Distorted Body Image

Possibly the most bewildering symptom of both eating disorders is the distorted body image ( body dysmorphia ). Although people typically associate distorted body image with severe anorexia, one study indicated that distortion may be more prevalent in people with bulimia. People with bulimia were more likely than those with anorexia to overestimate their size. There was also a greater disparity between what they wanted to look like and what they believed they looked like. In another study, people with anorexia tended to have an accurate perception of their upper body, but overestimated the size of their abdominal and pelvic area. Symptoms

Specific to Bulimia without Anorexia

People with bulimia nearly always practice it in secret, and, although they may be underweight, they are not always anorexic. Symptoms or signs of bulimia, then, may be very subtle and go unnoticed. They may include the following:

Evidence, such as discarded packaging, of laxatives, diet pills, emetics (drugs that induce vomiting), or diuretics (medications that reduce fluids). Regularly going to the bathroom right after meals. Suddenly eating large amounts of food or buying large quantities that disappear right away. Compulsive exercising. Broken blood vessels in the eyes (from the strain of vomiting). Swollen salivary glands. These occur within days of vomiting in about 8% of people with bulimia. They often give a pouch-like appearance to areas below the corners of the mouth.Dry mouth

Teeth develop cavities, diseased gums, and irreversible enamel erosion from excessive acid. (Gargling with baking soda after purging rather than using toothpaste may help neutralize the acid.)

Rashes and pimples.

Small cuts and calluses across the tops of finger joints. (These cuts can occur from repeated self-induced vomiting, in which a person thrusts the hand down the throat past the front teeth.)

Symptoms Specific to Anorexia

Weight Loss

The primary symptom of anorexia is major weight loss from excessive and continuous dieting, which may either be restrictive dieting or binge-eating and purging. Note. Young women who have both diabetes and eating disorders may have normal weight or even be overweight from the effects of insulin. However, they still are at high risk from the medical consequences of anorexia.

Other Symptoms

Other symptoms may include the following:

In women, menstruation may be infrequent or absent. Often, compulsive exercising coupled with emaciation leads to orthopedic problems, particularly in dancers and athletes. Such problems, in fact, may be the first sign of trouble that forces such patients to seek medical help. Refusal to eat in front of others. Ritualistic eating, including cutting food into small pieces. Hypersensitivity to cold. (In fact, some women wear several layers of clothing to both keep warm and hide their thinness.) Yellowish skin, especially on the palms of the hands and soles of the feet. (This occurs in people eating too many vitamin A-rich vegetables, such as carrots.) The skin may be dry and covered with fine hair. Normal scalp hair may be thin. The feet and hands may be cold or sometimes swollen. The stomach is often distressed and bloated after eating. Thinking may be confused or slowed, and an anorexic patient may have poor memory and lack judgment.

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Admitting the Problem

The first step toward a diagnosis is to admit the existence of an eating disorder. Often, the patient needs to be compelled by a parent or others to see a doctor because the patient may deny and resist the problem. Some patients may even self-diagnose their condition as an allergy to carbohydrates, because after being on a restricted diet, eating carbohydrates can produce gastrointestinal problems, dizziness, weakness, and palpitations. This may lead such people to restrict carbohydrates even more severely.

It is often extremely difficult for parents as well as the patient to admit that a problem is present. For example, because food is such an intrinsic part of the mother/child relationship, a child’s eating disorder might seem like a terrible parental failure. Parents themselves may have their own emotional issues with weight gain and loss and perceive no problem in having a “thin” child.

Interview Tests

It is recommended that a supportive companion be present during part of the initial medical interview to offer additional information on the patient’s eating history and to help offset any resistance or denial the patient may express.

Various questionnaires are available for assessing patients. For example, a brief British test called the SCOFF questionnaire is proving to be very reliable in accurately identifying people who are at high risk for either eating disorder.

SCOFF Questionnaire

S Do you feel Sick because you feel full?

C Do you lose Control over how much you eat?

O Have you lost more than One stone (about 13 pounds) recently?

F Do you believe yourself to be Fat when others say you are thin?

F Does Food dominate your life?

Answering yes to two of these questions is a strong indicator of an eating disorder.

Diagnosing Bulimia Nervosa

In spite of the prevalence of bulimia, in one study only 30% of Midwest family physicians had ever diagnosed bulimia in a patient. Younger and female physicians are more likely to detect bulimia. A physician should make a diagnosis of bulimia if there are at least two bulimic episodes per week for three months. Because people with bulimia tend to have complications with their teeth and gums, dentists could play a crucial role in identifying and diagnosing bulimia.

Diagnosing Anorexia Nervosa

Generally, an observation of physical symptoms and a personal history will quickly confirm the diagnosis of anorexia. The standard criteria for diagnosing anorexia nervosa are:

The patient’s refusal to maintain a body weight normal for age and height. Intense fear of becoming fat even though underweight. A distorted self-image that results in diminished self-confidence. Denial of the seriousness of emaciation and starvation. In women, the loss of menstrual function for at least three months.

The physician then categorizes the anorexia further:

Restricting (severe dieting only). Anorexia bulimia (binge purge behavior).

Because the disorder rarely shows up in men, physicians may not be on the look out for it in male patients, even if they show classic symptoms of anorexia. Physicians should be very aware of these symptoms in anyone, particularly in athletes and dancers. Diagnosing Complications of Eating Disorder Once a diagnosis is made, physicians should immediately check for any serious complications of starvation. They should also rule out other medical disorders that might be causing the anorexia. Tests should include the following:

A complete blood count.Tests for electrolyte imbalances. Low potassium levels indicate that the disorder is more likely to be accompanied by the binge-purge syndrome. Test for protein levels. An electrocardiogram and a chest x-ray. Tests for liver, kidney, and thyroid problems.

A bone density test.

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