BULIMIA

It is an eating disorder. People with bulimia may secretly binge — eating large amounts
of food with a loss of control over the eating — and then purge, trying to get rid of the
extra calories in an unhealthy way.

To get rid of calories and prevent weight gain, people with bulimia may use different
methods. For example, you may regularly self-induce vomiting or misuse laxatives,
weight-loss supplements, diuretics or enemas after bingeing. Or you may use other
ways to rid yourself of calories and prevent weight gain, such as fasting, strict dieting or
excessive exercise.

If you have bulimia, you're probably preoccupied with your weight and body shape. You
may judge yourself severely and harshly for your self-perceived flaws. Because it's
related to self-image — and not just about food — bulimia can be hard to overcome. But
effective treatment can help you feel better about yourself, adopt healthier eating
patterns and reverse serious complications.

Symptoms
Bulimia signs and symptoms may include:

 Being preoccupied with your body shape and weight

 Living in fear of gaining weight

 Repeated episodes of eating abnormally large amounts of food in one sitting

 Feeling a loss of control during bingeing — like you can't stop eating or can't
control what you eat

 Forcing yourself to vomit or exercising too much to keep from gaining weight after
bingeing

 Using laxatives, diuretics or enemas after eating when they're not needed

 Fasting, restricting calories or avoiding certain foods between binges

 Using dietary supplements or herbal products excessively for weight loss

The severity of bulimia is determined by the number of times a week that you purge,
usually at least once a week for at least three months.

When to see a doctor

If you have any bulimia symptoms, seek medical help as soon as possible. If left
untreated, bulimia can severely impact your health.

Talk to your primary care provider or a mental health professional about your bulimia
symptoms and feelings. If you're reluctant to seek treatment, confide in someone about
what you're going through, whether it's a friend or loved one, a teacher, a faith leader, or
someone else you trust. He or she can help you take the first steps to get successful
bulimia treatment.

Helping a loved one with bulimia symptoms

If you think a loved one may have symptoms of bulimia, have an open and honest
discussion about your concerns. You can't force someone to seek professional care, but
you can offer encouragement and support. You can also help find a qualified doctor or
mental health professional, make an appointment, and even offer to go along.

Because most people with bulimia are usually normal weight or slightly overweight, it
may not be apparent to others that something is wrong. Red flags that family and
friends may notice include:

 Constantly worrying or complaining about being fat

 Having a distorted, excessively negative body image

 Repeatedly eating unusually large quantities of food in one sitting, especially foods
the person would normally avoid

 Strict dieting or fasting after binge eating

 Not wanting to eat in public or in front of others

 Going to the bathroom right after eating, during meals or for long periods of time

 Exercising too much

  Having sores, scars or calluses on the knuckles or hands

 Having damaged teeth and gums

 Changing weight

 Swelling in the hands and feet

 Facial and cheek swelling

Causes
The exact cause of bulimia is unknown. Many factors could play a role in the
development of eating disorders, including genetics, biology, emotional health, societal
expectations and other issues.

Risk factors
Girls and women are more likely to have bulimia than boys and men are. Bulimia often
begins in the late teens or early adulthood.

Factors that increase your risk of bulimia may include:

 Biology. People with first-degree relatives (siblings, parents or children) with an

eating disorder may be more likely to develop an eating disorder, suggesting a
possible genetic link. Being overweight as a child or teen may increase the risk.

 Psychological and emotional issues. Psychological and emotional problems,

such as depression, anxiety disorders or substance use disorders are closely
linked with eating disorders. People with bulimia may feel negatively about
themselves. In some cases, traumatic events and environmental stress may be
contributing factors.

