Monday, July 16, 2012

Management of Anorexia and Bulimia

Medivision presents an excerpt from our 60 minute medical education video Management of Anorexia and Bulimia, featuring Mary E. Muscari, PhD, CRNP, CS and Marrian Farrell, PhD, RNC, CS. The full length film, along with many other medical education titles, is available on VHS or DVD from and describes the clinical manifestations and potential complications associated with anorexia and bulimia nervosa; the nursing techniques used to prevent and manage the physiologic consequences, and assists the physician in developing an understanding of the psychosocial needs of clients with eating disorders while examining various psychosocial interventions based on appropriate theoretical perspectives for clients with eating disorders.

Competent and comprehensive care of eating disorders must involve understanding the medical aspects of these illnesses, not just for physicians but for any clinician treating them. A therapist must know what to look for, what certain symptoms might mean and when to send a patient for medical evaluation. A dietitian will likely be a team member who performs the nutrition evaluation and must have adequate knowledge of all medical/nutritional aspects of eating disorders. A psychiatrist may prescribe medication for an underlying mood or thought disorder and must coordinate this with the rest of the treatment.

Eating disorder medical complications vary with each individual; some patients who self-induce vomiting have low electrolytes and a bleeding esophagus while others can vomit for years without ever developing these symptoms. It is necessary to have a well-trained and experienced physician as part of the treatment team of an eating disordered patient. Not only do these physicians have to treat symptoms that they find, but they have to anticipate what is to come and discuss what is not revealed by medical lab data. Unfortunately, physicians with special training and/or experience in diagnosing and treating eating disorders are not very common, and patients who seek psychotherapy for an eating disorder often have their own family doctors which they prefer over a therapist referral.

Most eating disorder complaints like headaches, stomachaches, insomnia, fatigue, weakness, dizzy spells, and even fainting do not show up on lab results. Parents, therapists and doctors too often make the mistake of expecting to scare patients into improving their behaviors by having them get a physical exam in order to discover whatever damage has been done. Patients are rarely motivated by medical consequences and often have the attitude that being thin is more important than being healthy, or nothing bad is really going to happen to them, or they don't care if it does. Furthermore, patients can appear to be healthy and receive normal lab results even though they have been starving or vomiting for months or years.

Managing binge eating disorder patients most likely involves the same medical considerations to be taken into account when treating obese individuals, such as heart or gallbladder disease, diabetes, high blood pressure, and so on. Most symptoms of binge eating will be a result of the accompanying weight gain associated with this disorder. Occasionally people have binged to the point of becoming breathless when their distended stomachs press up on their diaphragms. In very rare cases a medical emergency may occur if the stomach wall becomes so stretched that it is damaged or even tears. 

While many people with an eating disorder will recover fully, relapse is common and may occur months or even years after treatment. An estimated 5 to 10 percent of anorexics will die from the disorder; their deaths most commonly result from starvation, suicide or electrolyte imbalance. More favorable outcomes for anorexics have been associated with a younger age of onset of the disorder, less denial, less immaturity, and improved self-esteem.
The outcome for bulimia nervosa is not as well documented, and mortality rates are not yet known. It is a chronic, cyclic disorder. Of those bulimics who are treated for the disorder, fewer than one-third will be fully recovered three years after treatment, more than one-third will show some improvement in their symptoms at a three-year follow-up, and about one-third will resume chronic symptoms within three years.

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