What, exactly, does anorexia nervosa do inside the human body? The heart and bones suffer the most.

(August 2005) -- Anorexia nervosa takes an enormous toll on the body. But that's not all. It has the highest death rate of any mental illness. Between 5% and 20% of people who develop the disease eventually die from it. The longer you have it, the more likely you will die from it. Even for those who survive, the disorder can damage almost every body system.

What happens exactly? Here's a look at what anorexia does to the human body.

The first victim of anorexia is often the bones. The disease usually develops in adolescence -- right at the time when young people are supposed to be putting down the critical bone mass that will sustain them through adulthood.

"There's a narrow window of time to accrue bone mass to last a lifetime," says Diane Mickley, MD, co-president of the National Eating Disorders Association and the founder and director of the Wilkins Center for Eating Disorders in Greenwich, Conn. "You're supposed to be pouring in bone, and you're losing it instead." Such bone loss can set in as soon as six months after anorexic behavior begins, and is one of the most irreversible complications of the disease.

But the most life-threatening damage is usually the havoc wreaked on the heart. As the body loses muscle mass, it loses heart muscle at a preferential rate -- so the heart gets smaller and weaker. "It gets worse at increasing your circulation in response to exercise, and your pulse and your blood pressure get lower," says Mickley. "The cardiac tolls are acute and significant, and set in quickly." Heart damage, which ultimately killed singer Karen Carpenter, is the most common reason for hospitalization in most people with anorexia.

Although the heart and the bones often take the brunt of the damage, anorexia is a multi-system disease. Virtually no part of the body escapes its effects. About half of all anorexics have low white-blood-cell counts, and about a third are anemic. Both conditions can lower the immune system's resistance to disease, leaving a person vulnerable to infections.

Anorexia Damage Starts Early

Even before a person with anorexia starts to look "too thin," these medical consequences have begun.

Many young women who begin eating a severely restricted diet stop menstruating well before serious weight loss sets in. Since so many people with anorexia are teenage girls and young women, this can have long-term consequences on their ability to bear children.

"In truly, fully recovered anorexics and bulimics, it looks like the rate, frequency and number of pregnancies is normal," says Mickley. "However, if you look at infertility clinics, and those patients in the clinics who have infrequent or absent periods, the majority of them appear to have occult eating disorders. They may think they're fully recovered, but they haven't gotten their weight up high enough."

Many women with anorexia would rather seek fertility treatment than treatment for their eating disorder, Mickley says. And even among women who have fully recovered from their anorexia and bulimia, there may be a slightly higher rate of miscarriages and caesarean sections. "There also may be up to a 30% higher incidence of postpartum depression as compared to other women," she says.

The Risks of Bulimia

Bulimia, which often goes hand in hand with anorexia, does its own unique health damage. Bulimics who purge by vomiting wreak havoc on their digestive tracts by chronically bathing them in stomach acid, which can lead to digestive disorders like reflux esophagitis.

"It feels like I've been drinking Drano," said one woman who posted to a forum on digestive diseases about the consequences of her lifelong anorexia and bulimia. Some reported cases suggest bulimia may have led to a condition called Barrett's esophagus, which may can lead to esophageal cancer.

continue: Damage from Anorexia May Be Reversible

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Reviewed: 03/2006