EDIT: I want to apologize for an oversight in this blog entry. Shelly and I forgot to mention Diabulimia Helpline in our list of organizations that help raise awareness and support sufferers with type 1 diabetes and eating disorders. Diabulimia Helpline is the only non-profit in the US dedicated to “education, support, and advocacy for diabetics with eating disorders, and their families.” I also want to highlight some services that Diabulimia Helpline offers: “a 24 hour helpline available via (425) 985-3635, an insurance specialist to walk clients and/or their parents through the complicated world of getting insurance to cover eating disorders, and a referral service to help people find the treatment centers, doctors, therapists, and counselors that would be a good fit for them on their road to recovery.” – Sincerely, Tetyana
Type 1 diabetes (DMT1, or T1DM) is a lifelong disease often diagnosed in children or adolescents. Though causes of DMT1 are complex and not fully understood, it results from the body’s immune system destroying its own insulin-producing cells. This drastically lowers insulin levels and leads to …
Eating disorders are mental disorders with physical complications. Sometimes lots of them. I’ve blogged before about medical complications that are likely to come up in an emergency room setting, but that was a while ago. So I thought today I’d focus specifically on medical complications that occur in bulimia nervosa (BN) as a result of purging (self-induced vomiting, laxative abuse, and diuretic abuse).
These complications are particularly important because patients with BN often appear healthy and can thus more easily hide their disorder, meaning that treatment is often initiated many years after disorder onset, and the duration of BN is often long, with recovery rates far lower than they should be (in one study, the 5-year recovery rate was a little more than 50%), which means that these complications can persist for many years.
I’ll go through some of the complications of self-induced vomiting, laxative abuse, diuretic abuse, and briefly mention some complications in patients with type 1 diabetes.
I. COMPLICATIONS OF SELF-INDUCED VOMITING
Oral complications of self-induced vomiting:
It is to be expected that the Diagnostic and Statistical Manual of Mental Disorders, at least when it comes to anorexia nervosa, relies heavily on measures that are hard to quantify and measure objectively. The big exception is amenorrhea: the absence of menses (commonly known as “periods”) for three consecutive months. As I’ve mentioned before, this criterion will be removed from the next edition of the DSM, thankfully. But for now, it is still there.
Perhaps because it is easy to measure objectively, the resumption of menses is often taken to be a marker of “health” and “recovery.” It is a common goal in treatment for patients to reach a “menstruating weight.”
[Conversely, not losing one's menstrual cycle is often perceived by the patient that they are not "sick enough." Their eating disorder is not legitimate because clearly they are eating enough for their menstrual cycle to continue, and thus they should "snap out of it" or they "don't deserve treatment," which is of course not true.]
I often run into questions online with individuals in recovery who are weight restored and eating well, …
Is getting the flu shot a good idea if you have anorexia nervosa? Is it safe?
To be honest, I’ve never asked myself that question before. Last year, when I was underweight, I got a flu shot mainly because the laboratory where I am doing my graduate degree is in a hospital–the same hospital that was at the centre of the SARS epidemic in Toronto–and I didn’t want to put patients at risk. Sure, I spent most of my time staring at worms through a microscope (true story) but in the rare event I ventured outside for a coffee, I didn’t want to cough on newborn.
So I was kind of excited to find out the answer when someone asked me this question earlier today on tumblr. As expected, I didn’t find much information, but I did find one relevant paper published online in 2011 by Arne Zastrow and colleagues. I thought I’d make a quick post about it to make the information available to others.