 Dieting. People who diet are at higher risk of developing eating disorders. Many
people with bulimia severely restrict calories between binge episodes, which may
trigger an urge to again binge eat and then purge. Other triggers for bingeing can
include stress, poor body self-image, food and boredom.
Complications
Bulimia may cause numerous serious and even life-threatening complications. Possible
complications include:

 Negative self-esteem and problems with relationships and social functioning

 Dehydration, which can lead to major medical problems, such as kidney failure

 Heart problems, such as an irregular heartbeat or heart failure

 Severe tooth decay and gum disease

 Absent or irregular periods in females

 Digestive problems

 Anxiety, depression, personality disorders or bipolar disorder

 Misuse of alcohol or drugs

 Self-injury, suicidal thoughts or suicide

Prevention:

Major types of therapies for Eating Disorder

1. Cognitive Behavioral Therapy ( CBT )

- Cognitive behavioral therapy (CBT) is a form of psychotherapy that
focuses on negative patterns of thinking as well as beliefs that
contribute to these thought patterns. CBT teaches participants skills
that allow them to identify problematic beliefs as well as healthy ways
to cope with emotion.

CBT has been shown to effectively help those who may be struggling
with eating disorders or mood disorders and decrease destructive
behaviors. In relation to eating disorder, CBT may include educational
components and development of a meal plan as well as
addressing various facets.

2. Dialectical Behavioral Therapy

 Dialectical Behavior Therapy (DBT) is a form of psychotherapy that
connects cognitive and behavioral methods as an approach to coping
with painful emotions. The focus of this therapy is usually on
individuals who react to emotional circumstances with extreme
behaviors.
DBT includes the practice of Mindfulness as well as emotional
regulation. It has become an effective treatment therapy for men and
women who deal with emotional instability.

Although there's no sure way to prevent bulimia, you can steer someone toward
healthier behavior or professional treatment before the situation worsens. Here's how
you can help:

 Foster and reinforce a healthy body image in your children, no matter what their
size or shape. Help them build confidence in ways other than their appearance.

 Have regular, enjoyable family meals.

 Avoid talking about weight at home. Focus instead on having a healthy lifestyle.

 Discourage dieting, especially when it involves unhealthy weight-control behaviors,

such as fasting, using weight-loss supplements or laxatives, or self-induced
vomiting.

 Talk with your primary care provider. He or she may be in a good position to
identify early indicators of an eating disorder and help prevent its development.

 If you notice a relative or friend who seems to have food issues that could lead to
or indicate an eating disorder, consider supportively talking to the person about
these issues .Diagnosis & treatment

REFRENCES

1. Bulimia nervosa. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American
Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Feb. 1, 2018.
2. Bulimia nervosa. WomensHealth.gov. https://www.womenshealth.gov/a-z-topics/bulimia-nervosa. Accessed Feb. 1,
2018.

3. Bulimia nervosa. Merck Manual Professional Version. http://www.merckmanuals.com/professional/psychiatric-

disorders/eating-disorders/bulimia-nervosa. Accessed Feb. 1, 2018.

4. Engel S, et al. Bulimia nervosa in adults: Clinical features, course of illness, assessment, and diagnosis.
https://www.uptodate.com/contents/search. Accessed Jan. 25, 2018.

5. Davis H, et al. Pharmacotherapy of eating disorders. Current Opinion in Psychiatry. 2017;30:452.

6. Eating disorders. National Alliance on Mental Illness.

https://www.nami.org/Learn-More/Mental-Health-Conditions/Eating-Disorders/Overview. Accessed Jan. 25, 2018.

7. AskMayoExpert. Bulimia nervosa. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
Accessed Feb. 1, 2018.

8. Harrington BC, et al. Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American
Family Physician. 2015;91:46.

9. Herpertz-Dahlmann B. Treatment of eating disorders in child and adolescent psychiatry. Current Opinion in
Psychiatry. 2017;30:438.

10. Forman SF. Eating disorders: Overview of epidemiology, clinical features, and diagnosis.
https://www.uptodate.com/contents/search. Accessed Jan. 25, 2018.

11. Rienecke RD. Family-based treatment of eating disorders in adolescents: Current insights. Adolescent Health,
Medicine and Therapeutics. 2017;8:69.

