At least 30 million people in the United States suffer from an eating disorder at any given time, with 0.9 percent of women suffering from anorexia nervosa (or anorexia for short) in their lifetime. Anorexia is the most deadly mental illness, with 1 in 5 deaths associated with anorexia owing to suicide.

To someone who has never suffered from or studied the disorder, it can be difficult to understand what about this disorder could drive a person to suicide. As you will learn in this article, anorexia leads to tremendous physical, mental, and emotional pain.

It is challenging, but certainly not impossible, to recover from anorexia nervosa. If you know someone with anorexia and want to support their recovery, it’s important to understand how they feel, physically, mentally, and emotionally. Here are some of the daily struggles that patients with anorexia may face.

Anorexia and Physical Health

Doctors used to diagnose anorexia nervosa with strict weight criteria, which required a BMI of less than 17.5. While anorexia is often associated with dramatic weight loss, however, patients with anorexia can present at any size.

Someone who has anorexia but does not lose a significant amount of weight might be diagnosed with a form of eating disorder not otherwise specified (EDNOS) known as “atypical anorexia.” New studies are broadening the criteria they use to identify symptoms of anorexia in patients to include patients with atypical anorexia, revealing that the prevalence of anorexia may have been severely underestimated in the past.

Even when anorexia is not associated with underweight, it can lead to dangerous health problems. Medical complications are responsible for nearly half of all deaths associated with anorexia nervosa. One complication we have written about in the past, refeeding syndrome, results in a dangerous imbalance of electrolytes that can lead to heart or kidney failure. Refeeding syndrome occurs in about 28 percent of adolescents hospitalized for anorexia nervosa.

Other, less severe physical exam findings include bradycardia (a dangerously slow heart rate), amenorrhea (absence of a regular menstrual period), constipation, dizziness, fatigue, and intolerance to cold. Anorexia may also cause dry skin, brittle nails, and hair loss. Patients with binging-and-purging-type anorexia may display knuckles on their callouses (from self-induced vomiting), erosion of the dental enamel (from exposure to stomach acid due to vomiting), and inability to have a bowel movement (due to laxative abuse).

In the long term, untreated anorexia nervosa can lead to infertility (due to anovulation, or failure to release an egg from the ovaries during the menstrual cycle, which is a common cause of amenorrhea), cardiac complications such as arrhythmias, decreased bone mineral density (which may lead to spontaneous bone fractures and osteoporosis later in life), and birth complications during pregnancy.

Anorexia and Mental Health

The devastating effects of eating disorders reach far beyond physical health. Other mental health conditions like mood disorders, anxiety disorders, obsessive-compulsive disorder, somatization disorder, and substance abuse commonly coexist with eating disorders like anorexia nervosa, which can be both a risk factor and an effect of anorexia.

Mood Disorders and Anorexia

Mood disorders are frequently seen in patients with anorexia nervosa. The most common comorbidity among patients with anorexia is major depressive disorder (MDD), with a lifetime risk of up to 80 percent. MDD causes patients to experience episodes of depression, including low mood and lethargy, that last for at least two weeks and can recur at any time.

There is also a high rate of eating disorders in patients with a mood disorder known as bipolar disorder. As much as 14 percent of patients with bipolar disorder also have an eating disorder. Bipolar disorder is associated with a more severe course of disease in patients with anorexia nervosa.

Bipolar disorder causes patients to oscillate between episodes of depression and episodes of mania. During a manic episode, patients may experience grandiose self-image, racing thoughts, disorganized speech, and poor decision-making (for example, gambling or committing a crime).

Anxiety Disorders and Anorexia

A 2004 study found that two-thirds of patients with eating disorders suffer from an anxiety disorder in their lifetime, with more than 40 percent displaying signs of an anxiety disorder in childhood. Generalized anxiety disorder and social phobia often precede an eating disorder, but panic disorder (characterized by random panic attacks with no discernable cause) tends to emerge after.

Obsessive-Compulsive Disorder and Anorexia

30 percent of patients with eating disorders like anorexia nervosa also have obsessive-compulsive disorder (OCD). OCD is characterized by obsessions, unwanted and distressing thoughts that won’t go away, and compulsions, ritualized behaviors designed to relieve anxiety associated with the obsessions. People with OCD believe their rituals will help get rid of the obsessions, but quickly find that their compulsions only become stronger. For someone with anorexia, compulsions often manifest as food-related rituals, such as cutting food into tiny pieces or measuring and weighing everything they eat.

Somatization Disorder and Anorexia

Somatization disorder is a little-known mental illness associated with anorexia nervosa. It used to be called hypochondriasis and presents as recurring, multiple, current complaints about physical symptoms with no medical cause. Anorexia patients with comorbid somatization disorder experience longer and more severe disease courses than those without. However, somatization disorder is a controversial diagnosis. More women than men are diagnosed with somatization disorder, leading some to wonder if women’s physical complaints are more readily dismissed by doctors as psychological in nature.

Substance Abuse and Anorexia

People who abuse alcohol or drugs are diagnosed with eating disorders at a rate 11 times higher than that of the general population. They may abuse substances to self-medicate their body image anxiety. As much as 18 percent of patients with anorexia display symptoms of a co-occurring substance use disorder. Substance use disorders encompass the abuse of alcohol, prescription, and illicit drugs, as well as s to things like gambling and gaming. Recently, the colloquial term “drunkorexia” has emerged to describe fasting or restricting eating habits to compensate for binge drinking, but according to the current criteria, a person cannot be formally diagnosed with drunkorexia.

Anorexia and Emotional Health

Eating disorders are about much more than food. On the surface, they often reveal a deep-seated fear of gaining weight or getting “fat,” which can stem from bullying or insecurities dating back to childhood. At the heart of an eating disorder, however, is emotional avoidance and a need for control.

People with eating disorders tend to be inflexible and rigid in thinking. They may become impulsive in times of distress and lose sight of their goals. Many times, a person with anorexia isn’t even aware of the uncomfortable emotions driving their behavior because they are so removed from their emotional experience. People with eating disorders have a lower tolerance for distress than their peers, leading them to turn back to familiar behaviors (such as restricting or purging) to cope even when it is unhealthy.

Many people with anorexia nervosa use strict control of food and exercise to avoid confronting uncomfortable emotions, such as anger or sadness. These are coping strategies learned early in life — and while dysfunctional in nature, they are often the only way in which a person with anorexia has learned to tolerate difficult emotions.

Therapy for Anorexia Recovery

The formation of negative coping strategies for dealing with emotions is known as emotional dysregulation. Treatment for eating disorders like anorexia often teaches patients emotional regulation, healthier coping strategies to substitute for eating disorder behaviors in times of distress.

Therapy for anorexia nervosa addresses symptoms like emotional dysregulation and inflexible, “black-and-white” thinking. Some types of therapy are better suited to particular challenges than others. For example, cognitive-behavioral therapy (CBT) teaches patients to analyze their black-and-white thoughts and replace unhelpful thoughts with better ones, while dialectical behavioral therapy (DBT) focuses on teaching skills like distress tolerance, helping patients increase their threshold for dealing with uncomfortable emotions.

Our trained therapists are deeply familiar with the physical, mental, and emotional challenges of anorexia nervosa. They are experts in helping patients recover from anorexia, using a combination of compassion and psychological science to treat the physical, mental, and emotional signs of anorexia. Contact us today to learn more about options for anorexia treatment at The Meadowglade, and how our trained therapists can help you heal.