An Approach to Eating Disorders and Their Medical Complications

Eating Disorders are often mis-diagonosed - Take these examples:

  1. The laxative-abusing patient with complaints of intermittent diarrhea and constipation gets diagonosed as lactose intolerance or irritable bowl syndrome. -- Treatment needs to be stopping use of laxatives, not a lactose free diet.
  2. Abdominal pain and elevated amylase in someone purging by vomiting is diagonosed as pancreatitis -- A restricted diet willl make the eating disorder much worse.
  3. Hypoglycemia is the result of a depleted hepatic glycogen stores in one with an eating disorder, not a defect in carbohydrate metabolism.
  4. Elevated cholesterol in anorexics, diagonosed and treated as hypercholesterolemia with restrictions on fat and cholesterol intake.
  5. Dysphoria and "bloating", diagnosed as PMS, then treated with dietay restrictions and diuretics.
  6. Mitral valve prolapse, commen in anorexia nervosa, needs weight gain and rehydration, other then antiarrhythmics.
  7. Fatigue and low T3 level, are often thought to be hypothyroidism, then treated with thyroid hormone supplement.
  8. Sysemic candidasis, food allergies, and chronic fatigue syndrome -- These diagnoses are treated as excuses to restrict caloric intake in the eating disorder population.

Prevalence

  1. 1 to 4% of adolescent and young adult women in white middle class groups.
  2. Increasing numbers are seen in males, minorities, and in women of all age groups.
  3. Bulimia nervosa is more common then anorexia nervosa.

Presenting complaints are frequently non-specific and include the following:

Fatigue, Lethargy, Weakness, Impaired Concentration, Non-Focall abdominal pain, Dizziness or faintness, Constipation, Diarrhea, "Cold Sweats", Frequenat sore throats, Chills, and Sore muscles

Then:

Consider the diagnosis of eating disorder in any young adult female with vague, unspecfic signs and symptoms. Diagnosis is made by history and recgonition of the central psychopathology of eating disorders, which have been expressed as either a drive for thinness or as a fear of fatness, accompianed by excessive regulation of self-esteem by concerns with body and shape.

 

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