Overeating and excessive dieting both increase a woman's health risks, but the effects become more life-threatening when preoccupation turns to disorder

What are eating disorders?
Eating disorders are a range of illnesses characterised by psychological and behavioural disturbances associated with food and weight. These are mainly psychological problems that people try to solve by controlling their food intake. (This does not include problems with weight and appetite that are found with severe physical illnesses such as cancer.)

The two main eating disorders are anorexia nervosa and bulimia nervosa. There are many physical problems associated with the profound weight loss, self-induced vomiting and laxative abuse found in these illnesses, which can lead to severe, sometimes life-threatening, complications.

What is anorexia nervosa?
Although associated in many people's minds with adolescent girls, anorexia can occur at any age and in both sexes, though ten times as many women are affected as men.The main feature of anorexia nervosa is weight loss. Some people achieve this purely by restricting their food intake, while others use extra means of weight control, such as self-induced vomiting and abuse of laxatives and diuretics (drugs that increase the amount of urine passed). Excessive exercising can also be used. Some people with anorexia also binge eat.

What are bulimia nervosa and binge eating?
Again more women than men suffer from these disorders. People with bulimia can often be of normal weight, but can also be under- or overweight.

Bulimia is characterised by binge eating. Excessive amounts of food are consumed, associated with a sense of loss of control. Bingeing often follows a period of dietary restraint, and this can lead to the establishment of a vicious circle in which bingeing is followed by further efforts at restraint. The bulimic feels intense guilt, which can often only be overcome by vomiting, use of laxatives and starvation. Bulimia is sometimes associated with other impulsive behaviours such as alcohol and drug abuse, repeated self-harm and stealing.

Physical complications
Prolonged and severe weight loss in anorexia nervosa can lead to some or all of the following problems:

Skin and hair: The hair on the head can become thin and fall out, but there can be an increase in body hair, which is of a very fine soft quality, like the hair growing on a developing baby. The skin can be dry and hands and feet cold and blue from poor circulation.

Periods: Once body weight drops below a certain level, periods become infrequent and then stop. Some women have problems becoming pregnant. In teenagers the drop in oestrogen levels caused by severe weight loss can lead to delay in or regression of secondary sexual characteristics.

Heart and blood vessels: The blood pressure can drop due to inadequate body fluid levels, causing episodes of fainting, feeling dizzy and palpitations. Some of these symptoms are secondary to anaemia and a low blood sugar.

Heart muscle can waste away and heart failure can develop. This is one of the commonest ways that anorexics die.

Metabolic: Low blood sugar from inadequate food intake and high cholesterol levels can be found. The liver does not function well. The body temperature drops and the anorexic feels cold all the time because there is so little subcutaneous fat.

Nutrition: The levels of vitamins and minerals can drop, causing low levels of potassium, sodium, magnesium, zinc and calcium. This can lead to abnormal heart rhythms and be very dangerous. Low protein levels can lead to swollen ankles.

Muscles and bones: Muscle weakness and wasting, particularly in the upper arm and leg muscles can occur. Bone protein loss and calcium deficiency can lead to osteoporosis and increased risk of fractures.

Brain power: Concentration is poor and there is difficulty in undertaking complex thought. People with anorexia are frequently depressed, low mood being a common finding in starvation. Epileptic fits can occur with low calcium levels.

Kidneys: Kidney stones can occur and getting up to pass urine at night is common.

Gastro-intestinal system: Emptying of the stomach slows down and constipation is common.

Complications of induced vomiting

Teeth: Acid from the stomach contents can wear away the enamel covering the surface of the teeth, leading to eroding of the surfaces of the back of the teeth. Some people with eating disorders develop gum disease. These problems can lead to premature loss of teeth.

Gullet: Acid regurgitation can also inflame the gullet causing oesophagitis. The symptoms are of heartburn and chest pains, particularly with eating and drinking, limiting food intake even more. Severe and frequent vomiting can even lead to tears in the wall of the oesophagus and stomach, which can be life-threatening.

Salivary glands: The salivary glands can become enlarged and painful. This is a common complication of dehydration.

Pancreas: Inflammation of the pancreas leading to severe abdominal pain and vomiting is another dangerous complication.

Heart: Heart rhythm disturbances can be induced by lack of potassium in the body fluids.

Hands: Calluses on the back of the hands can be caused by rubbing on the teeth to induce vomiting.

What is the outlook?
About one in five people make a full recovery following treatment, but the same number remains severely ill. For the remainder the disorder persists but fluctuates in severity. About one in 20 people with anorexia die as a result of the problems outlined above or they may commit suicide.

Self-help groups

Eating Disorders Association
1st Floor, Wensum House
103 Prince of Wales Road
Norwich NR1 1DW
Helpline: 01603 621414
Youth Helpline: 01603 765050

Anorexia and Bulimia Nervosa Association
Women's Health Centre
Tottenham Town Hall
Approach Road
London N15 4RS
Tel: 020 8885 3936