**3. Comorbid medical and psychiatric conditions**

Patients suffer multiple comorbid medical and psychiatric problems, as eating behavior affects health in multiple ways directly or indirectly [16].

Almost every system in the body is affected in AN, including gastrointestinal, cardiovascular, skeletal, nervous, endocrinological, and reproductive [17]. Physical examination results usually show low blood pressure, bradycardia, low body temperature, gastrointestinal problems, dehydration, hormonal deficits, amenorrhea or other menstrual problems, hair loss, and lanugo hair [18]. Cardiovascular problems include irregular heartbeats, heart attacks, and collapse of heart valves and may cause death [19]. Starvation affects menstrual functioning, resulting in poor reproductive health, with infertility problems. Even if anorexic women become pregnant, there is a high possibility of having small babies with complications or unhealthy children [20]. Self-induced vomiting may cause tooth erosion or calluses on hands [21]. AN usually begins at puberty, and this is an important time for the development of bones. Malnutrition can cause stunted growth and osteoporosis in the long term [22]. Anorexia is also associated with changes in the nervous system like loss of grey matter in the brain and reduction in pituitary size, resulting in deficits in attention, learning, memory, and visuospatial analyses [23, 24]. Above all, anorexia has the highest mortality rates among psychiatric disorders [25]. All of these medical problems can cause heart attacks or infections, but suicide is the most common cause of death [26].

In addition to physical problems, psychological complications are prevalent in AN. Almost half of the cases have a comorbid DSM diagnosis, especially depression being the most common among them [27]. Problems related to anxiety like social phobia and obsessive-compulsive disorders are highly associated with anorexia [28]. Trauma-related problems are more prevalent in the binge eating/purging type [29]. Comorbid psychological problems have a negative impact on prognosis and predicted suicide attempts [30]. As a result, AN is a chronic condition accompanied with a range of physical and psychological problems that interfere with daily functioning, and it has a high mortality rate.
