disorders under this umbrella, anorexia nervosa, bulimia nervosa and binge eating disorder (BED) are the most widely recognized. Each has a unique symptomatology, but their consequences are equally widespread. Patients may lose the ability to function in their daily lives, which negatively affects their interpersonal relationships and impedes occupational capabilities.
Sufferers often have diminished sexual performance and see romantic relationships fall apart, and some may even have reduced work-related skills that cost them academic standing and/or job stability.
Heart health and eating disorders
One of the most perilous effects of eating disorders is their impact on the heart, which is the epicenter of physiological function. Cardiac damage can be life-threatening. The three most notable eating disorders—anorexia nervosa, bulimia nervosa and binge eating disorder—are significantly harmful to heart health, and heart failure is one of the leading causes of eating disorder-related deaths.
People with anorexia who experience prolonged starvation are frequently hospitalized for heart complications. Anorexia causes a loss of muscle mass—the body essentially starts to "eat" itself for fuel—and the heart is a muscle. This effect prevents the heart from efficiently pumping blood, and to conserve energy, it slows down (bradycardia) and shrinks—sometimes to the point of failure.
Bulimia is harmful in its own right.
"People with eating disorders might engage in binge eating, self-induced vomiting, excessive exercise, and inappropriate use of laxatives and diuretics—all of these behaviors carry medical risks," explained Henry Cheng, M.D., the regional medical director of The Renfrew Center, an eating disorders treatment facility in New York City. "Of particular concern are electrolyte abnormalities that can be caused by vomiting, as these can lead to abnormal heart rhythms and even sudden death."
Many people with BED are overweight, so the extra strain on the heart can prevent it from pumping normally. Thus, they are consequently at an elevated risk for developing hypertension, type 2 diabetes and high cholesterol. These conditions can lead to strokes and heart attacks and potentially progress to heart disease and death.
Hormones, pregnancy and eating disorders
"Other parts of the system that get dysregulated are the appetite hormones," said Molly Perlman, M.D., MPH, CEDS, chief medical officer of Monte Nido & Affiliates, based in Miami, and a board of directors member with Eating Disorders Coalition.
These chemicals tell us when we're hungry and when we're satiated, according to Perlman. People who have a healthy relationship with food can listen to those cues, but regarding eating disorders, hunger hormones instead induce negative emotions that drive people to either avoid eating or overeat.
Similarly, people with bulimia and BED don't have as much signaling for satiation, which drives them to continue eating.
Pregnancy is negatively affected by eating disorders, too. Female reproductive hormones responsible for menstruation and ovulation diminish, potentially causing infertility. Pregnancy complications, including miscarriage, difficult labor, premature and underdeveloped infants, stillbirths and gestational diabetes, may also ensue.
New mothers may have difficulty with breastfeeding and are more likely to experience postpartum depression. Psychologically, existing eating disorder symptoms may be exacerbated, and some women even develop them during pregnancy.
Among the most common side effects of anorexia and bulimia are disruptions to the menstrual cycle, caused by reproductive hormone imbalances. Anorexia is predominantly responsible for amenorrhea (loss of periods), while irregular periods are typically caused more by bulimia, which is due to the degrees of malnutrition, as people with bulimia tend to take in more calories than those with anorexia.
However, both menstrual conditions can occur with either disorder and can lead to fertility issues.
Mental health and eating disorders
Eating disorders are detrimental on their own, but many people have additional comorbidities. Johnny Williamson, M.D., a Chicago-area psychiatrist who practices virtually with the eating disorder treatment program Alsana, said most people he encounters for eating disorder treatment have received some sort of mental healthcare prior to identification, diagnosis or even suspicion.
Experts have identified depressive and anxiety disorders, such as clinical depression and obsessive-compulsive disorder (OCD), to be prevalent dual diagnoses, along with borderline personality disorder (BPD) and substance use disorders.
