Wednesday, June 04, 2008

So, back to my original question...how much DO you know about eating disorders? A quick lil' quiz born of my absolute dismay when I walked past a group of RESIDENTS in the hall yesterday (after their ONE HOUR per MEDICAL SCHOOL CAREER 'lecture' on eating disorders) and was astonished--literally knocked to the ground and mauled--by the ignorance.

1. A 13 year old girl presents to the ER; she is roughly 15% below her ideal body weight. When asked about her diet, she says she vomits up nearly everything she eats--ie, she vomits twice a day, on average. She eats normal-sized meals; she just doesn't keep them. The most appropriate diagnosis would be:
anorexia nervosa (AN)
bulimia nervosa (BN)
eating disorder not otherwise specified (EDNOS)

The answer is AN; she has the purging type. Her weight and the fact that she doesn't binge are the clues (though in an f-ed up quirk of the DSM-IV, she wouldn't actually qualify for AN if she were still having periods. Seriously. You could be at 75% of ideal body weight, eat 500 calories a day, and still not be "officially" anorexic. If you think this is irrelevant, tell that to the insurance companies who won't pay for treatment for someone without an official DSM-IV diagnosis). Important lesson, diagnostically speaking--puking doesn't necessarily equal bulimia.

2. EDNOS, because it itsn't a "full blown" eating disorder, isn't as dangerous as AN or BN. True or False?

False, with a flashing red light and honking airhorn. It's right there in the name: EATING DISORDER not otherwise specified. People may be EDNOS when they're "almost" anorexic or bulimic (say, binging and purging once a week instead of the twice required for BN; engaging in all the behaviors necessary for an AN diagnosis but still menstruating, or still being above 85% of ideal body weight; showing typically anorexic behavior but occasionally binging and purging; Chewing food up and spitting it out instead of vomiting; using exercise to compensate for meals, etc. ) You can still end up with your potassium or sodium (or any electrolyte) in the toilet with EDNOS. You still suffer near-constant mental anguish. You can totally still die.

3. Eating disorders are always all about control. True or False?

False. That's like saying--I don't know, I can't think of a very good analogy right now--something stupid. Yes, control is often an issue, but EDs can also be responses to trauma (abuse, sexual assault, etc.), ways of displaying feelings in a family/society that discourages emotionality, a way of remaining a child and not having to deal with developmental issues, or a method of self-punishment for someone who feels (usually unjustified) shame or guilt.

4. Which of these factors make someone a more likely candidate for developing an ED?
Being female
Being 18 or younger
Experiencing physical, emotional or sexual abuse
Perfectionism
Hobbies or jobs focused on appearance and weight (gymnastics, modeling, jockeying)

That's right, all of them--though by no means are all ED sufferers like Steven Levenkron's character in "The Prettiest Little Girl in the World." Men get them; rugby players get them; 50 year olds from perfectly functional families get them. This is everyone's issue.

No comments: