Warning Signs & Health Consequences
I’m in the 10th grade and I am looking for help with my eating disorder. If I tell my counselor at school will he tell my parents?
Dear 10th grader,
I am glad that you contacted us. I was once a high school teacher and I can tell you from experience that teachers and guidance counselors care very much about their students lives’ not just academics. I think that you should talk with your guidance counselor and that he would be a great resource for connecting you with someone who treats eating disorders. I do not know if he would tell your parents but I would guess that he might. Your school districts policy may dictate to him that he has to discuss serious situations with parents. But let’s put that aside for a moment. I wonder why you are worried about your parent’s finding out that you have a problem. Have they been unsupportive of your problems in the past? Are you embarrassed or ashamed? Are you worried that you will get in trouble with your parents? I would guess that your parents would be upset by the news but they would also be very concerned and would want to help you. I know it is hard being your age and talking to parents, but one thing that is an advantage which you might not realize is that you have a guidance counselor who could help you talk with your parents about your problem. I think that your parents would want to be involved in helping you. Because you contacted us I think you want help, and I know it is scary but I encourage you to talk to your guidance counselor. I hope that you will.
If you would like to speak with a trained Helpline volunteer who can give you advice on how to approach your guidance counselor, please call 1-800-931-2237.
Danielle Z. Kassow, PhD
3/21/2006
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Help! I am 22 years old, have been bulimic for about 4 years now, and I am afraid of dying. I am too ashamed to admit this to any family or friends. I can't sleep through the night -- I wake up several times every night with my heart beating fast. I often feel weak, but still work out. I haven't eaten regular meals for a while, but I am starting to now. I also have had what appear to be two anxiety attacks and then I wake up at night. Have I gone too far? Is there a possibility that I've screwed my body up so much that I will die no matter what now or if I start eating normally and not work out to add more calories can I survive? Also, are these bouts of waking up in the middle of the night just anxiety or is this a sign of what’s to come? Please help.
It sounds as if you may not only have bulimia, but also an anxiety disorder with what are called “noctural panic attacks” Your body can recover. You can turn things around. But, you need help. Often, bulimia nervosa and anxiety disorders go hand in hand, and is common that when one gets worse the other does too. The good news is that they are very rarely fatal and both are very treatable. However, you certainly want to see a physician to make certain that there’s nothing else more serious going on. Sometimes treating the bulimia nervosa successfully will bring about an improvement in panic attacks, but usually you need to address both problems. Cognitive behavior therapy focusing on bulimia nervosa and on panic attacks (including nocturnal panic attacks) have been shown to be effective treatments. Many people find self-guided programs based on cognitive behavior principles to be helpful as well. “Overcoming Binge Eating” and “Eating Disorders: The journey to recovery workbook” are examples. All of these books are available from www.gurze.com. For panic attacks, you might read Panic Attacks Workbook: A Guided Program for Beating the Panic Trick by David Carbonell, available on Amazon.com. Often medications help as well. The trick is finding eating disorders and anxiety disorder specialists in your area that you can access. The Academy for Eating Disorders website may provide information about clinicians in your area.
I hope you can afford therapy with a therapist skilled in the treatment of eating disorders. If not, consider working where you can get health insurance to help you. Meanwhile, read, read, read. You are not alone. You can get better. Read “Life Without ED,” “Intuitive Eating,” “Rules of Normal Eating,” and “When Food Is Love” all available at www.gurze.com. Find other books at that site that call to you. Read them. Join a listserv devoted to recovery such as at www.paysonroad.com. Immediately leave any list that supports eating disorders. Good luck to you in your journal. It is hard work, and I promise you, worth the effort.
Karin Kratina, PhD, RD, LD/N
7/31/2006
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I have a 14 year old daughter who has been an exceptional athlete since early childhood. She “retired” from her gymnastics career due to several stress fractures in her back. Recently, after starting track and field she developed two stress fractures in her thigh, and her physician is concerned about her ability to absorb calcium. My wife and I, upon further reflection, are concerned because her eating habits have been steadily declining over the past 6 months, although we have no evidence she is systematic about it. She eats a lot of "junk food" and carbohydrates, and then will refuse to eat regular meals. It seems to us that her nutritional habits are probably a factor in her recurring fractures. It has not really been on our radar screen that she may have a possible eating disorder because her weight and appearance are normal. Now, however we are concerned, in part because when we attempt to speak with her she is defensive and unwilling to discuss her eating habits. At this point do we only treat the physical problems professionally or do we need to address the emotional and mental aspects professionally, as well?
I recommend that you have your daughter evaluated by a skilled clinician who specializes in eating issues. Your daughter may already have an eating disorder, or she may be headed towards one. I prefer erring on the side of being safe rather than sorry.
You did not mention if she still has menstrual periods. It is imperative that she be menstruating for her bone health. For this and other medical problems, she should, of course, be seeing a medical doctor. I prefer to send my patients to doctors who are skilled in treating individuals with eating disorders and who communicate and work within a treatment team setting (where the therapist, doctor and dietitian communicate regularly).
She could be feeling out of control around “junk food”, eating too much of it and then avoiding dinner for fear of weight gain. (By the way, I generally avoid the term “junk food” as it adds to the counterproductive moralization around food and weight so rampant in our culture) Certainly two of the most weight focuses sports are gymnastics and track. It is highly likely that your daughter frequently finds herself around conversations that focus on food and weight and that she is concerned about her own weight. It may be very helpful for her to see a dietitian who specializes in treating individuals with eating disorders to help her normalize her eating patterns.
Karin Kratina, PhD, RD, LD/N
7/31/2006
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My 19 year old step daughter has anorexia (less than 6 months)and has been meeting with a Medical Doctor, Physiologist and a Nutrients Therapist for 6 weeks. How long should we let her try to gain her weight back before thinking about inpatient treatment?
The decision regarding inpatient care for anorexia nervosa should be made based on medical and prognostic factors - not on the duration of illness. If serious medical symptoms are present (such as cardiac arrhythmia, severe anemia, marked dehydration, suicidal depression) then hospitalization clearly enhances safety. If the patient’s weight is 70% or less of expected weight for height (BMI of 13.7or less), there is consensus among the majority of eating disorder clinicians that inpatient care will most likely be necessary. The prognosis for benefit from outpatient care at weights below 70% of healthy weight for that individual is sharply poorer than at higher weights. Expected weight for height in young women of medium skeletal build is roughly 100 lbs for 5 feet and 5 pounds per inch in either direction. Although according to the usual height and weight charts a young woman 5’4” tall of medium bone size might be expected to weigh about 120lbs., in fact normal healthy weights can vary by at least 10% to either side of this median weight.
I am struck by the fact that the young woman described in the question has a treatment team that does not include a mental health professional. A forum for discussing one’s emotional life is an essential part of eating disorder treatment.
It is important to recognize that the treatment of anorexia nervosa can take quite a long time even when it is proceeding well. It is clearly a challenge to families and patients alike to adjust to the considerable time frames that the treatment of anorexia nervosa often requires.
Charles A. Murkofsky, MD, FAED
12/1/2006
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I think I am anorexic or at least quite underweight. In recent months I have lost a bit more weight, have not binged/purged in this time, and have been experiencing severe stomach cramps at night. They are bad enough that they wake me from my sleep. I am not sure what this means. Is it something I should be worried about?
From what you describe regarding your stomach, I cannot determine how much you should be alarmed, and so I advise consulting your doctor. However, your low weight is definitely concerning and so I strongly urge you to have an evaluation for possible anorexia. Since you do not appear to be in treatment already, it seems like you may have some ambivalence about treatment. But I again urge you to have an evaluation with someone knowledgeable about eating disorders, since there are many serious medical and psychological problems associated with anorexia. In brief: yes, you should be worried!
James I. Hudson, MD, ScD
2/1/2007
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Hi, I have been making myself throw up off and on for the past few years, and in the past three weeks it has significantly increased to 1 or 2 times a day. I am going to get some help before this gets any worse, but I was wondering if my body could already be having consequences even though my case isn't severe. If I eat an amount of food that I would normally throw up after, I sometimes get an upset stomach. I was just wondering what effects I can expect (if any) since this is not a long-term case. Thanks.
