Medical Management Of Anorexia Nervosa And Bulimia Nervosa - Medical Management Of Bulimia Nervosa

Written by HealthyPlace.com Staff Writer

EKG abnormalities are also common in anorexia, such as sinus brachycardia (slow heart rate), which is usually not dangerous. However, some cardiac irregularities can be dangerous, for example, prolonged QT intervals (measurement of electrical impulses) and ventricular dysrhythmia (abnormal heart rhythms). Some have opined that a baseline EKG is therefore indicated to screen for these findings.

By Carolyn Costin, M.A., M.Ed., MFCC and Philip S. Mehler, M.D. - Medical Reference from "The Eating Disorders Sourcebook"

HEMATOLOGICAL SYSTEM

Not infrequently, the hematological (blood) system is also affected by anorexia. Approximately one-third of individuals with anorexia nervosa have anemia and leukopenia (low white blood cell count). The relevance of this low white blood cell count for the functioning of the immune system of the patient with anorexia nervosa is controversial. Some studies have indeed found an increased risk of infection due to impaired cellular immune function.

In addition to the low white cell count, anorexic patients typically have low body temperature. Thus, the two traditional markers of infection, namely fever and a high white cell count, are often lacking in these patients. Therefore, there has to be heightened vigilance toward the possibility of an infectious process when these patients report some unusual symptom.

The hematological system is thus similar to other body systems that can be ravaged by anorexia nervosa. However, nutritional rehabilitation, if done in a timely and well-planned fashion, in concert with competent medical supervision, promotes a return to normal in all these systems.

ENDOCRINE SYSTEM

Anorexia nervosa can have profound negative effects on the endocrine system. Two major effects are the cessation of menstrual periods and osteoporosis, both of which are physiologically interrelated. While the exact cause of amenorrhea (lack of menstruation) is not known, low levels of the hormones involved in menstruation and ovulation are present in the setting of an inadequate body fat content or insufficient weight. Clearly, there is also an important contribution from the tenuous emotional state of these patients. Reversion to the age-appropriate secretion of these hormones requires both weight gain and remission of the disorder.

Due to the increased risk of osteoporosis seen in eating disordered patients who have amenorhea and to the fact that some studies suggest that the lost bone density may be irreversible, hormone replacement therapy (HRT) has often been suggested for these individuals. In the past, the traditional line of thinking has been that if the amenorrhea persists for longer than six months, HRT should be used empirically if there are no contraindications for such treatment. However, the results of recent research are unclear as to whether (and, if so, when) HRT should take place; consequently there has been much controversy over this issue. For further discussion of this important topic, see "Bone Density" below.

BONE DENSITY

Since the first edition of this book was published, there has been continued research in the area of bone mineral density (bone density) and hormone replacement therapy for eating disordered individuals with amenorrhea. Results have been conflicting. Bone loss or insufficient bone density is an important and possibly irreversible medical consequence of anorexia nervosa and, although less often, of bulimia nervosa as well. Therefore a thorough discussion of the current information is warranted.

There is increasing evidence that peak bone density is reached fairly early in life, at about age fifteen. After this, bone density increases very slightly until about the mid-thirties, when it begins to decline. This means that a teenager who suffers anorexia nervosa for as little as six months may develop a long-lasting bone deficiency. Bone density tests have shown that many twenty- to twenty-five-year-olds with anorexia nervosa have the bone densities of seventy- to eighty-year-old women. Whether bone density deficiency is permanent or whether it can be restored remains unknown.

Postmenopausal versus anorexia-caused bone deficiency. "Results of recent studies from London, Harvard, and other teaching centers are showing that the bone deficiency caused by anorexia is not identical to that of postmenopausal women. The major deficiency in postmenopausal osteoporosis is of estrogen and, to some extent, calcium. In contrast, in anorexia nervosa, chronic low weight and malnutrition often make estrogen ineffective, even when it is present through oral contraceptives" (Anderson and Holman 1997). Other factors that likely contribute to bone density problems in anorexia include inadequate dietary calcium; diminished body fat, which is necessary for the metabolism of estrogen; low body weight; and elevated serum cortisol levels from weight loss and comorbid depression.