12. Castillo M, et al. Bulimia nervosa/purging disorder. Current Problems in Pediatric and Adolescent Health Care.
2017;47:85.

13. Using dietary supplements wisely. National Center for Complementary and Integrative Health.
https://nccih.nih.gov/health/supplements/wiseuse.htm. Accessed Jan. 31, 2018.

14. Bipolar II disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. Arlington, Va.: American
Psychiatric Association; 2013. http://dsm.psychiatryonline.org. Accessed Feb. 15, 2018.

15. Sim LA (expert opinion). Mayo Clinic, Rochester, Minn. Feb. 21, 2018.

16. Campbell K, et al. Eating disorders in children and adolescents: State of the art review. Pediatrics. 2014;134:582.

17. Gerwitz O'Brien JR (expert opinion). Mayo Clinic, Rochester, Minn. March 6, 2018.

Is there a difference?
Anorexia and bulimia are both eating disorders. They can have similar symptoms,
such as distorted body image. However, they’re characterized by different food-
related behaviors.

For example, people who have anorexia severely reduce their food intake to lose
weight. People who have bulimia eat an excessive amount of food in a short period of
time, then purge or use other methods to prevent weight gain.

Although eating disorders aren’t specific to age or gender, women

are disproportionally affected by them. About 1 percent of all American women will
develop anorexia, and 1.5 percent will develop bulimia, according to the National
Association of Anorexia Nervosa and Associated Disorders (ANAD).

Overall, ANAD estimates that at least 30 million Americans are living with an eating

disorder such as anorexia or bulimia.

Keep reading to learn more about how these conditions present, how they’re
diagnosed, available treatment options, and more.

What are the signs and

symptoms?
Eating disorders are usually characterized by an intense preoccupation with food.
Many people who have an eating disorder also express dissatisfaction with their body
image.

Other symptoms are often specific to the individual condition.

Anorexia
Anorexia often stems from a distorted body image, which may result from emotional
trauma, depression, or anxiety. Some people may view extreme dieting or weight loss
as a way to regain control in their lives.

There are many different emotional, behavioral, and physical symptoms that can
signal anorexia.

The physical symptoms can be severe and life-threatening. They include:

 severe weight loss

 insomnia
 dehydration
 constipation
 weakness and fatigue
 dizziness and fainting
 thinning and breaking hair
 bluish tinge to the fingers
 dry, yellowish skin
 inability to tolerate cold
 amenorrhea, or absence of menstruation
 downy hair on the body, arms, and face
 arrhythmia, or irregular heartbeat

Someone with anorexia may exhibit certain behavioral changes before physical
symptoms are noticeable. This includes:

 skipping meals
 lying about how much food they’ve eaten
 eating only certain “safe” — usually low-calorie — foods
  adopting unusual eating habits, like sorting food on the plate or cutting food
into tiny pieces
 talking badly about their body
 trying to hide their body with baggy clothes
 avoiding situations that could involve eating in front of other people, which can
result in social withdrawal
 avoiding situations where their body would be revealed, like the beach
 extreme exercising, which may take the form of exercising for too long or too
intensely, like an hour-long jog after eating a salad

Emotional symptoms of anorexia may increase as the disorder progresses. They

include:

 poor self-esteem and body image

 irritability, agitation, or other mood changes
 social isolation
 depression
 anxiety

Bulimia

Someone with bulimia may develop an unhealthy relationship to food over time. They
may get caught up in damaging cycles of binge eating and then panic about the
calories they’ve consumed. This may lead to extreme behaviors to prevent weight
gain.

There are two different types of bulimia. The attempts to purge are used to
differentiate them. The new edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) now refers to attempts to purge as “inappropriate compensatory
behaviors”:
  Purging bulimia. Someone with this type will regularly induce vomiting after
binge eating. They may also misuse diuretics, laxatives, or enemas.
 Non-purging bulimia. Instead of purging, someone with this type may fast or
engage in extreme exercise to prevent weight gain after a binge.

