January 9th, 2015 Heather Purdin
From Mirasol ED Recovery Guest Blogwriter ~ Faith
As with any mental health diagnosis, eating disorders come with many stereotypes. Most often, eating disorders tend to be oversimplified by the general public as merely a reaction to social pressures about food and body image. Or, it is assumed the patient is probably just victim of exposure to a sport or industry that pressures people to maintain low body weights.
With steady diagnostic surge among males and the rise in increasingly younger AND older patients, the outdated image of the white, middle-to- upper class teenage female no longer works when we’re talking eating disorders.
Incredibly complicated diseases, most recent research suggests eating disorders actually result from a complex web of factors interplaying into the perfect storm. Genetics, social & familial factors, neurobiology, stress, and physical illness are just a few examples.
Eating disorders are further complicated by the fact that they are not just mental health issues. While the mental aspect is incredibly debilitating, the patient may also be suffering with complicated medical issues, which also need to be treated. In some cases, the medical issues may need to be the primary concern and treated first.
With their alarming mortality rate surpassing any other mental illness and half of the deaths resulting from medical complications, acute attention must be paid to each patient’s medical stability. Stereotypic images of stick thin, media-hyped models like “Twiggy” and “Kate Moss” along with assumptions of “teenage angst” leave many doctors overlooking the severity of a patient’s physical condition. Surmising everything as a routine “phase” can lead to failure of thoroughly examining co-occurring or underlying medical complications like gastroperesis, a condition where food is slow to leave the stomach.
Though still underfunded, eating disorder research continues to progress every month. We now know gastrointestinal distress commonly correlates with eating disorders. So far, though, it is assumed that the eating disorder causes the digestive distress.
While some cases may be logically explained by a history of prolonged disordered eating, what if this is the root factor issue for others?
GI issues, such as gastroparesis, GERD, and colonic issues, can actually pose a close presentation to anorexia or bulimia when people begin to fear food and the discomforts of digestion. I’m left wondering how often digestive disorders are assumed to be eating disorders and misdiagnosed. Including the diagnosis of a mental illness in one’s chart changes the course of the medical care one receives and should be decided with thorough consideration.
Patients with core digestive issues are at risk of being treated improperly by the mental health system. The primary diagnosis as eating disorder sends the patient down the path of behavioral and mental health based care, where actual “true GI issues” are often minimized or ignored. Because of the “eating disorder” diagnosis, the patient is assumed to be fabricating the distress to get out of eating. Other times, the facility is just ill-equipped and inexperienced at managing the patient’s particular physical issues.
I know someone suffering with GERD and gastroparesis, who was misdiagnosed in the beginning of her illness. It is possible her initial symptoms could have been controlled with prescription medication. Almost a decade after “x” number of eating disorder program admissions, for an eating disorder she doesn’t think she even had to begin with, she now has to have a feeding tube and possibly additional surgeries.
Thousands of dollars have been spent on “conventional eating disorder treatment centers” that repeatedly missed the target. It also seemed to introduce her to a culture of “ED” that she never knew existed before. While rare, it is almost as though she learned how to have an actual DSM-V eating disorder by being in the wrong level of care.
Where do we go from here?
First, we need to continue to push for research funding toward eating disorders in general. For example, The NIH has allocated only $1.20 in research funding per affected eating disorder patient, compared to $159.00 per affected individual for schizophrenia, less than 1%.
Following suit with recent research data, eating disorders and feeding disorders have been coupled together in DSM-V. For example, anorexia and avoidant/restrictive food intake disorder are in the same category. Evolutions in eating disorder diagnosis have occurred in each of the most recent revisions to the DSM. It seems logical that some digestive and gastrointestinal disorders may also impact food behaviors that result in weight changes, food intolerances, preoccupation with food, and body image distress.
Physicians need to be mindful of this possibility as many of these same complaints come from patients with eating disorders, blurring the diagnostic lines leading to possible confusion and diagnostic error.
