head to toe: recognizing the complications of eating disorders
TRANSCRIPT
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Head to Toe: Recognizing the Complications
of Eating Disorders
Anna Vinter, MD Medical Director
Eating Recovery Center of California
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Who might benefit from this talk
• Family members • Therapists • Dieticians • Someone struggling with an eating disorder yourself
You may know something is wrong, but you may not know just how serious the problem is, and you may not know how to advocate to get help for yourself or someone you care for.
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Eating Disorders May Be Invisible
• Eating disorders occur in males and females • People in average and large size bodies can experience
starvation and malnourishment • Even experienced clinicians may not recognize the medical
consequences of EDs (AED Guide to Medical Management)
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Eating Disorders Come In All Sizes
“Weight is not the only clinical marker of an ED.
People who are at normal weight [and high weight] can have EDs.”
(AED Guide to Medical Management)
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Eating Disorders are Lethal
• Anorexia nervosa has the highest mortality rate of any psychiatric disorder
• About 40% of deaths in Anorexia are from suicide
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0 5 10 15
Anorexia Nervosa (15-24)
Anorexia Nervosa (25-44)
Bulimia Nervosa (15-24)
Bulimia Nervosa (25-44)
Schizophrenia
Depression
Bipolar Disorder
Standardized Mortality Ratio
Standardized MortalityRatio
Comparison of Mortality
Int J Eat Disord 2014; 47::507-515
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Eating disorders must be diagnosed to be treated
Earlier diagnosis and treatment of eating disorders lead to fewer medical
complications and better outcomes
LeGrange and Loeb 2007
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Resource #1
http://aedweb.org/web/index.php/education/eating-disorder-information/eating-disorder-information-13
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Resource #2
By Dr. Philip Mehler Chief Medical Office of Eating Recovery Center
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Medical Complications of Eating Disorders
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• In Anorexia (Restricting Type), medical complications are due to starvation and weight loss
• In Bulimia/Purging Disorders, medical complications are from the type and frequency of purging
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Restricting Anorexia
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No system is spared!
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General Symptoms
• Weight loss
• Fatigue
• Poor sleep
• Muscle wasting
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Psychiatric
• Depression
• Anxiety
• Suicide
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Dermatologic • Hair
changes/loss
• Lanugo
• Dry skin
• Brittle nails
• Acrocyanosis
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Acrocyanosis and Delayed Capillary Refill
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Cardiovascular
• Arrhythmias
• Low heart rate (bradycardia)
• Low blood pressure
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Metabolic • Low body
temperature (hypothermia)
• Low blood sugar (hypoglycemia)
• Low thyroid hormone
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Gastrointestinal
• Delayed movement of food through
stomach (gastroparesis)
• Constipation
• Feeling of fullness
• Nausea after eating
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Hormonal • Loss of period/
infertility
• Low
testosterone
• Bone loss
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Hematologic
Blood cell development failure:
• red blood cells
• white blood cells
• platelets
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Bulimia/Purging Disorders
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General Symptoms
• Weight loss or weight gain
• Fatigue
• Poor sleep
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Psychiatric
• Depression
• Anxiety
• Addiction
• Suicide
• Mood swings
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Head, Eyes, Ears, Nose, and Throat (HEENT)
• Dental erosion • Parotid gland swelling • Sore throat
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Gastrointestinal
• Heartburn (GERD) • Ulcers • Bleeding • Esophageal tear/rupture • Constipation from laxative abuse • Permanent bowel muscle damage
(cathartic colon syndrome)
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Cardiovascular • Arrhythmias
• Low heart rate (bradycardia)
• Palpitations
• High blood pressure
( from diet pill toxicity)
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Metabolic • Low potassium
(hypokalemia) • Dehydration • Disruption in acid-
base balance (metabolic alkalosis)
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Hormonal • Irregular periods
• Disrupted fluid
balance → extreme swelling after STOPPING purging (Pseudo-Bartter’s syndrome)
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Most medical complications from eating disorders will resolve with
appropriate and adequate treatment.
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Eating Recovery Center of California 916-574-1000
www.eatingrecoverycenterca.com