When I was first diagnosed with anorexia nervosa during a six-week admission at the start of 2017, I felt a sense of disbelief. I didn’t feel like my weight was low enough for me to diagnosed with anorexia . I hadn’t lost my period so I didn’t think I could be diagnosed with anorexia . I didn’t look emaciated and “on death’s door” so I couldn’t be diagnosed with anorexia . But here’s the thing: those thoughts themselves were the anorexia talking. My weight was low enough. My BMI fell within the criteria. I may not have lost my period, but it was irregular and met the criteria for oligomenorrhea, and the updated DSM-5 didn’t require amenorrhea anyway. I didn’t look emaciated and on death’s door, but not all anorexics do. I accepted my diagnosis, but it wasn’t an easy journey. Although I was able to accept the diagnosis, I wasn’t as ready to accept the facts that come along with the diagnosis: the fact that anorexia nervosa has the highest mortality rate of all psychiatric disorders. That anorexia can lead to numerous medical complications, some that may resolve with recovery, and others that may have lasting effects. Not only have I had to grapple with the fact my disorder is taking a toll on my body and affecting my physical health, but I’ve also had to deal with other people’s assumptions about anorexia in general, and their assumptions about my journey with anorexia . Even those closest to me, who have the best intentions, have made comments about the fact I don’t look underweight and I don’t look like I have anorexia . And because of that, people also assume my struggle can’t be that bad compared to others and they can minimize the effect it’s having on my body. But here’s the thing: Underweight is underweight. In the context of anorexia , if you are utilizing behavior to maintain a bodyweight that is lower than expected for height, age, sex, etc., it means you are placing your body at risk of health complications. I might not be severely underweight, but for the last three years, I have been keeping my body at a weight that is considered underweight by BMI standards and has been below the weight my body naturally wants to sit at. So even though I may not be severely underweight, my body is struggling, and as time goes on its struggling more and more despite the fact my anorexia is relatively stable. Everyday activities I normally used to be able to do now exhaust me and my body. My heart struggles to do even simple tasks. I experience tachycardia when I stand up, bending over and picking things up makes me feel dizzy, and stairs are a nightmare — something I generally avoid now, even on good days. Last week, when I saw my GP, she was worried about my declining mental health but also my physical health. I’d lost weight since seeing her last, and I wasn’t eating sufficiently. She did an ECG which showed concerning abnormalities and so I was sent to the emergency department flagged for admission, but after three hours I left against medical advice. A week passed, and every day I questioned my decision to leave the hospital. What if something was really wrong with my heart? My ECG had shown a prolonged QT interval and one of the most common signs was fainting without warning. What if I fainted at home with no one around because I was living by myself? Anorexia nervosa has the highest mortality rate for psychiatric disorders with two main causes being sudden cardiac death and suicide. What if I became one of those statistics? The week passed with every day being physically draining. Every day was full of racing heartbeats, dizziness, shortness of breath and chest pain. Every day, I tried to bury my concern: I wasn’t that underweight. My anorexia wasn’t that bad. It couldn’t happen to me. I saw my GP again after a week. Although my ECG on that occasion was relatively normal, she was still worried because of the symptoms I was experiencing. She was still under the impression I should be in the hospital, but I was still resisting an admission. She rang my case manager, advocating for an admission, insisting that although my ECG was normal at the time, there were probably irregularities going undetected, but she was met by a roadblock. Although my case manager agreed, there wasn’t anything they could do to make me go because I remain a voluntary patient, and I wasn’t meeting the criteria to be placed under the Mental Health Act. So instead, she found another way to catch me out. She proposed that if I was truly fine, I wouldn’t object to having a Holter monitor for 24 hours to continuously monitor my heart activity. She found a way to ensure the ECG wouldn’t miss any irregularities. I felt like a deer caught in headlights. There was no way I could get out of this one, and I was worried. How could this be happening? I knew of other GPs with extensive experience of treating eating disorders , utilizing Holter monitors but I’d always thought it couldn’t happen to me. And yet, it was happening to me, and only time would tell if there was something wrong with my heart that required hospitalization. And as I wait for the results and share my story, I want those reading this to realize, any eating disorder is serious. It’s not only anorexia nervosa that has serious medical complications. Perhaps you or your loved one has been diagnosed with atypical anorexia nervosa , meaning all criteria are met, except the person isn’t yet underweight despite significant weight loss. If that’s the case, you’re not immune to health complications just because you’re not underweight. Bulimia nervosa and binge eating disorder also carry medical complications and carry the same risks relating to the heart. Even if you don’t meet the criteria for any of these diagnoses, any disordered eating can affect your health. It is vital you and the people around you take it seriously and that you access medical advice.