In the case where both digestive issues and eating disorder issues are present, individualized care is absolutely vital. Special accommodations not normally thought of as acceptable by eating disorder programs may be necessary, such as supporting a dairy-free or gluten-free diet.
If treatment providers could approach each patient as if they were assessing an eating disorder for the first time, fewer assumptions would cloud their ability to make a complete and thorough assessment.
Editor’s response from Mirasol ED Recovery Blog Publishing Editor:
My first read through of Faith’s blog sent chills down my spine. I had to include my response because only in the last couple of months have I connected the dots between my own eating disorder and digestive distress.
I have high functioning autism traits and am easily fixated. I always had a heightened interest in food. I loved to play restaurant, make mud pies, and even had a toy grocery cart full of plastic food.
I also had a lot of extreme food dislikes and food preferences.
Eating is a multisensory experience, from the taste, texture, temperature, and even the sound of eating.
My sensory issues probably contributed a bit to my lengthy dislike list as a child, but I now wonder how much of this was also my body’s intuition telling me to stay away from foods that were causing physical distress and discomfort! In fact, it’s taken me several years of experimentation to find food combinations that work best for me. Though completely balanced with ample variety and nutrient content, most non-integrative treatment centers would consider my eating preferences eating disordered. Looking back, many of my “odd” food preferences were things that were naturally soothing to my digestion.
Basically, I’ve always had food stuff, eating disorder or not. Laxative, suppository, and enema abuse presented as my first clinically detectable eating disorder behavior, which all started at age 10. After having to receive an enema for severe constipation due to IBS, I was instantly hooked on the sense of relief from having a cleared out colon after such prolonged
This also happens to be the age when I developed suicidal ideation that eventually became chronic suicidal obsession. Stress and anxiety attacks usually correlated with more IBS flares and spasms. Of course prolonged laxative abuse only exacerbated the GI distress.
A a lot of factors merged together to create grounds for my perfect storm. In addition to depression, autism, and gastrointestinal distress, I also felt the social pressures to be thin. I was bullied for many things, including being chubby. Perfectionistic in nature, I once checked out all of the eating disorders books available at the school library. I have an innate drive to be good at whatever I do, and the eating disorder was no exception. I became especially pre-occupied with becoming emaciated, which only worsened after my first inpatient stay, further triggered by exposure to severely ill patients. I didn’t openly admit this at the time but I also adopted a lot of ED rituals out of desire for belonging in the ED community. Socially awkward, I desperately needed to fit in somewhere. I definitely didn’t fit in at school or home.
Eventually, and it actually didn’t take long, the eating disorder became my entire world.
It leaves me wondering how the course of my life may have unfolded had my ASD and gastrointestinal issues been diagnosed when I was a tender ten.
When I was in treatment, I always complained to treatment providers of distracting sensitivity to my digestive track while following prescribed meal plans. I routinely experienced bloating, pain, constipation, diarrhea, and even hemorrhoids. Without exception, my voice was always dismissed as eating disordered thinking or ordinary body image related distress.
Digestive Disorder? Eating Disorder? Both? Great topic, Faith!
December 22nd, 2014 Heather Purdin
This is a great article originally published by Gurze – Salucore Eating Disorders Resource Catalogue blog. This article has been selected as one of their Top 5 Blogs of the year. It resonates so well with the Mirasol philosophy that we wanted to share the wisdom here with our own followers.
Order your free 2015 Gurze Resources Catalogue for the newest eating disorder related print publications, recovery tips, and treatment center resources!
Ten Things I Wish Physicians Would Know About Eating Disorders by Edward P. Tyson, M.D., Austin, TX
The most important things physicians need to know have to do not with technical aspects of assessing or treating physical aspects of an illness, although those are important. It is about the physician first addressing his or her own attitudes about eating disorders and those who have those illnesses.
1. Physicians are lucky to have people with eating disorders as their patients. People who suffer from eating disorders are a special group. Almost without exception, they are empathic, creative, intuitive, hard working, and usually gifted in at least one of the following (and quite often in all 3): academics, creative expression, and athletic endeavors. When these sufferers are free of their illness, they are incredible people to know and be around. And their recovery encompasses all the reasons why, hopefully, most doctors go into that profession.
