Thursday, September 22, 2022

How Do Doctors Know If You Have An Eating Disorder

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What Are The Complications Of Anorexia

How do I tell if I have an eating disorder?

The medical complications and health risks of malnutrition and starvation, which are common in people who have anorexia, can affect nearly every organ in your body. In severe cases, vital organs such as your brain, heart and kidneys can sustain damage. This damage may be irreversible even after a person has recovered from anorexia.

Severe medical complications that can happen from untreated anorexia include:

In addition to physical complications, people with anorexia also commonly have other mental health conditions, including:

  • Depression, anxiety and other mood disorders.
  • Personality disorders.
  • Alcohol use disorder and substance misuse.

If these mental health conditions are left untreated, they could lead to self-injury, suicidal thoughts or suicide attempts.

If youre having suicidal thoughts, call the National Suicide Prevention Lifeline at 1-800-273-8255. Someone will be available to talk with you 24/7.

Is There A Test For Eating Disorders

While eating disorders are serious illnesses with physical complications, there is no laboratory test to screen for eating disorders. However, there are multiple questionnaires and assessment tools that may be used to assess a person’s symptoms. These may include self-report instruments, such as the Eating Disorder Inventory, the SCOFF Questionnaire, the Eating Attitudes Test, or the Eating Disorder Examination Questionnaire .

An eating disorder professional will also usually interview the person about his or her experience. Questions will typically include topics such as:

  • Current eating and exercise habits
  • How much a person weighs
  • Whether they have recently lost weight
  • The person’s thoughts on weight, food, and body image

A professional may also ask about physical symptoms, such as being cold much of the time or bruising easily.

It is not uncommon for patients with eating disorders, especially patients with anorexia nervosa, to not believe that they are ill. This is a symptom called anosognosia. So, if you are concerned about a friend or loved one and he or she denies having a problem, it does not necessarily mean there is not a problem.

Within the course of a physical examination, a physician may also use a number of diagnostic tools, includingbut not limited toblood work, a bone density exam, and/or an electrocardiogram , to assess whether there are any medical complications from the eating disorder.

Could You Spot Someone With An Eating Disorder

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In the summer of 2013, Kathryn, 31, a novelist, sat shaking on an exam table in Savannah, about to reveal some intensely personal information to a doctorand she was nervous. After exchanging the usual pleasantries, she blurted out her confessions: Her food issues were so out of control that her weight frequently swung up and down by 20 pounds, and she had recently fainted while running. “I also told him straight out that sometimes I didn’t eat all day, then binged at night,” she says.

If these symptoms sound like classic signs of an eating disorder, that’s because they are. Kathryn even told the doctor that if she ate too much she would “try to balance it out with ‘compensatory behaviors,'” medspeak for behavior including self-induced vomiting or the misuse of laxatives. Yet the physician neither diagnosed Kathryn with an eating disorder nor mentioned the possibility of one. “Just eat three meals a day,” he told her instead, “and stop being so dramatic.”

What good doctors do

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Denial & Eating Disorder Recovery

One of the biggest barriers to eating disorder recovery can be a lack of awareness about the severity of ones disordered eating. It can be frustrating for loved ones to witness their friend or family member struggling with an eating disorder while they deny they have a problem.

Similarly, sometimes denial can be so strong that we dont recognize how bad things have become or that theres even a problem at all. Its common in the beginning phases of recovery for someone to be struggling with denial about the problem.

Whats Normal Eating Behavior And What Isnt

Disordered Eating Treatment

How can you know if your concern about your diet and your bodys shape is veering toward or may already be an eating disorder? You cant just look in a mirror. Despite what many people think, you dont have to be female or skinny or fat to have an eating disorder. You dont even have to look as though anything is wrong.

Weight can be an indicator of an eating disorder, but it certainly isnt the only one, says Ilene Fishman, a licensed clinical social worker in New York City and Montclair, New Jersey, who spent a decade during her adolescence battling and eventually recovering from her own severe anorexia.

Biological Psychiatry: A Journal of Psychiatric Neuroscience and Therapeutics

  • Anorexia This disorder is marked by extreme control over calorie intake, an intense fear of gaining weight, and often an unrealistic view of body size and shape.
  • Bulimia Also known as binge-purge syndrome, bulimia is marked by frequent, rapid overeating followed by purging to avoid gaining weight. Purging may include forced vomiting, obsessive exercising, and misuse of laxatives and diuretics.
  • Binge-Eating Disorder This disorder is marked by frequent out-of-control eating in a short amount of time, often until the person feels uncomfortably full. Binge-eating disorder often occurs in secret because of self-disgust and embarrassment. People with this condition dont purge.

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Complications Of Eating Disorders

Although many people in the grip of an eating disorder appear very high-functioning on the outside, excelling at work and at home, inside, their bodies are in crisis. Some eventually fully recover. Others cycle through periods of recovery and relapse. And some become chronically ill or die.

According to NEDA, eating disorders have the highest mortality rate of any psychiatric illness. An estimated 20 percent of people with eating disorders eventually die from complications such as irregular or very low heartbeat , sudden cardiac arrest, severe liver disease, or suicide.