Many people with bulimia will experience anxiety because their eating behavior is out
of control.

As with anorexia, there are many different emotional, behavioral, and physical
symptoms that can signal bulimia.

The physical symptoms can be severe and life-threatening. They include:

 weight that increases and decreases in significant amounts, between 5 and 20

pounds in a week
 chapped or cracked lips due to dehydration
 bloodshot eyes, or eyes with busted blood vessels
 callouses, sores, or scars on the knuckles from inducing vomiting
 mouth sensitivity, likely due to eroding tooth enamel and receding gums
 swollen lymph nodes

Someone with bulimia may exhibit certain behavioral changes before physical
symptoms are noticeable. This includes:

 constantly worrying about weight or appearance

 eating to the point of discomfort
 going to the bathroom immediately after eating
 exercising too much, especially after they’ve eaten a lot in one sitting
 restricting calories or avoiding certain foods
 not wanting to eat in front of others
Emotional symptoms may increase as the disorder progresses. They include:

 poor self-esteem and body image

 irritability, agitation, or other mood changes
 social isolation
 depression
 anxiety

What causes an eating disorder

like these?
It isn’t clear what causes anorexia or bulimia to develop. Many medical experts
believe it may be due to a combination of complex biological, psychological, and
environmental factors.

These include:

 Genetics. According to a 2011 studyTrusted Source, you may be more likely to

develop an eating disorder if you have a family member who has one. This may
be because of a genetic predisposition to traits associated with eating disorders,
such as perfectionism. More research is needed to determine whether there’s
truly a genetic link.

 Emotional well-being. People who have experienced trauma or have mental

health conditions, such as anxiety or depression, may be more likely to develop
an eating disorder. Feelings of stress and low self-esteem may also contribute
to these behaviors.
  Societal pressures. The current Western ideal of body image, self-worth, and
success equated with thinness can perpetuate the desire to achieve this body
type. This may be emphasized further by pressure from the media and peers.

How are eating disorders

diagnosed?
If your doctor suspects that you have an eating disorder, they’ll run several tests to
help make a diagnosis. These tests can also assess any related complications.

The first step will be a physical exam. Your doctor will weigh you to determine your
body mass index (BMI). They’ll likely look at your past history to see how your
weight has fluctuated over time. Your doctor will likely ask about your eating and
exercise habits. They may also ask you to complete a mental health questionnaire.

At this stage, your doctor will likely order lab tests. This can help rule out other
causes of weight loss. It can also monitor your overall health to make sure that no
complications have occurred as a result of a possible eating disorder.

If the tests reveal no other medical causes for your symptoms, your doctor may refer
you to a therapist for outpatient treatment. They may also refer you to a nutritionist to
help you get your diet back on track.

If severe complications have occurred, your doctor may recommend that you get
inpatient treatment instead. This will allow your doctor or another medical
professional to monitor your progress. They can also watch for signs of further
complications.

In either case, your therapist may be the one to actually diagnose a specific eating
disorder after talking about your relationship with food and weight.
Diagnostic criteria

There are different criteria that the DSM-5 uses to diagnose anorexia or bulimia.

The criteria required to diagnose anorexia is:

 restricting food intake to maintain a weight below the average weight for your
age, height, and overall build
 an intense fear of gaining weight or becoming fat
 connecting your weight with your worth or other distorted perceptions about
body image

The criteria required to diagnose bulimia is:

 recurrent episodes of binge eating

 recurrent inappropriate compensatory behaviors — like excessive exercise,
self-induced vomiting, fasting, or misuse of laxatives — to prevent weight gain
 bingeing and inappropriate compensatory behaviors both occurring an average
of at least once per week, for at least three months
 connecting your weight with your worth or other distorted perceptions about
body image
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What treatment options are

available?
There’s no quick cure for an eating disorder. But there are a number of treatments
available to treat both anorexia and bulimia.
Your doctor may recommend a combination of talk therapies, prescription
medications, and rehabilitation to treat either condition.

