When Dieting Becomes Dangerous:
Diagnosis and Treatment of Eating Disorders
Deborah Marcontell Michel, Ph.D.
Clinical Assistant Professor of Psychiatry Tulane University School of Medicine

Prevalence: An estimated 5 - 10 million girls and women have some type of eating disorder and approximately 1 million boys and men are affected. -National Eating Disorders Association

Earlier Diagnosis = Better Prognosis

Anorexia Nervosa

  • Refusal to maintain normal body weight
  • Intense fear of weight gain
  • Body image distortion, self evaluation based on weight, or denial
  • Amenorrhea

2 Types

  1. Restricting type: no regular bingeing/purging
  2. Binge Eating/Purging type: regular episodes of bingeing and purging

Physical Signs and Symptoms

  • Constipation
  • Cold intolerance
  • Fatigue or hyperactivity
  • Low body temperature
  • Dry, pale skin
  • Lanugo
  • Slow heart rate
  • Amenorrhea
  • Low blood pressure
  • Anemia
  • Dental problems
  • Brittle nails and hair loss
  • Early morning awakening
  • Abdominal pain

Mortality Rate

Up to 20% Highest of any psychiatric disorder

Bulimia Nervosa

  • Regular episodes of binge eating
  • Compensatory behavior
  • Feelings of loss of control
  • Self evaluation over reliant on weight
  • Purging type: regular use of self-induced vomiting, laxatives, diuretics, emetics
  • Nonpurging type: use of excessive exercise, fasting

Physical Signs and Symptoms

  • Dental problems
  • Swollen salivary glands
  • Calluses or scars on hands
  • Menstrual irregularities
  • Edema
  • Diarrhea
  • Constipation
  • Dizziness or weakness
  • Broken blood vessels in the eyes
  • Dry skin
  • Dry, brittle hair
  • Weight fluctuations
  • Abdominal pain
  • Heartburn
  • Hypokalemia

Life Threatening Consequences

  • Arrhythmias
  • Cardiac Arrest
  • Gastric Rupture

Binge Eating Disorder

  • Recurrent binge eating
  • No regular, compensatory behavior
  • Feelings of guilt, shame, embarrassment, or depression following a binge
  • 30% prevalence in weight loss patients
  • 8% prevalence in community

Questions for Clinicians to Ask

  1. How do you see your body?
  2. How do you feel about the way you look?
  3. What do you think would be your ideal weight?
  4. Are you dieting?
  5. Do you count calories or fat grams?
  6. How often do you exercise and for how long? When was your last menstrual period?
  7. How often do you weigh yourself?
  8. Do you ever vomit after eating?
  9. Do you ever take laxatives or syrup of ipecac?
  10. Do you ever use diet pills, herbal teas, or diuretics?
  11. Do you ever take mini-thins or fat burner pills?
  12. Do you ever use enemas?

Development of Eating Disorders

  • Genetic predisposition
  • Societal messages
  • Media images
  • Fitness and the perfect body
  • “Westernization” of cultures
  • Definitions of successful women
  • Changing roles of women
  • Individual personality characteristics
  • Perfectionism
  • Need for control
  • Low self-esteem

Family characteristics

  • Separation/individuation problems
  • Communication difficulties
  • Boundary issues

An eating disorder is an imagined physical solution to coping with underlying psychological issues and a disturbance in identity.

Multidisciplinary Treatment of Eating Disorders

  • Individual Psychotherapy: To resolve the underlying psychological problems of growing up and forming an independent sense of self and identity.
  • Nutritional Counseling: To address the overt symptoms of food and weight issues.
  • Family Therapy: To identify and address family issues that have contributed to the development and maintenance of the eating disorder.
  • Medical Management: To assess and treat any medical complications as well as support the mental health professionals.

Recommendations to Facilitate Treatment

  • Associate yourself with a team of eating disorder specialists with whom you are comfortable.
  • Treat any medical complications and refer to eating disorders specialists as soon as possible.
  • Assist all parties involved recognize eating disorders are psychiatric disorders with medical ramifications.
  • Be available to work with resistant families from your perspective.
  • Communicate medical information to the individual therapist or nutritionist.
  • See the patient as infrequently as possible and allow only the nutritionist to weigh the patient.

Conclusions

The earlier the eating disorder diagnosis is made and treatment is initiated, the better the prognosis. The best chance of successful treatment is through the cooperative and integrated efforts of a multidisciplinary team of professionals. Full recovery is possible with comprehensive treatment and a motivated patient.

The Phoenix Society wishes to thank Deborah Marcontell Michel, Ph.D. for contributing these materials to the website.