222 Eating Disorders
For example, a patient diagnosed with AN at age 15 can be predicted to
live for 25 years less than someone without AN. For the majority of
patients, however, it may not cause death but is associated with a wide range
of either reversible or irreversible problems. The health effects of weight cycling
are considered in chapter 9. The impact of anorexia on the skeleton and
teeth, reproductive function, and the cardiovascular and nervous systems
is considered below.
Skeleton and teeth
Adolescence is the key time for the development of bones, and malnutrition
causes poor bone growth and decreased bone density. If anorexia develops
at this time, the sufferer may be left with the irreversible problems of stunted
growth (Misra, 2008). It can also lead to osteoporosis, and there is some
evidence that this is worse in male sufferers than female sufferers (Mehler
et al., 2008). Later-onset anorexia also causes osteoporosis, but this may
be reversed by dietary and hormonal supplements (Treasure and Szmukler,
1995). Teeth are also affected by anorexia, particularly if the sufferer vomits
regularly, as this causes erosion of the tooth enamel which eventually
results in exposure of the dentine making the teeth vulnerable to caries.
Tooth erosion is sometimes the way in which persistent vomiting is recog-
nized by health professionals.
Reproductive function
Starvation directly affects menstrual functioning, and the absence of men-
strual periods is a key diagnostic criterion for anorexia. One study showed
that of 69 women attending an infertility clinic, 16 percent (11 cases) fulfilled
the criteria for an eating disorder (Stewart et al., 1990). Similarly, Freizinger
et al. (in press) reported that of 82 patients attending for infertility treat-
ment in a clinic in the US, 17 (20.7 percent) met the criteria for either past
or current diagnosis of an eating disorder. This is five times higher than
the usual prevalence rate in the US. Those women who do become pregnant
while anorexic are more likely to have small babies, who may have com-
plications such as respiratory distress and jaundice (Russell and Treasure,
1988). One of the largest studies of the reproductive effects of anorexia exam-
ined 140 patients over a period of 10 to 12 years. Of these women, 50 had
had children (Brinch, Isager, and Tolstroop, 1988). The results showed that
the rate of premature birth was twice the expected rate and the babies were
six times more likely to die. Of the 86 children born, 79 were alive at follow-
up, and seven had died within the first week due to prematurity, stillbirth,