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Medical Complications of Anorexia Nervosa and Bulimia
Open accessAbstract
Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
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“Unlike cancer or Alzheimer’s disease, most medical complications associated with anorexia can be treated with adequate nutritional intake and weight restoration, even in severely emaciated patients (3, 146).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [146]
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“These impairments contribute to a vicious cycle where malnutrition exacerbates cognitive deficits that hinder effective treatment engagement and decision-making, resulting in a pattern of diminished capacity that fuels the disorder itself (146).”
From Assisted death in eating disorders: a systematic review of cases and clinical rationales (2024) · cites this paper as [146]
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“most medical complications are reversible with nutritional rehabilitation and expert care [9].”
From Terminal anorexia nervosa is a dangerous term: it cannot, and should not, be defined (2022) · cites this paper as [9]
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Anorexia nervosa: COVID‑19 pandemic period (Review)
Dumitrașcu, M. C., Şandru, F., Carşote, M., Petca, R., Gheorghisan-Galateanu, A. A., Petca, A. T., & Valea, A. (2021) · Experimental and Therapeutic Medicine · doi:10.3892/etm.2021.10236 · Cited by 30
Mindfulness in Anorexia Nervosa: An Integrated Review of the Literature
Dunne, J. P. (2017) · Journal of the American Psychiatric Nurses Association · doi:10.1177/1078390317711250 · Cited by 29
Anorexia nervosa in adolescents
Peterson, K., & Fuller, R. (2019) · Nursing · doi:10.1097/01.nurse.0000580640.43071.15 · Cited by 29
Zhang, R., Kuja‐Halkola, R., Birgegård, A., Larsson, H., Lichtenstein, P., Bulik, C. M., & Bergen, S. E. (2021) · Psychological Medicine · doi:10.1017/s0033291721001574 · Cited by 28
“Furthermore, it is well known that EDs are associated with multiple somatic complications and illnesses (Herpertz-Dahlmann, 2015; Olguin et al., 2017; Westmoreland et al., 2016).”
BackgroundBone density status in a large population of patients with anorexia nervosa
Workman, C., Blalock, D. V., & Mehler, P. S. (2019) · Bone · doi:10.1016/j.bone.2019.115161 · Cited by 32
Complicações clínicas da anorexia nervosa e bulimia nervosa
de Assumpção, C. R. L., & Cabral, M. D. (2002) · Brazilian Journal of Psychiatry · doi:10.1590/s1516-44462002000700007 · Cited by 28
The Role of Serious Video Games in the Treatment of Disordered Eating Behaviors: Systematic Review
Tang, W. S. W., Ng, T. J. Y., Wong, J. Z. A., & Ho, C. S. H. (2022) · Journal of Medical Internet Research · doi:10.2196/39527 · Cited by 21
“Besides their implications for mental health, eating disorders also cause multisystemic medical complications [4].”
Eating disorders and oral health: a scoping review on the role of dietitians
Norrie, T. P., Ramjan, L. M., Sousa, M. S., Sank, L., & George, A. (2020) · Journal of Eating Disorders · doi:10.1186/s40337-020-00325-0 · Cited by 27
Lin, J., Jhe, G., Vitagliano, J. A., Milliren, C. E., Spigel, R., Woods, E. R., Forman, S. F., & Richmond, T. K. (2021) · Journal of Eating Disorders · doi:10.1186/s40337-021-00415-7 · Cited by 27
“The medical complications of EDs can affect all organ systems and are largely driven by malnutrition [2, 3].”
BackgroundRoubalová, R., Procházková, P., Dvořák, J., Hill, M., Papežová, H., Kreisinger, J., Bulant, J., Lambertová, A., Holanová, P., Bilej, M., et al. (2021) · Frontiers in Nutrition · doi:10.3389/fnut.2021.680870 · Cited by 27
“Further, various cardiac, pulmonary, hematological, and musculoskeletal disorders are connected with this disease (9).”
BackgroundSeverity of somatic symptoms in outpatients with anorexia and bulimia nervosa
Weigel, A., Löwe, B., & Kohlmann, S. (2018) · European Eating Disorders Review · doi:10.1002/erv.2643 · Cited by 26
Riddle, M., O’Melia, A. M., & Bauschka, M. (2022) · Journal of Eating Disorders · doi:10.1186/s40337-022-00605-x · Cited by 25
“While receiving nutrition is immensely distressing to an individual with an eating disorder, it is critical to note that malnutrition is not a terminal illness and nearly all of the resulting medical complications can be reversed with nourishment [16].”
BackgroundAsaria, A. (2025) · Journal of Eating Disorders · doi:10.1186/s40337-024-01145-2 · Cited by 25
“15 Studies have shown that osteoporosis tends to be more severe in male ED sufferers [141, 142].”
