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

Written by HealthyPlace.com Staff Writer

Most eating disorder complaints, like headaches, stomachaches, insomnia, fatigue, weakness, dizzy spells, and even fainting do not show up on lab results. Parents, therapists, and doctors too often make the mistake of expecting to scare patients into improving their behaviors by having them get a physical exam in order to discover whatever damage has been done. For one thing, patients are rarely motivated by medical consequences and often have the attitude that being thin is more important than being healthy, or nothing bad is really going to happen to them, or they don't care if it does. Furthermore, patients can appear to be healthy and receive normal lab results even though they have been starving, bingeing, or vomiting for months and, in some cases, years. The following journal entries from patients reveal how disturbing this can be.

When I first was dragged into the doctor's office by my mother when my weight had dropped from 135 to 90 pounds, all my lab tests came back fine! I felt vindicated. I just felt like, "See, I told you so, I'm fine, so leave me alone." My doctor told me then, "You may seem healthy now but these things will show up later. You are doing damage to your body that may not show itself for years." I didn't believe it and even if I did, I felt helpless to do anything about it.

When I went for an exam and lab work I was bingeing and vomiting up to twelve times daily and was also smoking marijuana and snorting cocaine regularly. I was very worried about my health! On the way to the doctor's office I snorted cocaine. When my lab test came back normal, I felt excited thinking, "I can get away with this." In some ways I wish the tests had been worse, I wish they would have scared me, maybe it would have helped me to stop. Now, I feel like since it hasn't done any damage, why stop. I know I am damaging myself, my voice is raspy and my salivary glands are swollen from the constant acid wash of the vomit. My skin is grayish and my hair is falling out, but . . . my lab tests were fine!

A NOTE ON BINGE EATING DISORDER

Managing binge eating disorder patients most likely involves the same medical considerations to be taken into account when treating obese individuals, such as heart or gallbladder disease, diabetes, high blood pressure, and so on. Most symptoms of binge eating will be a result of the accompanying weight gain associated with this disorder. Occasionally people have binged to the point of becoming breathless when their distended stomachs press up on their diaphragms. In very rare cases a medical emergency may occur if the stomach wall becomes so stretched that it is damaged or even tears. The reader is referred to other sources on obesity and binge eating disorder for further information on this topic.

MEDICATION

One last aspect of medical management involves the use of medication to treat the coexisting psychological conditions that cause or contribute to eating disorders. Prescribing and managing this type of medication are sometimes undertaken by the family physician or internist but is more often relegated to a psychiatrist who has special training in psychopharmacology. The information regarding mind- altering medication for use with eating disorders is extensive and is covered in chapter 14.

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