The first comment I have is that throwing up 1 to 2 times a day IS getting pretty severe. Whether you will develop physical consequences -- such as loss of tooth enamel, fluid and electrolyte disturbances, and difficulties with your intestinal tract -- is not possible to predict with any certainty. But, the more frequent the vomiting and the longer it goes on, the greater are the chances of some significant physical problem. The good news is that most of these problems are reversible if you can overcome the eating disorder, so getting help soon is a great idea.
B. Timothy Walsh, MD
10/1/2006
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I started throwing up my food when I was 13 years old. I am now 21 and the feeling comes and goes, but 99% of the time wins me over. I don't binge eat, I don't sneak food, I don't obsessively exercise, and I don't take laxatives. Yet, for the past eight years, at least twice a week, I think about it and try to fight the urge, but I have to do it. Is this bulimia, or is this all in my head?
We are seeing, with increasing frequency, people who present with an eating disorder that do not fall ‘neatly’ into any specific diagnostic category. One of these ‘newer’ presentations has come to be called ‘purging disorder’ by some of our colleagues. This manifestation of an eating disorder can be described as when someone engages in inappropriate compensatory behaviors, such as self-induced vomiting, in the absence of eating excessive amounts of food or binge eating. Binge eating is when one eats a large amount of food in a short period and experiences a feeling of loss of control while eating. This is followed by a feeling of remorse about consuming such a large amount of calories. Anyone who presents with such symptoms should seek professional advice, both to help the individual overcome these symptomatic behaviors, as well as to make sure that there are no electrolyte disturbances or other medical complications as a result of frequent purging behaviors.
Daniel F. Le Grange, PhD
6/26/2007
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My 9-year-old grandson choked on a piece of hard candy in Feb 2006. Since that time, he says he is afraid to swallow and has systematically stopped eating any food except those that are smooth and creamy. He has lost from 91 lbs to 71 lbs since Feb. He takes 1-2 hours to eat every meal and has to be forced to eat anything. What kind of treatment should we be seeking for him?
Your grandson is clearly showing signs of a traumatic reaction to the choking incident and he’s obviously fearful of choking again. The incident may have touched other psychological chords, however. Given his young age, it’s very likely that he would have difficulty verbally expressing aspects of his psychological reaction. I recommend that he see an experienced child psychologist or child psychiatrist well versed in play therapy. Play therapy can help children identify and work though such issues and conflicts. Some clinicians would recommend behavioral desensitization, using imagery, and other related tactics.
In the meantime, allowing him to take his time eating and to eat soft foods seems like a sensible approach. I would strongly urge the adults around him remain upbeat, reassuring and non-critical of his struggle. I would encourage but not force him to eat, for now, and then co-ordinate what the family does with the therapeutic approach adopted by the clinician with whom he’ll work.
Charles A. Murkofsky, MD, FAED
12/1/2006
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I have always had an unhealthy relationship with food. Sometimes I'd binge and then I would purge by eating hardly anything and doing a lot of exercise. Over the past 6 months I have started taking ipecac to help induce vomiting after my binges. I have only taken it 8 times. Will that affect my health? Is there any way to know? Is there any emetic that is less dangerous?
If you continue to abuse Ipecac (and using it to purge is abuse), you are clearly jeopardizing your health. Ipecac is toxic to muscle of all kinds, including your heart (cardiac muscle). In addition to the cardiac effects, Ipecac can lead to seizures, shock, hemorrhaging, blackouts, high blood pressure, respiratory complications, dehydration, electrolyte abnormalities and death. Some studies suggest that daily use of ipecac for only several weeks may cause irreparable heart muscle damage and cause death.
There are no safe emetics for continuing use. There is no way to tell how long you can abuse Ipecac and not be adversely affected. The only sensible advice anyone can offer you is to discontinue Ipecac immediately.
Charles A. Murkofsky, MD, FAED
12/1/2006
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How do you know if someone actually has an eating problem?
Several of this month’s questions surround two issues that many people find worrisome. The first is how to know whether someone actually has an eating problem. The second is what to do if you suspect that you or someone you care about may have an eating problem.
So, how do you know if someone actually has an eating problem?