So, B. P.-H., Lai, D. K.-H., Cheung, D. S. K., Lam, W., Cheung, J. C., & Wong, D. W. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19105821 · Cited by 34
“Individuals with dementia often compounded with dysphagia resulting in sarcopenia [91] that mediates the vicious cycle toward anorexia and the risk of aspiration pneumonia [92].”
BackgroundVarela, C., Hoyo, Á., Tapia-Sanz, M. E., Jiménez‐González, A. I., Moral, B. J., Rodríguez-Fernández, P., Vargas-Hernández, Y., & Sánchez, L. J. R. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1221679 · Cited by 26
Langlet, B. S., Odegi, D., Zandian, M., Nolstam, J., Södersten, P., & Bergh, C. E. K. (2021) · JMIR Serious Games · doi:10.2196/24998 · Cited by 24
“However, most of these physical and mental problems normalize with weight regain [8].”
Costandache, G., Munteanu, O., Salaru, A., Oroian, B. A., & Cozmin, M. (2023) · Postępy Psychiatrii i Neurologii · doi:10.5114/ppn.2023.127237 · Cited by 29
Schnepper, R., Roemmel, N., Schaefert, R., Lambrecht-Walzinger, L., & Meinlschmidt, G. (2024) · JMIR Mental Health · doi:10.2196/57986 · Cited by 28
“Anorexia nervosa (AN) and bulimia nervosa (BN) are severe EDs with many medical complications, high mortality rates [32], slow treatment progress, and frequent relapses [33].”
Rienecke, R. D., Dimitropoulos, G., Duffy, A., Grange, D. L., Manwaring, J. L., Nieder, S., Sauerwein, J., Singh, M., Watters, A., Westmoreland, P., et al. (2023) · European Eating Disorders Review · doi:10.1002/erv.3010 · Cited by 23
Grammer, A. C., Fitzsimmons‐Craft, E. E., Laing, O., DePietro, B., & Wilfley, D. E. (2020) · Current Psychopharmacologye · doi:10.2174/2211556009999200416153022 · Cited by 25
Farrell, N. R., Brosof, L. C., Vanzhula, I. A., Christian, C., Bowie, O. R., & Levinson, C. A. (2019) · Behavior Therapy · doi:10.1016/j.beth.2019.01.008 · Cited by 22
Kidney Disease Associated With Anorexia Nervosa: A Case Series With Kidney Biopsies
Marumoto, H., Sasaki, T., Tsuboi, N., Ito, T., Ishikawa, M., Ogura, M., Ikeda, M., & Yokoo, T. (2020) · Kidney Medicine · doi:10.1016/j.xkme.2020.03.007 · Cited by 25
“Eating disorders, including anorexia nervosa, are abnormal eating behaviors that occur mainly in young women and are characterized by complications such as higher-order dysfunction, mental distress, and other psychiatric disorders.(1) Although the prevalence of anorexia nervosa has remained stable in recent years, it…”
BackgroundManagement of anorexia nervosa in pregnancy: a systematic and state-of-the-art review
Galbally, M., Himmerich, H., Senaratne, S., Fitzgerald, P., Frost, J., Woods, N., & Dickinson, J. E. (2022) · The Lancet Psychiatry · doi:10.1016/s2215-0366(22)00031-1 · Cited by 24
Braude, M. R., Con, D., Clayton‐Chubb, D., Nandurkar, R., Chua, L.-E., & Newnham, E. (2019) · Internal Medicine Journal · doi:10.1111/imj.14329 · Cited by 21
Metadata
- Authors
- Westmoreland, P., Krantz, M. J., & Mehler, P. S.
- Affiliations
- Denver Health Medical Center (US)
- Corresponding author
- Mehler, Philip S.
- Venue
- The American Journal of Medicine
- Publisher
- Elsevier BV
- Published
- 2016-01
- Volume
- 129
- Issue
- 1
- Pages
- 30-37
- ISSN
- 0002-9343 (ISSN-L)
- OpenAlex
- W808601510
- Cited by
- 467
- References
- 121
- Citations by year
- 2026: 33 · 2025: 55 · 2024: 36 · 2023: 58 · 2022: 56 · 2021: 56 · 2020: 61 · 2019: 43 · 2018: 17 · 2017: 17 · 2016: 16
- FWCI
- 2.39
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The American Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
- Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
- Health Sciences › Medicine › Psychiatry and Mental health › Child Nutrition and Feeding Issues
- Keywords
- anorexia nervosa, bulimia nervosa, eating disorders, medical complications, malnutrition, weight loss, purging behavior, body image distortion, psychiatric comorbidity, complication treatment
- MeSH terms
- Anorexia Nervosa, Humans, Comorbidity, Bulimia Nervosa
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