Published on 03/03/2015 by admin
Filed under Neurology
Last modified 03/03/2015
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27 Eating Disorders
Kenneth Lakritz
Ellen W. had gained 15 pounds during her freshman year at college and felt out of control. She began a strict diet, limiting her intake to 1000 calories daily. She also began to run every day. By summer’s end she had returned to her baseline weight but decided to continue her diet and exercise regime. She was continually hungry and sometimes binged, but she soon discovered how to induce vomiting and settled into a regular pattern of bingeing and purging. After another year, she came to medical attention when she was brought—against her objections—to an emergency room after collapsing while running.
On examination she was cachectic, hypotensive, and bradycardic. Her teeth were eroded and she had parotid enlargement. Laboratory studies revealed microcytic anemia, metabolic alkalosis, and hypokalemia. She was admitted and eventually required forced feeding to correct her life-threatening nutritional deficiencies. Throughout her hospitalization, she insisted that she was well but slightly overweight and needed to lose 10 more pounds. Five years later, she participated in regular individual and family psychotherapy. She had stopped bingeing and had negotiated a slightly less rigorous diet with her therapists, but she continued to monitor her caloric intake and weight every day.
Ellen W. suffers from anorexia nervosa, one of the two main eating disorders described in Diagnostic and Statistical Manual of Mental Disorders–Fourth Edition (the other is bulimia). Anorexia nervosa is characterized by distorted body image, an unwillingness to maintain normal weight, emaciation, amenorrhea, and severely disordered eating habits. Anorexia nervosa is one of the deadliest of psychiatric disorders—a recent estimate is that 6% of anorectics die from their illness.
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