Although eating disorders are considered emotional illnesses with compulsive elements associated with them, restricting and malnutrition, bingeing, purging and over-exercise behaviors can seriously impact the physical health of someone. That said, medical complications often accompany people with eating disorders. It is imperative these medical issues be recognized and treated at the same time the addictive and emotional issues are addressed in treatment. Doing otherwise will result in a longer and more acute level of care [hospital stay], long-term disability and even death. [APA Practice Guidelines-Eating Disorders, 2015]
Eating disorder recognition and treatment are lagging in medical schools and practices. As such, it follows the experience and skill set needed by primary care physicians and healthcare professionals who are “first line” providers is deficit.
Given the complexity of eating disorders and the medical complications related to them, the following physical manifestations usually go unrecognized and untreated.
- Withdrawal and Detox from purging behaviors [rebound edema, hypertension, GI problems]
• Gastroparesis [delayed gastric emptying and reduced gastric motility]
• Liver function abnormalities
• Eye pain
• Swallowing difficulties
• Electrolyte abnormalities [low potassium / hypokalemia]
• Constipation and/or irritable bowel, atonic bowel syndrome, obstructed bowel
• SMA syndrome [abdominal artery] RARE Superior mesenteric artery (SMA) syndrome is an uncommon but well recognized clinical entity characterized by compression of the third, or transverse, portion of the duodenum between the aorta and the superior mesenteric artery. This results in chronic, intermittent, or acute complete or partial duodenal obstruction
• Abdominal pain
Most, medical professionals are unaware of the need to withdraw from purging behaviors (including self-induced vomiting, laxative and/or diuretic abuse, etc.). In other words, a patient that ceases purging will often experience: abdominal pain, rebound edema, hypotension, and constipation after they cease taking laxatives, or they may initially experience significant weight gain from retaining fluids. Edema ensues as a consequence persistent and severe volume depletion [dehydration]. Rebound edema is often exacerbated by overuse of a rapid IV infusion of saline fluids [routine procedure in medical settings] or for treatment of low blood pressure, dehydration, hypokalemia [low potassium] and alkalosis [fluid imbalance], creating a potentially lethal set of conditions. Unaware of these issues and their effects, individuals often return to their eating disordered [purging, restricting, or binge eating] behaviors in response to the discomfort [withdrawal] of the very behaviors necessitating medical treatment.
The net effect of this and abbreviated treatment is what is referred to as the “revolving door phenomenon.”. Whether having negative experiences with medical professionals with limited knowledge of eating disorders or prematurely discharged from eating disorder treatment programs [limited stays given managed care level of care criteria], the recidivism / relapse statistics remain far too high.
Conservative estimates suggesting mortality rates of four percent for anorexia nervosa, 3.9 percent for bulimia nervosa and 5.2 percent for eating disorders not otherwise specified [APA Practice Guidelines]. In reality it’s probable eating disorders are responsible for far more deaths than these statistics portray. Individuals suffering from an eating disorder may ultimately die from organ failure, complications from malnutrition, or suicide. In these instances, Similar to other life threatening diseases, the cause of death is often reported as the symptom and not the disease [example: cardiac arrest]
Although the above information may seem extremely pessimistic and scary, the fact is with competent treatment most, if not all these complications are either reversible or can be arrested. Providers and programs with extensive experience with treating these disorders, within the framework of a multi-specialty team, is essential to address both the medical and emotional issues related to an eating disorder. Such programs and providers make use of specialists who represent psychiatry, internal medicine, clinical psychology, registered dietitians experience with eating disorders, and eating disorder trained therapists.
In sum, managing the medical complications at the time of addressing the emotional and obsessive aspects of an eating disorder is called for. Having medical professionals working alongside with the dietary and therapy team is the best way to accomplish this. Doing so insures someone’s physical status [blood pressure, vital signs, body mass, fluid balance [electrolytes], etc are monitored and addressed as needed, along with the dietary and emotional needs of the individual.
Marty Lerner, PhD.