Persistent psychiatric morbidity is common, especially dysthymia, major depression and obsessive-compulsive disorder. The disease leads to brain atrophy and a disorder of myelination, and it may have a persistent effect on cognition. Cardiac arrhythmias are a common cause of sudden death in anorexia nervosa patients. Long-term physical morbidity is also common and serious. Growth retardation is present in some patients who have an early onset of disease.
Anovular infertility is common in some women who have only partially recovered.
Osteopaenia leading to osteoporosis is a serious complication of the active disease, but may also have long-term effects because bone mineralization in women terminates with the menopause. Those who have not accumulated sufficient bone in younger life are prone to developing osteoporosis with ageing earlier than their peers. More women die as a result of a fractured femur than of breast cancer. Renal and hepatic function are frequently permanently impaired by anorexia nervosa, and a neurogenic bowel with subsequent rectal prolapse is common, sometimes but not invariably associated with laxative abuse. The effects of the disease on the family are horrendous.