A body suffering from starvation will trigger natural survival mechanisms. These biological systems stimulate intense hunger and repeated thoughts of food to remind us to eat and stay alive. Once triggered, a preoccupation with food is maintained and exaggerated by cognitive distortions (faulty and irrational thoughts or errors in thinking). For example, an individual with an eating disorder may justify a binge if they eat one cookie, since that small slip has ruined a perfect day of dieting.
Cognitive distortions can become so pervasive and ingrained that anorexics lose the ability to understand reality and the dangerousness of their behaviors. Body image distortion, mentioned previously, is particularly common and problematic for individuals with anorexia. Anorexics do not see themselves as dangerously thin (and often see themselves as fat), and this consistent misjudgment of body image interferes with their ability to acknowledge that they have a problem which requires help. Furthermore, many anorexics set unrealistic weight loss goals and believe that satisfaction will follow from meeting them. Despite dramatic weight loss, anorexics are still unhappy because they still believe they are fat and should lose more weight.
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Even after relatively short periods of anorexic behaviors, individuals with this disorder can experience serious and life threatening medical complications. Insufficient vitamins and minerals in the diet and severe weight loss cause abnormalities in electrolyte levels. As mentioned previously, electrolytes are electrically charged chemicals in your blood and cells that help to keep your heart and body functioning properly. Imbalances in electrolytes can cause fatigue, overall weakness, confusion, decreased concentration, and even seizures. Electrolyte problems and hormone imbalances can also lead to insomnia (impaired sleep). Hypokalemia is a deficiency in potassium that causes diminished reflexes, fatigue and cardiac abnormalities.
Long-term dieting and poor nutrition can decrease the level of iron in the blood, causing frequent or easy bruising, lethargy (fatigue), and anemia. Also, hypoglycemia (low levels of sugar in the blood) can lead to shakiness, anxiety, restlessness, and sometimes fainting. A condition called hypocalcemia may also occur when there is not enough calcium in the blood, resulting in muscle spasms, numbness or tingling in the hands and feet, decreased vision, and chronic tiredness. Weak or brittle bones (osteoporosis) and teeth are also significant signs of an eating disorder, as is osteopenia (low bone density).
Long-term vomiting can cause chronic bad breath, rupturing of the esophagus, bloating, distention, damage to the ling of the stomach, and gastric distress. Weak abdominal muscles caused by chronic vomiting can lead to a buildup of gastric poisons and byproducts in the stomach chamber, which eventually weakens the immune system. Gastroesophageal reflux disease (GERD) can also develop. GERD is a potentially life threatening condition in which the contents of the stomach, including acid, reflux (back up) into the esophagus causing inflammation and heartburn symptoms. Constipation, abdominal pain, bladder incontinence, and urinary tract infections are all common symptoms because of poor nutrition in the diet. A prolonged use of laxatives can also cause chronic diarrhea.
Thermoregulation (body temperature regulation) problems are common for individuals with anorexia. These individuals often complain of being cold, no matter how warm it is outside. Growth of long, downy hair on the face, arms and body (called lanugo) is a sign that an emaciated body is attempting to stay warm.
There are other symptoms as well, including delayed or permanently stunted growth. Severe dehydration is also not uncommon. This often leads to water retention (edema) and swollen hands and feet, and impaired kidney functioning. A prolonged lack of fat intake in the body causes skin to become blotchy, dry and gray or yellow in hue. Also, fingernails become brittle and hair weakens and falls out.
Many individuals who have had anorexia for long periods develop serious heart problems. A decrease in size of the heart muscle and chamber size can cause fainting, disruptions in blood pressure, and irregular or slow heartbeats (bradycardia and arrhythmia). Without appropriate medical intervention and treatment, heart problems and other organ distress can lead to serious complications and even death.
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