As you probably know, getting the flu vaccine is especially important for individuals …
Anonymous asked, “I’ve never lost my period. Weight restored I am naturally thin, but even at a BMI of 15 or so I always got my period (although it wasn’t always regularly). This makes me feel like I’m not actually sick because I hear about everyone losing their period.”
eatruncats replied: “To the anon who asked about losing periods: For all the times she worries about not being sick enough because she never lost her period, there are people who lost their periods at BMIs of 18, 19, and 20 who worry about not being sick enough because they never got to a BMI of 15. If you have an eating disorder, you are “sick enough.” Period.“
As it stands now, amenorrhea–or the loss of three consecutive menstrual cycles–is a diagnostic criterion for anorexia nervosa. Individuals who have not lost their periods are diagnosed with eating disorder not otherwise specified (EDNOS). A problematic catch-all diagnosis that makes up the majority of those diagnosed with eating disorders. I’ve discussed some of the problems with the EDNOS diagnosis elsewhere, so today I …
You know how you are not supposed to get on the topic of kids on your first date? Well, I did. Clearly I wasn’t good at following social rules (in my defense, this was many years ago). “It would be cool to be surrogate mother,” I said. And then I thought about it. “But that would probably be difficult, who would want me to carry their child?” Needless to say, my date was confused. I thought, surely having had an eating disorder and a long history of amenorrhea would put me at an increased risk of complications during pregnancy?
So this made me wonder, what is the effect of having had an eating disorder on pregnancy? And more specifically, are women who’ve had eating disorders more likely to experience perinatal and delivery complications?
Like with a lot of things, the information out there is mixed. (This is why one study is never enough and replication is crucial.) Early studies seemed to have suggested that women with EDs face an increased risk complications during the last stage of pregnancy and during delivery. …
Type 1 diabetes mellitus (DMT1) is a lifelong chronic disorder that occurs when the body is unable to produce enough insulin – a hormone that is required for carbohydrate metabolism. Patients must learn to manage their disorder by monitoring their blood sugar levels on a regular basis, carefully selecting the foods they eat and how much exercise they do. Before insulin was extracted and purified (at University of Toronto!), type 1 diabetes, which usually occurs in children and adolescents, would very quickly lead to death – the body, unable to take in the very thing it needs to survive.
Unfortunately, patients with type 1 diabetes are at increased risk of developing eating disorders or disordered eating behaviours. Diabulimia refers to an eating disorder in patients with DMT1 who reduce or skip insulin doses to reduce their weight.
The exact prevalence rates vary study by study, depending on the population sample, how disordered eating/EDs are defined and a multitude of other factors. But, nonetheless, some numbers are helpful.
Kelly et al provides a nice overview of the prevalence studies. I’ve summarized some below:
There are …
A healthy-looking young woman comes into the emergency room complaining of lightheadedness, dizziness, tiredness, dehydration and constipation. She tells you she doesn’t know what’s wrong, but what she is not telling you is that she has an eating disorder. How do you find out? More importantly, how do you avoid complications that may arise from using conventional treatments for patients without eating disorders?
I often come across questions posted on websites and forums asking if others have experienced a particular symptom, what could be causing it and whether going to the hospital is necessary. I am not a physician, not training to be a physician and not doing research in anything directly relevant to medicine or health. Moreover, I always use caution when answering questions online – the best advice is to go see a doctor (but of course, that’s not always possible, unfortunately).
My goal with this post is to do a brief overview of some common health complications faced by eating disorder sufferers, their underlying causes and some advice on proper treatment/management.
This information is coming from a …
Recovery from an eating disorder is really hard. Unfortunately, the negative effects of that occur as a result of the eating disorder often persist long after recovery. It is hard to undo the mental and psychological aspects of anorexia or bulimia nervosa, but it may be just as hard, if not impossible, to undo the damage done to body.
What are some of the long-term health effects of eating disorders? What do patients with eating disorders – recovered or not – have to live with, for years, often decades, after recovery?
A really common consequence of anorexia nervosa is osteoporosis: thinning of bone tissue and loss of bone density. Unlike delayed gastric emptying - another consequence of EDs - which can make every meal a nightmare (particularly for someone recovering from an eating disorder): acid reflux, stomach pain and abdominal bloating are just some of the symptoms, bone density loss is easy to overlook. You don’t feel its effects (not initially, anyway), you probably wouldn’t even know it is happening. Many are unaware of just how quickly bone health can deteriorate and …