2. Don’t be afraid of an eating disorder. It is an illness, with signs and symptoms and causes, and really good treatment. What other illness would a physician feel so inadequate about and also not seek the advice of colleagues or the literature? Sadly that happens so frequently and it is the topic of sufferers, family members, and professionals in the eating disorder field. Please do not be one of those people we talk about like that. Get educated or get help, but do not ignore, dismiss, or fail your professional responsibility.
3. Eating disorders will test one’s ability to be humble. These are some of the most complicated illnesses there are, as they involve both complex medical and psychiatric issues. In addition, there are not that many medical experts around, so, yes, most doctors will feel like they are in unchartered territory. And you will make mistakes; we all do. But learn from them and approach the problem in the way that patients expect of physicians—with a cool head and keen mind, unfettered from a sensitive ego.
4. You will likely need help at some point. A physician cannot know all details about every illness, especially ones as complex as eating disorders. As with any illness one encounters as a physician, the professional approach is to determine what the best assessments and treatments are. Again, be humble enough to ask for or seek advice. One can seek opinions of experts in the field in any number of ways—a phone call (a so-called “sidewalk consult”), go to the literature, use the AED medical guide, or any number of texts on the subject (consider the books by Mehler & Andersen, and Birmingham & Treasure, or, maybe even my chapter in the book by Maine, McGilley & Bunnell).
5. You will not be able to successfully separate out the physical from the psychiatric. Both must be treated at the same time. It is no longer appropriate to say, as a physician, that these are psychiatric illnesses. Nor is it permissible for psychiatrists to say that they are not the ones to deal with the medical. Again, if you do not know, do not reject the patient—instead, call in a consultant and work with that other physician.
The same applies to medical and psychiatric hospitals. Eating disorder patients should never be placed in a medical “no-mans land” where they are ping-ponged back and forth from one to the other, each claiming they cannot treat an eating disorder. These hospitals, by the way, do not have a sign outside saying, “WE TREAT EVERYTHING…except eating disorders.”
6. Keep checking every organ system every time. Use screening tools and a consistent pattern to the history and physical to make it easier, faster, and more likely not to miss something important. Use a BMI graph in those who have restricted to predict how serious the decline is, as the more dramatic the drop or angle of decline on the graph, the more likely that cardiovascular complications are present. A dramatic drop of the BMI can be very alarming and convincing to family members and to patients (see example). As I say often in those cases, “Imagine you’re flying Southwest Airlines and this is how the plane is going down. What would you want the pilot to do about now?” The answer is universally: “Pull up”…How soon? “Now!”
7. While they are complex, eating disorder’s medical complications follow specific, predictable physiological patterns resulting from the ED behaviors. However, physicians must consider the specific circumstances of that individual patient and what behaviors and conditions can predict certain medical (or psychiatric) complications. If they are purging, for example, they could have bleeding, electrolyte and dehydration issues, and signs and symptoms consistent with those conditions. Always consider cardiac complications, and in those who are restricting, screen for Refeeding Syndrome. Those who restrict should have signs of hypometabolism, with low body temperature, bradycardia, capillary refill delay, acrocyanosis, and such.
8. Check lab values frequently, including electrolytes and especially phosphorus and magnesium in those at risk of Refeeding Syndrome. Purgers are at risk of bleeding, so the CBC needs to be followed. The AED medical guide provides a good summary of labs needed.
9. Remember that many of the psychological issues may be a result of medical issues and vice versa. What one may think is anxiety or panic could easily be hypoglycemia. What may appear to be depression, bipolar disorder, or personality disorder may actually be malnutrition, brain starvation, and such. And the medical issues will tend to worsen what psychiatric issues are present.
10. Athletes can get eating disorders, too. Don’t assume because the patient is a high performing athlete, that physical findings that would be considered abnormal in others is due just to the patient being an “athlete.” A common mistake is to assume that one’s bardycardia (slow heart rate) is due to being a fit athlete. However, if the resting heart rate is below 50, evaluate if hypometabolism and energy conservation are ongoing, and not due from a fit heart but one that is losing its exercise capacity.
