Endocrine Issues Related to Anorexia Nervosa and Bulimia Nervosa

According to the National Association of Anorexia Nervosa and Associated Disorders, about 30 million people suffer from eating disorders in the United States alone, and some can cause serious endocrine issues along with other physical health manifestations. Among these are the well-known disorders anorexia nervosa and bulimia nervosa. Although binge eating disorder is the most common eating disorder in the United States, millions of people will experience one or both of them.

Anorexia Nervosa

Affecting about 2% of people (both female and male) in the United States, anorexia nervosa is characterized by restricting food intake to such a degree that there can be devastating consequences for the physical health of the individual. It usually first appears during adolescence, although its first onset can occur at any time.According to NEDA, an anorexia nervosa diagnosis consists of:

  1. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
  2. Intense fear of gaining weight or becoming fat, even though underweight.
  3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.

It is not uncommon for people with an anorexia nervosa diagnosis to have a full list of medical problems that must be tended to in addition to the psychological treatment that is needed. Often, a weight restoration program will be central to the nutritional part of the recovery plan. In extreme cases, feeding tubes may be necessary. In any case, anorexia nervosa can precipitate organ and glandular problems caused by deficient nutrition.

Bulimia Nervosa

Bulimia nervosa can also cause nutritional deficiencies, but instead of food restriction, it involves a binge-and-purge cycle. People with bulimia also suffer from distorted or negative body image and engage in disordered eating behaviors to lose weight. Also according to NEDA, the criteria for diagnosis of bulimia nervosa include:

  1. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
    1. Eating, in a discrete period (e.g. within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period and under similar circumstances.
    2. A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop eating or control what or how much one is eating).
    3. Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

Although many people with bulimia nervosa do not become medically underweight, the purging behaviors in addition to frequent dieting can also cause nutritional deficiencies resulting in glandular and endocrine problems. Other medical concerns related to bulimia nervosa include dental issues, heart problems, fatigue, and anemia, along with many other problems.

The pathophysiology of anorexia nervosa, as well as bulimia nervosa, is directly relative to the fact that those who have received an anorexia nervosa diagnosis or bulimia diagnosis usually have deprived their bodies of the basic nutrition necessary for proper function. Therefore, it is quite common for those with anorexia nervosa and bulimia nervosa to have specific endocrine deficiencies and abnormalities. Take a look at some of the examples of the endocrine abnormalities that can be present.

There May Be an Increased Secretion of the Stress Hormone Cortisol

Cortisol is often called the stress hormone because it is released when you are stressed, but the hormone serves several vital purposes within the body. Cortisol can help with things like controlling blood pressure levels, blood glucose levels, and even regulating metabolism. However, if there is too much cortisol in the bloodstream, it can be detrimental to the body. Unfortunately, people who have anorexia nervosa and bulimia nervosa do tend to have higher levels of cortisol in their bodies, which can cause problems with muscle weakness, unstable blood glucose levels, and a tendency to bruise easily.

There Can Be Lower Levels of Gonadal Hormones

Gonadal hormones are produced by the gonads, which include things like progesterone and estradiol from the ovaries or testosterone from the testes. After looking at the pathophysiology of anorexia nervosa, scientists have concluded that people who have anorexia nervosa and bulimia nervosa can have reduced gonadal hormone secretions.

For women with either disorder, menses can cease. For men with either disorder, fertility issues can be a problem. For both men and women, there can be a range of physical side effects that come along with low gonadal hormone levels. The most common signs of lower levels of gonadal hormones beyond fertility and menstruation changes include:

  • Hot flashes
  • Slow or no breast growth
  • Body hair loss
  • Low sex drive

There May Be a Decrease in Thyroid Hormone Production

The thyroid is responsible for the production and regulation of multiple types of hormones in the body, and this function of the thyroid can be disrupted in people who have received an anorexia nervosa diagnosis. Two hormones offered by the thyroid are thyroxine and triiodothyronine. These two hormones are created from iodine that is derived from certain foods, which means if an individual is not getting enough food in their body, the thyroid does not have what it needs to create thyroxine and triiodothyronine. Both of these hormones are considered essential for the proper functioning of the body and the brain. For younger individuals, the lowered levels of these thyroidal hormones can cause delayed development.

Treating Eating Disorders With Medical and Psychiatric Therapy

Anorexia nervosa is one of the more dangerous types of mental health disorders. Fatality rates are high for individuals with the disorder, and proper treatment to address both their physical and emotional needs is a must. Although bulimia nervosa does not have as high a death rate, the physical problems caused by the disorder are many and quite serious. Either can require extensive medical care to stabilize the individual in the early stages of treatment.

Many people unfamiliar with the intricacies of eating disorders think that they are simply mental health disorders. However, it’s clear that as the mind and body are closely interconnected, an eating disorder has extensive physical complications. This is why it’s important to find a center that employs medical, psychological, and psychiatric methodologies integrated into a personalized treatment program.

Residential Treatment

When anorexia nervosa or bulimia nervosa has begun to seriously affect physical health, residential treatment is the preferred option.This option provides round-the-clock medical care as well as providing coverage for psychiatric emergencies and suicide prevention. Residential treatment normally lasts at least 30 days, although it can last longer if necessary. It’s usually followed by day treatment and/or PHP outpatient care as a step-down process. Most residential treatment centers have medical doctors and nurses as well as therapists and recovery coaches, providing a complete continuum of care for eating disorders and co-occurring disorders.

Day Treatment / Outpatient

Outpatient care is an essential part of the spectrum of eating disorder treatment. As mentioned earlier, these day treatment programs can be utilized as a follow-up program for people who have complete a residential program, but they can work as standalone programs as well. Of course, these programs can’t offer the kind of medical support that residential programs can, but they can be supplemented with regular physician visits or a PHP program if the individual needs further medical care. Many endocrine and glandular difficulties caused by prolonged disordered eating behaviors require long-term hormone therapy that can be addressed in these programs.

Combining Psychological, Medical, and Nutritional Treatment

The psychological treatments for eating disorders often continue for years after a residential treatment stint. Normally a combination of traditional talk therapy sessions and group therapy sessions are combined with highly specialized behavioral treatments like Cognitive Behavioral Therapy (CBT) and its offshoots. These forms of therapy use a back-and-forth series of discussions between the therapist and client to identify and remove disordered thoughts and behaviors.

Nutrition is also extremely important in eating disorder recovery. Although some attempts to medically treat endocrine and hormonal difficulties like amenorrhea and anemia caused by nutritional deficiencies with medication have been tried, they have found limited success. Clinicians agree that a long-term, continued nutritional program is the best way to address these issues. Therefore, a coordinated effort between medical doctors and nutritionists is the best way to re-balance a client’s endocrine system. With time and a balanced, weight gain-oriented meal plan, many of these difficulties can be healed.

The philosophy of care at Oliver-Pyatt Centers is grounded in mindfulness and the belief that each person has the capacity for a mindful relationship with food and their body. Present in every aspect of our clinical program, this philosophy encompasses nutrition and eating, as well as movement.


With 20 years of behavioral health business development experience, Carrie combines world-class marketing, media, public relations, outreach and business development with a deep understanding of client care and treatment. Her contributions to the world of behavioral health business development – and particularly eating disorder treatment – go beyond simple marketing; she has actively developed leaders for her organizations and for the industry at large.