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Medical complications of anorexia nervosa and bulimia nervosa

Mitchell, James Ea; Crow, Scottb

Current Opinion in Psychiatry: July 2006 - Volume 19 - Issue 4 - p 438–443
doi: 10.1097/01.yco.0000228768.79097.3e
Medical comorbidity

Purpose of review This review focuses on recent publications concerning medical complications in patients with eating disorders, including anorexia nervosa and bulimia nervosa.

Recent findings Recent literature continues to reflect that multiple organ systems are frequently affected by eating disorders. The literature underscores the frequently cited risk of premature death in those with anorexia nervosa. A plethora of dermatologic changes have been described, some signaling serious underlying pathophysiology, such as purpura, which indicates a bleeding diathesis. Much of the literature continues to delineate the fact that diabetic patients with eating disorders are at high risk of developing diabetic complications. Gastrointestinal complications can be serious, including gastric dilatation and severe liver dysfunction. Acrocyanosis is common, and patients with anorexia nervosa are at risk of various arrhythmias. Low-weight patients are at high risk for osteopenia/osteoporosis. Nutritional abnormalities are also common, including sodium depletion and hypovolemia, hypophosphatemia and hypomagnesemia. Resting energy expenditure, although very low in low-weight patients, increases dramatically early in refeeding.

Summary Medical complications are common and often serious in patients with eating disorders, particularly those with anorexia nervosa.

aDepartment of Clinical Neuroscience, University of North Dakota School of Medicine and the Neuropsychiatric Research Institute, Fargo, North Dakota, USA

bDepartment of Psychiatry, University of Minnesota School of Medicine, Minneapolis, Minnesota, USA

Correspondence to Professor James E. Mitchell, Neuropsychiatric Research Institute, 120 South 8th Street, Fargo, ND 58103, USA Tel: +1 701 365 4916; fax: +1 701 293 3226; e-mail:

© 2006 Lippincott Williams & Wilkins, Inc.