The overall goal of treatment is to:

 address the underlying cause of the condition

 improve your relationship with food
 modify any unhealthy behaviors

If you’re concerned about your eating behavior and don’t already have a mental
healthcare provider, you can view doctors in your area through the Healthline
FindCare tool.

Medication

According to a 2005 studyTrusted Source, medication has shown little efficacy for the
treatment of anorexia.

However, of the few trials conducted, there’s evidence to suggest that:

 Olanzapine (Zyprexa) may stimulate appetite and encourage eating.

 Antidepressant selective serotonin reuptake inhibitors (SSRIs),
like fluoxetine (Prozac) and sertraline (Zoloft), can help treat depression and
OCD, which could be a side effect of or even cause the eating disorder.

Medicinal options for bulimia appear to be a little more promising. The 2005

studyTrusted Source indicates a number of medications may be effective in treating
this disorder.

They include:
  SSRIs like fluoxetine (Prozac) can help treat underlying depression, anxiety, or
OCD, and reduce bingeing-purging cycles.

 Monoamine oxidase inhibitors like buspirone (Buspar) can help decrease

anxiety and reduce bingeing-purging cycles.

 Tricyclic antidepressants like Imipramine (Tofranil) and desipramine

(Norpramin) can help reduce bingeing-purging cycles.

 Antiemetic medications like ondansetron (Zofran) can help reduce purging.

Therapy

Cognitive behavioral therapy (CBT) uses a combination of talk therapy and

behavioral modification techniques. It may involve addressing past trauma, which
could have caused a need for control or low self-esteem. CBT can also involve
questioning your motivations for extreme weight loss. Your therapist will also help
you develop practical, healthy ways to deal with your triggers.

Family therapy may be recommended for adolescents and children. It aims to improve
communication between you and your parents, as well as teach your parents how to
best support you in your recovery.

Your therapist or doctor may also recommend support groups. In these groups, you
can talk with others who have experienced eating disorders. This can provide you with
a community of people who understand your experience and can offer helpful insight.

Outpatient vs. inpatient

Eating disorders are treated in both outpatient or inpatient settings.

For many, outpatient treatment is the preferred approach. You’ll see your doctor,
therapist, and nutritionist regularly, but you can resume your daily life. You won’t
have to miss substantial amounts of work or school. You can sleep in the comforts of
your own home.

Sometimes, inpatient treatment is required. In these cases, you’ll be hospitalized or

placed in a live-in treatment program designed to help you overcome your disorder.

Inpatient treatment may be necessary if:

 You haven’t complied with outpatient treatment.

 Outpatient treatment hasn’t been effective.
 You show signs of excessively misusing diet pills, laxatives, or diuretics.
 Your weight is less than or equal to 70 percent of your healthy body weight,
putting you at risk for severe complications.
 You’re experiencing severe depression or anxiety.
 You’re demonstrating suicidal behaviors.

Are complications possible?

If left untreated, anorexia and bulimia can lead to life-threatening complications.

Anorexia

Over time, anorexia can cause:

 anemia
 electrolyte imbalance
 arrhythmia
  bone loss
 kidney failure
 heart failure

In severe cases, death may occur. This is possible even if you aren’t yet underweight.
It can result from arrhythmia or an imbalance of electrolytes.

Bulimia

Over time, bulimia can cause:

 tooth decay
 inflamed or damaged esophagus
 inflamed glands near the cheeks
 ulcers
 pancreatitis
 arrhythmia
 kidney failure
 heart failure

In severe cases, death may occur. This is possible even if you aren’t underweight. It
can result from arrhythmia or organ failure

What’s the outlook?

