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Forum Name: Psychiatric Topics

Question: Anorexia- What am I really at risk for?


 sdrake - Wed Apr 09, 2008 3:46 pm

I am 26 years old and developed an eating disorder (anorexia) when I was 19. The lowest weight I have ever been at is about 80 lbs. I'm 5'5 and currently 97 lbs after a recent 20 lb weight loss in 6 weeks. I have been restricting and the few times a week I eat something other than celery sticks, I tend to throw up-involuntarily, not forced. I just start thinking about the food I just ate and it happens. I know I had a slightly abnormal EKG recently and a bone density scan showed some bone loss although my doctor said it "wasn't as bad as she expected". She also diagnosed a heart murmur which I have not had before. I exercise moderately, walking my puppy 2-3 miles about 4 or 5 days a week. I've also been taking a water pill (OTC) every night because I'm afraid of gaining any weight. What should I be on the lookout for and expect. Is this as serious as some people treat it, or at my current weight and habits, am I really even considered an anorexic?
 Dr. E. Seigle - Fri Apr 11, 2008 10:13 am

Dear sdrake,

It sounds like you most likely do have anorexia nervosa, as it's called. Usually, a cessation of menstrual periods goes along with your degree of being underweight.

Anorexia is a very serious illness which when untreated, can lead to multiple, severe medical problems and occasionally death (not to be alarmist). People with anorexia usually experience a very powerful preoccupation or obsession around food, calories, weight and their body image, which they tend to misperceive as "fat" when it is in fact dangerously underweight. This distortion of body image is often resistant to change; as treatment occurs and normal weight begins to be restored, the distortion abates. Frequent vomiting as well as using diuretics (which with some over-eating changes the label to bulimia nervosa), can cause body electrolyte imbalances which can be dangerous, depleting your body of potassium in the case of vomiting, which can cause cardiac arrest. Some of the medical complications include osteoporosis (the lack of periods means lack of estogen, which causes bone depletion), heart failure, problems thinking clearly, malnutrition, and others. The longer one has the disorder, the harder it is to treat. The disease often carries with it a lot of denial and anxiety around becoming a healthy weight. Often, people with anorexia also have depression and obsessive-compulsive tendencies or full fledged disorder. The societal bias elevating the value of extreme thinness, and extolling its supposed beauty, in place of healthy weight and nutrition, is though to foster the development of the disorder in our society.

I strongly recommend that you consider getting a thorough evaluation and treatment. Your evaluation should include a psychiatrist, a nutritionist, a family doctor or internest, and a psychotherapist. Not just anybody will do, as eating disorders require special expertise that not all mental health professionals have. It is ideal if you can access an eating disorder clinic or team of professionals who work togther, to give you the best care. Certain types of psychotherapy are helpful, some are not, so you don't want to get just any therapy. Sometimes, medication can be an adjunct in treatment; it doesnt work by itself, and isnt always necessary.

It took you some courage and curiousity to contact us, and I think you're on the right track. You can ask around at the nearest university medical center, community mental health center, or your physician to start to get names of professionals with expertise in eating disorers. It is also an option that you may want to start with a period of in-patient treatment, depending on how medically unstable you may be. There are a number of specialty, private hospitals which focus solely on eating disorders.Many people with anorexia fear losing control of themselves when they ask for treatment. Remember that you are in charge and that treatment is collaborative, involving a joint enterprise between you and your professionals. It sounds like right now anorexia may be running your life, not you, This is a great chance for you to reclaim control from the anorexia. Remember, the treatment takes time and patience, it generally goes slowly but surely for those who desire change.

Well, I'm glad you've taken the first step toward getting well, try not to be ashamed of this as it's very common and almost a societal illness. Best of luck!

-Eliot Seigle MD

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