Starvation can also be associated with cognitive impairment, Cheng said. Obsessive thoughts about food and impaired reasoning skills are common, especially in advanced stages of malnutrition. He explained that the impacts on emotional health, such as finding it difficult to eat with others and avoiding situations that might involve food, can lead to impaired social function and isolation. These effects are particularly damaging because eating disorders thrive in solitude.
A history of trauma—especially sexual or violent in nature—often coincides with an eating disorder.
"We also see a lot of other forms of trauma, a lot of bullying or emotional neglect…it's tough being a kid these days, so you can imagine some of the things people have been exposed to," Perlman explained. "If you don't address both, you're just cycling through and one gets worse while the other gets better."
Eating disorders, ED and sexual health in men
Eating disorders are not just women's diseases. Plenty of men develop them. Many of those men experience a strong impact on sexual health related to malnutrition and insufficient testosterone levels. Erectile dysfunction (ED) and impaired libido are two consequences of eating disorders for men. Physical and psychological factors, such as depression and anxiety, that cause and are caused by eating disorders take a toll on sexual health.
Circulatory problems can further impede a person's ability to get and maintain an erection, potentially resulting in self-shame and further inhibition.
Endocrine systems are the basis for sexual health, so anything that affects their balance can cause sexual dysfunction, Williamson said.
Both Perlman and Williamson emphasized the effect of problematic body image and poor self-esteem on libido and the desire for intimacy. With any eating disorder, these insecurities may further contribute to performance anxiety and an unwillingness to participate in sexual encounters.
Perlman recalled severe instances where the eating disorder—rather than the person's partner—becomes the main relationship in someone's life.
Complications and related conditions
The dangers of eating disorders affect every part of the body and its systems.
The gastrointestinal system is directly correlated, and patients may experience bowel movement difficulties, metabolic changes and chronic stomachaches and pains.
Purging behaviors are detrimental as well. Chronic vomiting causes the salivary glands to swell, and stomach acid erodes the esophagus—potentially to the point of rupture—and rots teeth.
Organ rupture can occur with both BED and bulimia anywhere within the gastrointestinal system.
Medical complications related to binge eating disorder resemble complications that result from clinical obesity, including:
- Cardiovascular disease
- Type 2 diabetes
- Several cancers
Starvation can lead to:
- Skin and hair dryness
- Frequent bone injuries
Lack of insulation causes the core body temperature to drop, leading to hypothermia and the growth of fine, downy hair called lanugo. Furthermore, malnutrition from any eating disorder alters brain structure.
"There have been imaging studies that show loss of gray matter in the brain, so the brain actually shrinks," Perlman said. "More studies show it does come back, but it takes a lot of time, sometimes with months or years of recovery. If someone falls back into old patterns, it can affect brain volume."
Other neurological complications include problems with concentration, fainting and dizziness, peripheral neuropathy, sleep disturbances and seizures from severe dehydration, and electrolyte imbalances.
The direst of all eating disorder-related complications is death. A longitudinal study in 2016 revealed elevated standardized mortality ratios for each condition, with anorexia being the highest at 5.35, meaning more than five times as many deaths are expected in people with anorexia than in people without anorexia. Bulimia and binge eating disorder are less threatening, with rates of 1.49 and 1.50, respectively.
Though many people with anorexia or BED die from associated medical conditions, people with bulimia have significantly high rates of suicide.
Eating disorders are complicated conditions. They manifest physically but are psychological disorders, and their effects impact all bodily systems. Don't let an eating disorder take over your life. Talk to someone.
If it's not a family member or a friend, talk to a professional. Don't have a regular therapist? Then taking that first step can be difficult but not impossible. Giddy telehealth takes the difficulty out of such a search, providing access to hundreds of healthcare professionals who offer video visits as a regular part of their practices. It is an easy-to-use online portal whose therapists and physicians have expertise across the full scope of medical care. Many have same-day appointments.