Do not be surprised how many calories it takes to refeed someone who has been malnourished, especially one who was exercising heavily with their eating disorder. It can be enormous calories and the patient may only then slowly gain weight at first. This is because the metabolism has to be reversed and turned from hypometabolic to hypermetabolic and that requires enormous calories, fat, protein, and carbohydrates. It is not uncommon for someone at a very low weight to be eating 5,000 calories per day at a treatment center and very slowly gaining at a rate of 1 or 2 pounds a week after a few weeks of no weight gain or even weight loss.
If a physician were to follow just the above, he or she would know more about eating disorders than 95% of other physicians. We are not looking just for experts; we’re looking for volunteers to care for these deserving patients.
About the author -
Ed Tyson has been treating eating disorders for over 20 years and is in private practice in Austin (www.EatingDisordersDoc.com). He is a member of the AED’s Advisory Board and the Medical Care Standards Committee, and a co-author of the AED’s Medical Guide for Eating Disorders. He considers himself an advocate for those who have EDs, and teaches medical, nursing students and undergraduates and graduate students about EDs at the University of Texas, and presents at professional meetings whenever he can.
December 18th, 2014 Heather Purdin
From Mirasol ED Recovery Guest Blogwriter ~ Faith
I used to work in a level one trauma center, which basically means, you get EVERYTHING and anything. I was one the youngest employees there, earning early exposure to a number of things, and some shifts were just surreal. After a few years, death just became death. The end. To protect myself, my heart hardened. My sense of humor tarnished so that no one else could understand me beyond my co-workers.
I was the phone call no one wanted. “Are you Mr. Miller? Can you please come down? Your son is here in critical condition.”
Although I’m glad to have learned about life all I did, it took a number of years after leaving for the numbness to wear off. I could go into the blood and gore details of experience after experience, but what truly strikes me is the shadow of death. An emotion so often brushed under the rug, it’s easier to pretend it isn’t real.
One of my mother’s friends who had cancer fell out of remission just over a month ago.
In her sixties, a vibrant woman of all smiles, I always pictured her in a fluffy red boa, sparkly hat, silky purple dress, and jewelry with all the bling. When I heard the cancer had returned at a vicious rate, this image changed.
When I heard she had to go back to chemo, I made a fun bracelet for her to wear, complete with a ‘hope’ ribbon and pearls. Sometimes, small tokens like these give us a source of strength. She told me she’d wear it every time she got treatment. These are the little things to treasure that so many people let pass by.
For over seven years, I have been treated at various cancer centers due to an unknown blood disorder, and I have met and seen the most courageous, authentic, beautiful, humorous people living their life to the fullest.
I have dealt with depression, bipolar, eating disorders, etc. Sometimes I feared I would get overcome by life and let it pass by like so many of us do. Yet, here were these amazing people more full of life than anyone else I knew, despite the fact physically they were losing it. They were keeping it together where others of us just unravel, myself included. I have always prayed for these people and asked God, “Let them have their life, they obviously are passionate and have a thirst for life!”
I loved how the infusion centers were set up. The chairs faced one another, you became a group, you got to know everyone, and when a patient’s chemo was done, the nurses would come out with bells, kazoos, whistles, and a big birthday cake! In a cancer community, it’s about more than just medicine. Everyone knows your name. The staff get to know you so well, they even know what type of soda you always want, all the little things. That’s what medical care and treatment should be.
Memories flood me.
Last night I got a message. Beta had passed away before we could even get to the hospital.
Part of me almost longs for those post trauma center days, but I no longer feel that blank detached sense of darkness. I feel and experience the emotions of grieving and loss. The only condolence I am able to draw comfort from right now is that it was quick and it was painless.
