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What are the most serious problems associated with anorexia?

Dangers Of Anorexia

Divya Kakaiya (Program Founder and Clinical Supervisor) gives expert video advice on: What are the most serious problems associated with anorexia?; How many people die from anorexia?; What happens to an anorexic's menstruation cycle? and more...

What are the most serious problems associated with anorexia?

In my mind, the most serious problem is death. What is probably not known in the community is that eating disorders have the highest mortality rate of all psychiatric conditions. So the dangers associated with anorexia are death, suicide rates are high, but depression is high, and death actually occurs primarily out of medical conditions like heart arrhythmias or the heart just the person just doesn't wake up in the morning, or you know irregularities within their physical system. So what's important for people to understand is you know a lot of people will joke about "Oh I wish I could just get anorexia for a few days." What they're not realizing is that the medical complications that we have with anorexia are very very severe and they're lifelong and they tend to linger with a person for a long time. Digestive difficulties, hormonal difficulties. The miscarriage rates among women who are recovered from anorexia tend to be twice that of normal women.Ostopenia, osteoporosis is huge. Loss of teeth, loss of you know muscle mass, because the muscle mass has attritioned to it. And so all of those factors - kidney stones, severe malnourishment, you know the dehydration that comes along with eating disorders will often have kidney malfunction as result of it. Some of my patients will have lost a kidney to their anorexia.

How many people die from anorexia?

For a large outcome study that was done recently, 7.4 % die from anorexia nervosa. Four out of 10 of those deaths are attributed to suicide. Of the women who die from anorexia, four out of those are as a result of suicide, and the other six would be conditions related to the heart or other severe medical conditions, because the body goes through so much trauma. This death rate is a very high death rate for anorexia. 7.4% is very very high.

What happens to an anorexic's menstruation cycle?

Well typically, any time a person loses a certain percentage of their body weight then they stop having period's. When we lose that much muscle mass then we lose oestrogen. When we lose that much oestrogen then their period stops. When the period stops then the ovaries stop functioning. When the ovaries stop functioning, and because the ovaries produce the oestrogen and the bones need the oestrogen, then the bone starts to get affected. So my patients could lose their period for about six months. If an anorexic loses her period for six months, right away if we do a bone density scan we see the signs of osteopnea even if they just lost six menstrual cycles, and what we find is that even as they resume their nourishment again and they start to eat and the body can re-nourish itself, it takes a while for the period to come back, and some of the bone that the person loses is never regained. So you could have a sixteen year old that ends up having the bones of a three year old after she's had anorexia for two years. It's huge. This bone loss is huge and it's irreversible. So the menstrual cycle ceases because you don't have the muscle and the fat in your body, basically, to maintain the menstrual cycle. When you lose that menses, there is this ripple effect that occurs to the bones that is very dangerous.

Can an anorexic get pregnant?

Yes. Typically it's next to impossible for an anorexic to suffer from <a href="http://www.videojug.com/interview/signs-of-pregnancy">pregnancy symptoms</a> and get pregnant because they're not producing the estrogen in order to have a pregnancy. But what's really interesting is - my patients, and even in the data in our field, is that for majority of women with histories of anorexia where they're even completely recovered from the anorexia and they go and get married and they want to get pregnant, fertility is really affected for them. So that there are some windows of time during our adolescence if we don't have our period, it ends up having long term effects on a woman's fertility. And most girls are not thinking about that when they're anorexic that this is going to affect me having a family later on and even when we talk about it, often times, there is so much denial with anorexia that they're not seeing the immediate effects. 'You know, right now I feel good. I feel really good. I feel on top of the world. Who cares about whether I can have babies or not, i can adopt anyway.' There's that whole kind of a denial sort of thing but what the person doesn't even realize is that as a result of not having the period you got your bones that are getting affected and you going to start having fractures at a very young age and your bones are brittle. So if your bones are going to get brittle and you want to exercise and you want to do the things that you want to do then you're not going to be able to do those things. So your quality of life gets affected.

What can happen to an anorexic's teeth and digestive system?

Their teeth great really, because again when you get bone loss, you have enamel loss and so the teeth get loose and they start to get gaps in between them. There's a whole lot of enamel erosion as well as gum erosion, and so the teeth get really fragile and weak. Then, with their digestive system what starts to happen is that because the body is so traumatised by the irregularity with which it gets food, sometimes it gets food and sometimes it doesn't get food, and so the digestive system doesn't know if it should throw out the hydrochloric acid in order to digest food. It's constantly throwing out acid, so a lot of the time the patients will have heartburn. They'll have heartburn because they're not eating and they have a lot of bloating. They have got to eat just a little bit of food, and then the body kicks all this acid out, so what ends up happening is they are actually feeling very bloated.

Do the dangers go away once treatment for anorexia begins?

Absolutely not. With a lot of my patients, when the body starts to get recovered, they actually feel the worst when they're starting to get better. Because all these different systems are starting to heal, and particularly the digestive system. What I find in a lot of my patients is it takes about two to three years of regulating your food before your body knows how to deal with the digestive system in a more healthy, appropriate way. So, even when they start to get better, when they're healing, the bloating will still remain there, the constipation will be there, the diarrhoea will be there, they'll have tons and tons of cavities that they're having. I've had patients who spend anywhere from ten, to fifteen thousand dollars a year on the dental work they have to get done as a result of the eating disorder. These are not even people who are bulimic, these will be people who are anorexic - because of the amount of erosion that happens in the mouth, as a result of the eating disorder.