Many of us equate eating disorders with anorexia nervosa (AN) and bulimia nervosa (BN). Furthermore, we tend to think of anorexia as self-starvation and bulimia as the “binge-purge” syndrome. Anorexia certainly is marked by a refusal to maintain body weight at a minimally normal level for height, body type, age, sex, and activity level. Bulimia does indeed include repeated episodes of bingeing and purging. However, even without these “hallmark” symptoms, someone may be struggling with a serious eating problem. How would you know? What should you look for?
There are many potential signs of eating problems. Here are a few:
- Ritualistic eating habits such as chewing each bite a certain number of times or cutting food into very small bites;
- Denying hunger;
- Feeling out of control when you eat;
- Excessive exercise, including exercise that interferes with other activities or exercising when sick or injured;
- Eating low fat or no fat (or calorie) foods only (or primarily) with no medical reason;
- Bingeing without purging (which may be Binge Eating Disorder or BED);
- Purging without bingeing;
- Chewing food and spitting it out repeatedly;
- Thoughts and conversation focused on food and body shape;
- Eating in secret or being ashamed of eating;
- Shame or embarrassment about body shape or weight, including feelings of unworthiness or self-disgust.
- Loss of menstrual cycle in females or loss of sex drive in males (these indicate endocrine system dysfunction).
About half of the women who seek treatment for eating disorders do not meet the full criteria for anorexia or bulimia. Yet they are suffering from serious eating problems that threaten their health and well-being. For medical insurance purposes, they are often given a diagnosis of Eating Disorders-Not Otherwise Specified (EDNOS). In general, if thoughts or behaviors related to body shape and food are making you miserable, interfering with your social or professional (for students, this would be school) life, or worrying your friends and family, you should find a way to talk to someone. Similarly, if you have a friend or family member who focuses on food and body shape in ways that seem obsessive or leave that person isolated, it is important to help them find ways to get help.
Before discussing ways to seek help, it is important to emphasize that anyone can develop an eating disorder. Anorexia, bulimia, binge eating disorder, and EDNOS can affect males and females of any age, social class, or ethnicity. It is extremely important to seek help for eating problems for several reasons. First, eating disorders can be fatal. Among other things, they damage your heart, your gastrointestinal system, your brain chemistry, and your hormonal system. This can lead, for example, to heart arrhythmias or bleeding ulcerations that can be fatal. Second, eating disorders make you miserable. They sap your energy, your happiness, your self-esteem, and your personal relationships. They commonly coincide with depression and anxiety disorder. Treatment is needed to help people lead fuller and more satisfying lives.
Linda Smolak, PhD
11/1/2006
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I have recently been hearing about a disorder called binge eating. After reading all the symptoms, I felt like they were describing me. I am 26 and have been dealing with compulsive overeating since about 15 or so. I am not sure what I should do or if I should seek some kind of treatment?
Binge eating disorder, or BED for short, is a well-known eating disorder. It is primarily characterized by binge eating episodes. A binge is typically defined as eating an unusually large amount of food, given the circumstances, in a relatively short period of time. The individual engaging in binge eating usually feels out of control during such episodes, and experiences guilt/remorse/sadness afterwards. Finally, BED is diagnosed when binge eating occurs in the absence of regular compensatory behaviors, such as self-induced vomiting or laxative abuse. Several systematic efforts at finding the most efficacious psychosocial treatments for BED have been conducted. Evidence shows that both cognitive-behavioral therapy (CBT) and interpersonal therapy (IPT) can be effective for treating BED. Seeking professional help is recommended. Most eating disorders therapists will be knowledgeable of CBT as the approach that shows the highest levels of effectiveness in current research, although other treatments forms may also be effective. In addition, certain medications may be helpful.
Daniel F. Le Grange, PhD
6/26/2007
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I don’t know if I have a certain stage of bulimia. I’m always struggling because I think that I’m really fat even though everyone says otherwise, I rarely eat, and lately all I want to do is just be laying in my bed because I’m tired all the time. My period started acting up this month, I get a lot of bloatedness, I have stress, my hair has been falling out a lot. My fiancé says that I haven’t been acting the same lately because I’m always moody. My dad says that my face is getting yellow. I don’t know if I should be worried or not. Could this all just be in my head?
