Eating disorders

Physical symptoms

Although eating disorders are mental health problems they can also have serious effects on the body. Besides weight loss or changes in weight, there are many serious health risks associated with eating disorders. As a consequence of severe weight loss the physical symptoms of restrictive anorexia nervosa (where the amount food eaten is severely limited) are similar to when a person starves. The other behaviours that people carry out to stop themselves from gaining weight can also have serious physical consequences. People who binge (eat excessively) and purge (rid the body of food)– for instance by vomiting – will experience further symptoms. Problems can also result from exercising too much when a person’s weight is very low.

The physical and mental symptoms of eating disorders are closely linked. For example, problems with concentration and memory can result from physical problems, such as low blood sugar from not eating. The obsessions and rituals that are at the centre of restrictive or purging behaviour cause weight loss and fluctuation, and other physical symptoms.
 
Fatigue, sleep, aches and pain
“When I was first admitted to hospital I couldn’t even climb up the two steps into the ambulance. It was horrible.” -James
 
People we spoke with often felt constantly tired; “drained”, “exhausted” and “weak”. They felt both mentally and physically fatigued; consumed by thoughts and obsessions, as well as being affected by severe weight loss and low blood sugar levels. People talked about feeling dizzy and fainting a lot. The simplest of tasks could be impossible; James didn’t even have the strength to lift a kettle. People struggled to concentrate and found it difficult to remember things.
Sleep patterns often changed dramatically; people felt either so tired they were sleeping a lot or suffered from insomnia (trouble with sleeping). Some people found they slept in the day and stayed awake all night. Rob described how he would go for a few days without sleep, causing him to feel strange, like he was “floating”. Jasmin was prescribed medication for insomnia but it didn’t make any difference.
Often young people we talked with described suffering with pains and feeling “sore all over”. Eva described having to sit on a pile of cushions but it still hurt as her “bones were sticking out” Laura said that even leaning against a wall was painful. People had stomach pains and headaches. People described a point when it was difficult to distinguish hunger from other pains, as they felt so hungry it hurt.
 
“I would feel faint, I wouldn’t be able to do anything, I’d just want to curl up on the bed. But then I’d do that and I’d get to a place sometimes where I’d be completely high on it, I don’t know I’d feel almost like I was on some kind of a drug.” -Annabelle
 
Circulation and digestion
People with eating disorders can suffer from poor circulation of blood around the body as a result of lowered blood pressure. People suffered from low blood pressure and either a fast or a very slow heart rate (pulse). When the body is starved it slows everything down to conserve the limited energy that is available. For instance, the heart beats more slowly and weakly, to protect its weakened muscle. As a result blood pressure drops and circulation of blood to extremities is poor. This can cause loss of sensation in the fingers, numb arms and legs and some people said their fingers and lips turned blue. Maria constantly had black lips. People were often permanently “freezing”. This meant they had to make changes to their life to adapt' Annabelle wore a thick duffle coat for the whole summer and Elene kept having repeated baths to keep herself warm. Because of the loss of sensation, they could easily burn themselves in the bath because they didn’t sense the water was too hot. Poor circulation caused other problems too: it was very difficult for doctors and nurses to get a blood sample when the blood vessels had shrunk (constricted).
 
A starved body can’t make as many red cells, white cells or platelets as a healthy body. Red cells are the ones which carry oxygen around the body in the form of haemoglobin. Without enough red cells people are anaemic. Anaemia commonly affected the people we spoke to. It could cause sores, chilblains and make people bruise more easily. White cells are a crucial part of the immune system. Without enough of these people can’t fight off infections – often people don’t even realise they have infections. Platelets are the tiny little blood cells that stop us bleeding. People bruise easily without enough platelets.

People‘s digestion was often affected. They experienced a number of symptoms including' stomach aches, cramps and spasms, diarrhoea, indigestion, heartburn and feeling bloated. They also suffered from constipation which could leave them in “agony”; Rob couldn’t walk properly because of severe constipation. It was important for people to tell others about the "less glamorous" side of eating disorders as they felt that people weren’t aware of some of the effects. Some people didn’t realise that their physical symptoms were the result of their eating disorder and had tests for other illnesses instead.

Immune system and hormonal changes
Being starved of nutrients weakens the immune system, which is what protects the body from illness. People had been “ill all the time” and more prone to “coughs and colds” and other infections. Laura said she didn’t feel as strong as she had before.

Malnutrition could cause hormonal changes. Some women had tested low levels of the female hormone oestrogen and others had irregular periods or their periods stopped for years. When people were ill they could see their periods stopping as “a good sign” that they were losing a lot of weight. But for many, realising the damage the eating disorder could cause to their ability to have children (fertility) made them want to get better. For some, it was difficult to cope with periods returning as having their period had been one of the triggers of their illness. Fiona-Grace had been prescribed a contraceptive implant so that she wouldn’t have a period at all.

*The infertility caused by starvation in anorexia nervosa is usually reversible and not like the menopause. The ovaries are intact and waiting to activate once there is enough nutrition. Often fertility returns once they body is re-nourished.
People also described feeling “moody”, “irritable”, “emotional” and “crying all the time”. Many said they had no interest in sex and intimacy when they were ill.
Teeth, hair and nails
The effects of poor nutrition often affected hair and nails. People noticed their hair getting thinner or falling out, dry nails or nails that stopped growing. Skin could be bad and “flaky”. Some people with anorexia nervosa developed “lanugo hair”, a fine hair that grows all over when the body is starving, in order to keep the underweight and undernourished body warmer. 
The acid present from persistent vomiting often caused problems to teeth; acid eroded the enamel and caused cavities (holes in the teeth). Vomiting also caused sore throats and swollen glands. People often made excuses to their dentists as they felt unable to tell them the real reason for the state of their teeth.
Bones and internal organs
One of the most common and serious health risks linked to anorexia nervosa is osteoporosis. Osteoporosis is a condition where bones become weak; they develop holes, resembling a honeycomb structure. Osteoporosis can cause significant aches and pains and make the bones more likely to break. Osteopenia is a less severe form of bone weakness, which can progress to osteoporosis. Osteoporosis can affect different parts of the body; we spoke to people who had osteoporosis in their spine and hips. People had been advised to be careful not to do activities such as skiing or roller skating that could put them at a higher risk of falling and fracturing bones. It takes several months or even years for bones to completely repair after people get back to a normal weight. It can be tempting to be more active than the bones can bear. Some people had been given calcium supplements which could help reverse the effects. A few people said that the supplements had helped their initial diagnosis of osteoporosis reverse to osteopenia.
Internal organs were sometimes affected and damaged. Some people had problems diagnosed in their liver, kidneys and heart. When very ill, some had experienced organ failure which is when an internal organ stops working properly. Rachel had been told her body had gone into “starvation mode” and when Steph was hospitalised, she’d been a few days from “complete organ failure”.
Looking back, people felt regret that the eating disorder had got so bad that it had such a big physical impact. They said that while they were ill they had no idea there could be serious long term complications, affecting things like having children or doing sport in the future.
 
“I was so like into the whole eating and food thing I didn’t really consider anything that else that it would do to me like. I didn’t think of my bones, I was like, “Bones? Like bones schmones, that’s not a big deal.” But I’ve got osteoporosis now.” -Annabelle

Last reviewed July 2015.

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