If you have ever read Tuesday’s with Morrie, he wanted to celebrate his life and not have some sovereign funeral with crappy appetizers and people dressed in black all stoic. Beta would have celebrated, probably sucked some helium out of balloons, and sang karaoke with her high squeaky voice, and of course, glamorously dressed to the nines. So, I’m going to celebrate her too.
How does this have anything to do with eating disorders and recovery?
– Live your life –
Your life is precious. Live your life. Find connection when you feel lost. Do not zone out and let it pass you by!
Make a list or journal about how much the eating disorder has taken from your life: sports, hobbies, school, friends, finances, health, relationships, meaning, purpose, etc. Use this as motivation to no longer stay prisoner.
If you have a rough body image day, go pick out one of your favorite outfits you just love to wear. If you like to put on makeup and do your hair, go for it.
If you have friends and want to go out, do it. Getting out the door is the hardest part.
If it’s in the middle of the night, put on some good music and just dance away dark feelings rather than stay curled up. This can actually be very freeing and fun! Temporarily immerse yourself in the music and know you are beautiful. My level of dancing is right up there with Napoleon Dynamite. I actually got kicked out of a beginner’s tap dancing class my roommate and I took for fun in our twenties. I don’t care, though. I just let it go because it feels great!
If you have a special token from someone or something, keep it with you for frequent, uplifting reminders to take the next best step. One of my favorite nurses at the cancer center I currently live gave me this beautiful 23rd Psalm key chain and I always have it with me. (In fact, it’s what I use to scratch my lotto tickets)
Lastly, let emotions run their course. Things can get really, really hard. At times, it will seem overwhelming and intense. This was me yesterday reading part of some book at Target with tears streaming down my face. Despite what society portrays, it’s actually quite healthy to feel your emotions. The woman looking at me funny just doesn’t know that yet! After all, it took me decades to accept!
The holidays are coming, and they can be triggering for anyone. The triggers are not just centered on the food; it often goes much deeper into layers of relationships, memories, and years of old patterns that may resurface.
Christmas used to be my favorite time of year as a kid. The decorations, the smells, and the traditions were almost magical. Now, I am grieving and trying to use my wise mind no matter what the situation.
Be proactive and work out a plan for your holiday triggers. You are stronger than you think. Do what’s best and supportive of your recovery. This is a season of love and giving, self included! Be gentle. Be kind. Be wise.
Try not to let this be just another holiday season that passes you by. A woman in her sixties once to told me, “Honey! You might as well go for it!” Smiling, I know Beta did just that. She took life by the horns.
“If I only had a cape and tiara, I could change the world.” Beta had one; she definitely left a mark. We are hanging an angel in honor of her this year, and I know she is flying over us right now.
If you, too, are grieving this holiday season, I recommend trying to create a new tradition to honor and celebrate those you miss. A small token can make big waves.
And a mantra for you:
Keep Being Brave
Trust your Strength
Surrender your Fear
Sing Out Loud
Believe in Healing
Unleash you Joy
Celebrate the gift of Today
Never Give Up
November 18th, 2014 Courtney M
As we go through our lives, stress from daily routines and other factors can play a part in the development of eating disorders and other conditions. Compulsive overeating is one such condition and is also known as Binge Eating Disorder (BED). It is categorized by frequent binge eating without the consistent use of purging, laxatives, or excessive exercise to counter the eating. Often it is hard to tell if someone has an eating disorder, and it can be extremely difficult for the person to recognize what is happening to his or her body and seek assistance. Symptoms of compulsive overeating include:
- Frequently eating huge amounts of food
- Eating alone
- Hiding empty food containers and trash from others
- Vulnerability about weight or body image
- Feeling guilty after meals
While the exact cause of BED is unknown, there are biological, psychological, and social influencers that may trigger the development of the condition. If you feel that you may be overeating, there are many things you can do to help regain control. Make sure to eat three meals each day, along with healthy snacks, instead of junk food and sweets. Discontinuing a diet, and getting enough rest and exercise can help manage stress and get your body back to its natural healthy ways. If these do not work, seeking help and treatment from your doctor or a therapist who specializes in eating disorders are the best courses of action.