Mortality and Eating Disorders

Abstract

Although we have a fair understanding of some of the psychiatric comorbidities that contribute to the high mortality of eating disorders (alcohol use, comorbid psychiatric disorders, suicide, and poor psychosocial factors), the contribution of the physical complications in eating disorders remains poorly defined. Cardiac complications are speculated to cause much of the high mortality in anorexia nervosa. It is hypothesised that individuals are prone to arrhythmias in the setting of electrolyte derangements, specifically hypokalaemia, with additional contributions from hypoglycaemia and structural cardiac abnormalities that develop as a result of starvation. Cardiovascular causes have also been associated with the mortality of bulimia nervosa, including cardiac conduction defects and ischaemic heart disease, although the latter is not seen in anorexia nervosa. However, the direct cause of the mortality in people with eating disorders remains unknown, with electrolyte derangements only hypothesised to contribute.