I am curious about what is going on with your eating and if you are ingesting sufficient nutrients. Although you ask if you are dealing with bulimic symptoms, your symptoms seem to indicate restrictive eating behavior and therefore I suggest you seek an evaluation for anorexia nervosa, marked primarily by under-eating rather than bingeing and purging (although you may suffer from bulimic symptoms as well that deprive your body of nutrients). I am concerned by your description of your “hair falling out” and “face is getting yellow” because these symptoms emerge in a progressed anorexic state, when the body is reacting to starvation and nutritional deprivation.
Catherine Baker-Pitts, LCSW-R
5/1/2007
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My sister chews her food and then spits it out. Is this some kind of eating disorder? How can she stop her habit?
Chewing and spitting out food has certainly been associated with eating disorders, but probably occurs in individuals without frank eating disorders as well. Some research shows that chewing and spitting is associated with restrictive eating rather than an eating disorder per se. Whether this pattern represents an actual eating disorder probably depends on other associated features. Does this individual engage in other eating disorder behaviors such as binge eating or purging or markedly restrictive eating that result in a low body weight?
Does she have problems with body image disturbance and is she abnormally focused on weight and eating concerns? Therefore, the context in which chewing and spitting occurs matters, as does the frequency and impact of this behavior pattern.
With regard to how she might stop the habit, there are no published reports of treatment for chewing and spitting out food. In my clinical experience, if this pattern occurs in the context of an eating disorder the usual approaches to the treatment of these disorders, such as cognitive behavioral therapy for bulimia nervosa, can result in improvement or eradication of this symptom along with other target symptoms such as binge eating and purging. If she is engaging in chewing and spitting as a way to decrease caloric intake and maintain an abnormally low body weight, then the treatment would have to focus on her need to increase intake and probably the variety of foods eaten as well.
For more information please see:
Guarda AS, Coughlin JW, Cummings M, Marinilli A, Haug N, Boucher M, Heinberg LJ. Chewing and spitting in eating disorders and its relationship to binge eating. Eat Behav. 2004; 5:231 239.
Kovacs D, Mahon J, Palmer RL. Chewing and spitting out food among eating disordered patients. Int J Eat Disord; 2002; 32:112 115.
McCutcheon R, Nolan A. Chewing and spitting out food a neglected symptom? Int J Eat Disord, 1995; 17:197 200.
Mitchell JE, Pyle R, Hatsukami D, Eckert E. Chewing and spitting out food as a clinical feature of bulimia. Psychosomatics, 1988; 29:81 84.
Mitchell JE, Hatsukami D, Eckert ED, Pyle RL. Characteristics of 275 patients with bulimia. Am J Psychiatry, 1985; 142:482 485.
James E. Mitchell, MD
1/6/2006
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If someone who is pregnant has an eating disorder what are the chances of the baby surviving?
This isn't a simple question, because the risks to the fetus in part depend on the severity and the nature of the eating disorder. Lumped together, patients with eating disorders are more likely than others to have miscarriages and stillbirths, but the odds are still heavily in favor of having and carrying babies to term.
The more common question is how will the baby be affected. We know that mother's with eating disorder are not only more likely to suffer spontaneous miscarriages, but are also more likely than other women to deliver prematurely, have small term babies, and have babies with other complications at the time of delivery. How much the baby will be affected by the mother's eating disorder is an open question in any given case, but we clearly know something about factors that will contribute to the risk of some sort of complication in the baby. Babies are at greater risk for complications if during pregnancy the mother is very underweight, is purging, and/or is using alcohol, illicit drugs, or smoking.
Scientific evidence concerning risk to the unborn fetus as a result of prescribed medication is mixed. In general, if a patient can manage to avoid psychiatric medications during pregnancy, all to the better. But the fact is that many women with eating disorders are particularly prone to depression during pregnancy and the post-partum period, and in such instances treating the mother's depression and avoiding further episodes are essential both for the baby and the mother. For many patients with eating disorders, obsessive compulsive problems and impulsivity may also require continued use of medication during pregnancy.
If you have an eating disorder and are considering pregnancy, it is smart to consult with a psychiatrist or obstetrician with special expertise in this area. Some of the medications commonly used in the treatment of patients with eating disorders, such as selective serotonin reuptake inhibitors (SSRIs), are generally safe, but they vary in their impact on the developing fetus and newborn.
Joel Yager, MD
12/31/2005
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