A Review of Anorexia and Bulimia Nervosa for the Forensic Pathologist

Anorexia nervosa (AN) and, to a much lesser extent, bulimia nervosa (BN) are psychiatric illnesses that carry the highest mortality rates compared to other psychiatric illnesses. They tend to be chronic disorders with many acute fair-ups that have profound negative impact on the body as a whole. Many medical complications can arise acutely and chronically following excessive dieting, purging, over exercising, abuse of medications such as diuretics and laxatives or any combination of these. In contrast to the profound effects eating disorders can have, the postmortem findings and testing can be subtle to nonexistent and may be overshadowed by trauma (in the case of suicides), natural disease (in the case of diabetes and alcoholism) and postmortem shifts (in electrolyte testing and toxicology). A full understanding of how eating disorders affect the body in the acute, chronic, and refeeding stages is needed to properly certify these deaths.