Even those who survive may face serious health issues, including but not limited to:

  • Irreversible bone loss

Diagnosing Eating Disorders In Children & Adolescents

Doctors at Hassenfeld Childrens Hospital at NYU Langone have expertise in diagnosing eating disorders in children and adolescents. These disorders can lead to serious medical consequences, and in the most severe cases can be fatal.

If you suspect that your child may have an eating disorder, contact the specialists at the Child Study Center, part of Hassenfeld Childrens Hospital. We also treat adults with eating disorders.

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History And Presenting Symptoms

Patients with eating disorders can have a wide range of symptoms. Those with milder illness might have nonspecific complaints, such as fatigue, dizziness, or lack of energy.4 Patients might deny that they have symptoms, but their family members might express concern. Patients who have anorexia typically will be unconcerned about significant weight loss. Other symptoms that might be reported or elicited include amenorrhea, sore throat, gastroesophageal reflux disease, abdominal pain, cold intolerance, constipation, polyuria, polydipsia, and palpitations. When taking a medical history, it is also important to take a dietary history to ask about the use of laxatives or diuretics. Table 5 compares important clinical features of anorexia and bulimia.

Features

Some Final Food For Thought

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It is possible to learn how to eat when you are physically hungry and stop when you are politely satisfied. It is possible to unlearn all the cultural rules about exercise and find an enjoyable, peaceful relationship with movement and rest.

It is possible to find healthy ways to comfort yourself and sweeten your day. It is possible to tolerate difficult emotions and ride them out until they pass naturally. It is possible to learn how to spend your precious time on this planet thinking about more than just the size of your body and food. I wish this for you!

Andrea is an inspirational counselor, author, and speaker who uses professional expertise, humor and personal recovery to help others. For more information on her books, blogs, and podcasts, please visit www.andreawachter.com

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What Criteria Are Used To Diagnose Eating Disorders

Physicians and mental health professionals use diagnostic criteria from theDiagnostic & Statistical Manual of Mental Disorders, 5th edition , to diagnose eating disorders. The DSM is a manual published by the American Psychiatric Association. It is currently in its fifth edition. Each diagnostic category in the book has been created based on research and feedback from clinicians.

While the best-known eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder, there are other eating disorders as well. People who are struggling with some of the symptoms of an eating disorder but do not meet full criteria or who are struggling with issues surrounding weight and food to the point that it is an issue in their life may also be diagnosed with other specified or unspecified feeding and eating disorder .

Criteria for anorexia nervosainclude symptoms related to significantly low body weight, a fear of weight gain, and body image issues.

Criteria for bulimia nervosa include recurrent binge eating and purging behaviors occurring at least once per week for at least three months, as well as a self-evaluation that is based on weight and/or body shape.

Criteria for binge eating disorderinclude recurrent episodes of eating unusually large amounts of food at least once a week for three months. A sense of lack of control over eating during the episode needs to be present. At least 3 of these other features also have to be present.

How Can I Care For A Loved One Who Has Anorexia

There are multiple things you can do to help and support someone with anorexia, including:

  • Learn about anorexia: Educate yourself about anorexia to better understand what they are going through. Dont assume you know what they are experiencing.
  • Be empathetic: Dont downplay or dismiss their feelings and experiences. Let them know that you are there to listen and support them. Try to put yourself in their shoes.
  • Encourage them to seek help and/or treatment: While having an understanding and supportive friend or family member is helpful to a person with anorexia, anorexia is a medical condition. Because of this, people with anorexia need treatment such as therapy and nutritional counseling to manage their condition. Encourage them to talk to their healthcare provider if they are experiencing the signs and symptoms of anorexia.
  • Be patient: It can take a while for someone with anorexia to get better once theyve started treatment. Know that it is a long and complex process and that their symptoms and behaviors will eventually improve.

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Emotional And Physical Risks

Eating disorders not only take a toll on our emotional and social well-being, work, school, and future goals, they can have serious physical ramifications and are potentially life-threatening.

Potential Health Risks of Anorexia

  • Low heart rate and low blood pressure, which increases the risk for heart failure.
  • Loss of bone density which can lead to osteoporosis.
  • Severe dehydration.

Potential Health Risks of Binge Eating Disorder

  • High cholesterol.
  • Heart disease.

Its important to note that someone can have a body that is larger than our society deems healthy, and still be in excellent health. Conversely, a person can appear to look healthy and be extremely ill. Eating disorders are about a persons relationship with food, exercise, and their body. They cannot be assessed simply by looking at someone.

Signs And Symptoms Of Eating Disorders

Is FULL RECOVERY from an eating disorder even possible?
  • Being consumed by thoughts of food, weight, fat, or calories
  • Avoiding once favorite foods
  • Preferring to eat alone instead of with others so that no one can judge how little or how much is being eaten
  • Exercising excessively for example, planning the day around working out, setting unrealistic goals or ignoring signs of injury or fatigue
  • Finding more and more fault with ones body, or seeing it as looking very different from how other people say it does
  • Paying increased attention to other peoples bodies
  • Regularly using appetite suppressants, laxatives, diuretics, or enemas

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What Is The Prognosis For People Who Have Eating Disorders

People who get treatment for eating disorders often recover and go on to lead healthy lives. Its helpful to detect a problem early and start treatment right away.

