Forty-one years ago, on February 4, 1983, American singer Karen Carpenter suffered a fatal heart attack as a consequence of anorexia nervosa, at the age of 32.

Here, we not only wish to remember Carpenter but also the countless other victims of this unforgiving disorder.

Some of the risk factors for eating disorders tend to include childhood obesity, mood disorders, personality traits (impulsivity and perfectionism), sexual abuse as well as weight-related concerns from family or peer environments (Moore & Bokor, 2023). 

Studies have also concluded that anorexia nervosa sufferers are predominantly female, with an onset in late adolescence and early adulthood, with the lifetime prevalence being at 0.3% to 1% (EU: 2%-4%) irrespective of culture, ethnicity and race (Moore & Bokor, 2023). Nevertheless, it is important to note that men may also be affected. 

In the Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) of 2022, anorexia nervosa is defined as an eating disorder that is characterised by the restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory and physical health. 

A significantly low body weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected (DSM-V-TR, 2022).

"Carpenter’s untimely death has evidently shown the world that, as with any disorder, it is important that, as individuals, we are able to recognise the signs and symptoms of anorexia nervosa and refer sufferers for psychological and medical help as soon as possible"

Sufferers also tend to experience an intense fear of gaining weight and often have little to no insight about the severity of their condition.

Typically, sufferers limit their food intake and tend to exhibit obsessive behaviours when it comes to weight checks, calorie counting and food intake. Many studies have also reported that many sufferers of anorexia nervosa are left feeling miserable and guilty after consuming any types of food. 

A newspaper cutting reporting the death of Karen Carpenter.

As a result, other psychological comorbidities may also coexist with anorexia nervosa, including depression, obsessive-compulsive disorder, personality disorders, anxiety, substance misuse disorders, PTSD and suicidal ideation (DSM-V-TR).

Moreover, sufferers are usually very secretive about their eating regimes and body weight and, therefore, may wear baggy clothes and avoid partaking in social activities which involve eating or drinking. They also tend to experience rapid weight loss and, despite this, may exercise profusely and intensely, to the point of even experiencing intense anxiety when they are unable to do so.

Multiple studies have concluded that sufferers may report symptoms such as an absence of menstruation, cold intolerance, constipation, swelling in extremities, fatigue and irritability (Moore & Bokor, 2023).

Needless to say, suffers of anorexia nervosa may also develop multiple complications related to a prolonged starvation state and purging behaviours, which may also include the use of unprescribed drugs, such as thyroid stimulating agents. 

In the case of Carpenter, her heart muscle was reportedly thinner than a normal female adult heart at autopsy, primarily due to her lack of nutrient intake and, possibly, due to her continued use of thyroid stimulating agents.

Like Carpenter, many anorexic patients may experience heart complications, kidney problems, anaemia, low blood pressure and electrolyte imbalances, which may precipitate more serious and possibly deadly complications (Moore & Bokor, 2023). 

Severely anorexic patients may need to primarily be treated physiologically via intravenous fluids and feeding. Having said this, many sufferers are initially treated with intense psychotherapy (Moore & Bokor, 2023). Pharmacotherapy may be implemented in combination with psychotherapy in order to treat any underlying comorbidities and increase the likelihood of a positive outcome. 

Concluding on this point, Carpenter’s untimely death has evidently shown the world that, as with any disorder, it is important that, as individuals, we are able to recognise the signs and symptoms of anorexia nervosa and refer sufferers for psychological and medical help as soon as possible.

Gabriel Falzon is a psychology and English student at the University of Malta and Georgiana Farrugia Bonnici is a medical doctor.

In Malta, Dar Kenn Għal Saħħtek, a residential day care and outpatient facility, supports people with eating disorders and weight behavioural problems. It can be reached on 2145 3690, via their website www.dks.org.mt or on Facebook.