Eating disorders can be treated through a combination of behavioral modifications,
therapy, and medication. Recovery is a continuous process.
Because eating disorders revolve around food — which is impossible to avoid —
recovery can be difficult. Relapsing is possible.

Your therapist may recommend “maintenance” appointments every few months.

These appointments can help reduce your risk for relapse and help you stay on track
with your treatment plan. They also allow your therapist or doctor to adjust treatment
as needed.

How to support a loved one

It can be difficult for friends and family to approach someone they love with an eating
disorder. They may not know what to say, or worry about isolating the person.

If you notice that someone you love is exhibiting signs of an eating disorder, however,
speak up. Sometimes people with eating disorders are afraid or unable to ask for help,
so you’ll need to extend the olive branch.

When approaching a loved one, you should:

 Pick a private location where you can both talk openly without distractions.

 Choose a time when neither of you will be rushed.

 Come from a loving place instead of an accusatory one.

 Explain why you’re concerned, without judging or criticizing. If possible, refer

to specific situations and elaborate on why it caused concern.

 Share that you love them and want to help however they may need.

 Be prepared for some denial, defensiveness, or resistance. Some people may

get mad and lash out. If this is the case, try to stay calm and focused.
  Be patient, and let them know that if they don’t want help now, you’ll be there
if anything changes.

 Go into the conversation knowing some solutions, but don’t suggest them off
the bat. Only share resources if they’re open to taking next steps.

 Encourage them to get help. Offer to help them find a therapist or go with them
to the doctor if they’re scared. A doctor’s visit is crucial to help someone with
an eating disorder get on track and to make sure they’re getting the treatment
they need.

 Focus on their feelings instead of physical descriptions.

There are also a few things that you should avoid doing:

 Don’t comment on their appearance, especially as it relates to weight.

 Don’t shame someone about their potential disorder. To avoid this, use “I”
statements like “I worry about you” instead of “you” statements like “You’re
making yourself sick for no reason.”

 Don’t give medical advice you aren’t equipped to give. Saying things like,
“Your life is great, you have no reason to be depressed” or “You’re gorgeous,
you don’t need to lose weight,” do nothing to address the problem.

 Don’t try to force someone into treatment. Ultimatums and added pressure
don’t work. Unless you’re the parent of a minor, you can’t make someone go
into treatment. By doing so, you’ll only strain the relationship and take away a
stem of support when they need it most.
If you’re a minor and you have a friend who you believe has an eating disorder, you
can go to their parents to express your concern. Sometimes peers can pick up on
things that parents don’t, or see behaviors that they hide from their parents. Their
parents may be able to get your friend.

Emotional and behavioral symptoms

Behavioral symptoms of anorexia may include attempts to lose weight by:

 Severely restricting food intake through dieting or fasting

 Exercising excessively

 Bingeing and self-induced vomiting to get rid of food, which may include the use of
laxatives, enemas, diet aids or herbal products

Emotional and behavioral signs and symptoms may include:

 Preoccupation with food, which sometimes includes cooking elaborate meals for
others but not eating them

 Frequently skipping meals or refusing to eat

 Denial of hunger or making excuses for not eating

 Eating only a few certain "safe" foods, usually those low in fat and calories

 Adopting rigid meal or eating rituals, such as spitting food out after chewing

 Not wanting to eat in public

 Lying about how much food has been eaten

 Fear of gaining weight that may include repeated weighing or measuring the body

 Frequent checking in the mirror for perceived flaws

 Complaining about being fat or having parts of the body that are fat

 Covering up in layers of clothing

 Flat mood (lack of emotion)

 Social withdrawal
  Irritability

 Insomnia

 Reduced interest in sex

When to see a doctor

Unfortunately, many people with anorexia don't want treatment, at least initially. Their
desire to remain thin overrides concerns about their health. If you have a loved one
you're worried about, urge her or him to talk to a doctor.

If you're experiencing any of the problems listed above, or if you think you may have an
eating disorder, get help. If you're hiding your anorexia from loved ones, try to find a
person you trust to talk to about what's going on.