There are different levels of care, including:

  • Outpatient therapy .
  • Intensive outpatient therapy .
  • Inpatient therapy .

Your primary care doctor will work with you to decide what level of treatment would be right for you.

Left untreated, people with eating disorders can develop life-threatening complications. Some people may need to receive medical and mental health care at a hospital or treatment center.

Think Your Child May Have An Eating Disorder

If you start to notice signs or symptoms in your child that concern you, Dr. Myers said openly talking about them right away is key.

Express those concerns as a parent in a way that is supportive, not focusing on weight or shape but instead on specific behaviors, she said.

Its better, Dr. Myers said, just being upfront, not blaming, not trying to do a simple fix like, You just need to stop doing this, but instead coming from a more understanding viewpoint. This must be difficult, and Im here to talk, and I am so concerned I would like to set up an appointment with a professional to discuss this further.

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Your Doctor Will Not Judge You But Will Be A Resource For Your Recovery

You can expect your doctor to maintain a professional calm distance as you share about your eating disorder. He or she will not judge you nor criticize you. Your doctor should offer support and refer you to other healthcare providers like mental health specialists, psychologists, counselors, and nutritionists to make sure you get the care you may require.

In addition, your doctor will most likely want to take measurements such as your body weight, your body fat, and perhaps do some tests like an electrocardiogram, bone scan, and even laboratory tests to see how your organs are functioning and if you have any electrolyte or hormonal imbalances due to your eating disorder. He or she will probably also ask about various symptoms you may have like intolerance to cold, fine hairs covering the body, fatigue, mood swings, bleeding gums, and when the last time you menstruated was, if you are a female. Again, this information provides information on the severity of your eating disorder.

Making the brave decision to tell someone about your struggle with an eating disorder may be scary but if you choose to tell your doctor first, you can expect to get support. You will be guided toward treatment options and your health will be assessed. Telling someone is often a first step in from an eating disorder. If you choose to tell you doctor now you have an idea of what to expect.

How Is Anorexia Treated

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The biggest challenge in treating anorexia is helping the person recognize and accept that they have an illness. Many people with anorexia deny that they have an eating disorder. They often seek medical treatment only when their condition is serious or life-threatening. This is why its important to diagnose and treat anorexia in its beginning stages.

The goals of treatment for anorexia include:

  • Stabilizing weight loss.
  • Hospitalization.

Psychotherapy

Psychotherapy is a type of individual counseling that focuses on changing the thinking and behavior of a person with an eating disorder. Treatment includes practical techniques for developing healthy attitudes toward food and weight, as well as approaches for changing the way the person responds to difficult situations. There are several types of psychotherapy, including:

Medication

Some healthcare providers may prescribe medication to help manage anxiety and depression that are often associated with anorexia. The antipsychotic medication olanzapine may be helpful for weight gain. Sometimes, providers prescribe medications to help with period regulation.

Nutrition counseling

Nutrition counseling is a strategy to help treat anorexia that involves the following:

  • Teaching a healthy approach to food and weight.
  • Helping restore normal eating patterns.
  • Teaching the importance of nutrition and a balanced diet.
  • Restoring a healthy relationship with food and eating.

Group and/or family therapy

Hospitalization

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What Is Treatment Like

Earlier intervention and specialized treatment with a team experienced in treating individuals with eating disorders is really important, Dr. Myers said. The first step is a consultation and evaluation by a specialist to determine whether there is an eating disorder and a discussion about treatment options.

At Dr. Myers clinic, treatment typically includes an initial evaluation with all providers, a weekly therapy appointment with a psychologist, at least four appointments with a dietitian who specializes in treating eating disorders, and rechecks with the medical doctor every two to four weeks, with weekly rechecks possible depending on the condition of the patient starting treatment. Pertinent medical concerns could warrant a recheck sooner as well.

Initially in treatment, were going to focus on the eating behaviors or the exercise behaviors or the purging behaviors, and were working to normalize those, or return to a healthier pattern, Dr. Myers said.

Then we would address body image concerns or talk about what theyve learned from their experience and how they can prevent a relapse in the future.

Look At Your Functioning

Eating disorders get in the way of someones ability to function in work, school, or in relationships. Has your social, academic, or professional life been impacted by your body image or eating behaviors?

For example, if you dont go to work events because youre not sure what food will be there or because you have a binge ritual you want to complete, then you may be at risk for an eating disorder.

Another red flag is if your eating behaviors are impacting your medical functioning. You might know that your eating is starting to impact you if a doctor is telling you that based off your weight or labs. Another way you may know is that you are starting to show the physical effects of disordered eating.

It can be tempting to think that if you arent showing physical symptoms, then there isnt a problem. Medical functioning is just one aspect of your overall functioning. While medical concerns become priority given how dangerous eating disorders can be, even if you are technically healthy, the other signs and symptoms discussed are equally as important.

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