Request an Appointment at Mayo Clinic

Causes
The exact cause of anorexia is unknown. As with many diseases, it's probably a
combination of biological, psychological and environmental factors.

 Biological. Although it's not yet clear which genes are involved, there may be
genetic changes that make some people at higher risk of developing anorexia.
Some people may have a genetic tendency toward perfectionism, sensitivity and
perseverance — all traits associated with anorexia.

 Psychological. Some people with anorexia may have obsessive-compulsive

personality traits that make it easier to stick to strict diets and forgo food despite
being hungry. They may have an extreme drive for perfectionism, which causes
them to think they're never thin enough. And they may have high levels of anxiety
and engage in restrictive eating to reduce it.

 Environmental. Modern Western culture emphasizes thinness. Success and

worth are often equated with being thin. Peer pressure may help fuel the desire to
be thin, particularly among young girls.

Risk factors
Anorexia is more common in girls and women. However, boys and men have
increasingly developed eating disorders, possibly related to growing social pressures.

Anorexia is also more common among teenagers. Still, people of any age can develop
this eating disorder, though it's rare in those over 40. Teens may be more at risk
because of all the changes their bodies go through during puberty. They may also face
increased peer pressure and be more sensitive to criticism or even casual comments
about weight or body shape.

Certain factors increase the risk of anorexia, including:

 Genetics. Changes in specific genes may put certain people at higher risk of

anorexia. Those with a first-degree relative — a parent, sibling or child — who had
the disorder have a much higher risk of anorexia.

 Dieting and starvation. Dieting is a risk factor for developing an eating disorder.

There is strong evidence that many of the symptoms of anorexia are actually
symptoms of starvation. Starvation affects the brain and influences mood changes,
rigidity in thinking, anxiety and reduction in appetite. Starvation and weight loss
may change the way the brain works in vulnerable individuals, which may
perpetuate restrictive eating behaviors and make it difficult to return to normal
eating habits.

 Transitions. Whether it's a new school, home or job; a relationship breakup; or the

death or illness of a loved one, change can bring emotional stress and increase the
risk of anorexia.

Complications
Anorexia can have numerous complications. At its most severe, it can be fatal. Death
may occur suddenly — even when someone is not severely underweight. This may
result from abnormal heart rhythms (arrhythmias) or an imbalance of electrolytes —
minerals such as sodium, potassium and calcium that maintain the balance of fluids in
your body.

Other complications of anorexia include:

 Anemia
  Heart problems, such as mitral valve prolapse, abnormal heart rhythms or heart
failure

 Bone loss (osteoporosis), increasing the risk of fractures

 Loss of muscle

 In females, absence of a period

 In males, decreased testosterone

 Gastrointestinal problems, such as constipation, bloating or nausea

 Electrolyte abnormalities, such as low blood potassium, sodium and chloride

 Kidney problems

If a person with anorexia becomes severely malnourished, every organ in the body can
be damaged, including the brain, heart and kidneys. This damage may not be fully
reversible, even when the anorexia is under control.

In addition to the host of physical complications, people with anorexia also commonly
have other mental health disorders as well. They may include:

 Depression, anxiety and other mood disorders

 Personality disorders

 Obsessive-compulsive disorders

 Alcohol and substance misuse

 Self-injury, suicidal thoughts or suicide attempts

Prevention
There's no guaranteed way to prevent anorexia nervosa. Primary care physicians
(pediatricians, family physicians and internists) may be in a good position to identify
early indicators of anorexia and prevent the development of full-blown illness. For
instance, they can ask questions about eating habits and satisfaction with appearance
during routine medical appointments.
If you notice that a family member or friend has low self-esteem, severe dieting habits
and dissatisfaction with appearance, consider talking to him or her about these issues.
Although you may not be able to prevent an eating disorder from developing, you can
talk about healthier behavior or treatment optio