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Contributor: Margherita Mascolo, MD, Medical Director, ACUTE Center for Eating Disorders at Denver Health
Patients suffering from an eating disorder present a diagnostic dilemma even to the most astute physician as these patients often minimize their symptoms and at times hide any evidence of their disease.
Although there are clear diagnostic criteria for diagnosis of anorexia nervosa in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), there are no such criteria for a diagnosis based on symptoms, signs, and physical exam findings.
I wanted to share with you some of the most common symptoms of an eating disorder in an effort to educate the public and perhaps help patients that are struggling with an eating disorder in an effort to get them the medical attention they really need.
Eating Disorder Signs and Symptoms
The most common complaints of patients with eating disorders and malnutrition are related to the gastrointestinal system. This is no surprise for several reasons. First of all, there is such a strong connection between the brain and the gut that any mood alteration can affect the gastrointestinal tract and vice versa. In second place, as the body becomes more and more malnourished as a result of starvation, there are several protective mechanisms that the organism sets in place in order to deal with such a reduced caloric intake.
As a consequence of starvation, the gastrointestinal tract slows down in an effort to absorb as much as possible from the few calories ingested. The longer it takes food to pass from the mouth to the rectum, the more nutrients it can absorb. This results in delayed emptying of the stomach (gastroparesis) and delayed transit of food throughout the entire gastrointestinal tract (small and large bowel).
This slowed transit results in complaints such as early satiety/fullness, bloating, nausea, acid reflux, abdominal pain, and constipation. This series of physical manifestations is very unfortunate as it negatively reinforces the underlying eating disorder. When patients begin to try and eat they physically feel ill, nauseated, and have pain which causes them to revert back to their eating disorder behaviors. Sadly, the continued caloric restriction leads to worsening of these physical complaints and only perpetuates the cycle of restriction and its physical consequences.
These patients should be carefully examined by an experienced physician that can make the diagnosis of starvation related gastrointestinal abnormalities based on history and symptoms alone without the use of expensive and at times, futile medical tests. The patients need to be reassured that these complaints, while very real and distressing, are the response the body has to malnutrition and will improve once they weight restore.
The best treatment is to cease any eating disorder behaviors (whether that is restricting or purging), begin to consistently take in an adequate level of nutrition, and remain hydrated. There are a few medications that can alleviate the symptoms of bloating, fullness, and constipation but they should be administered under medical supervision.
Identifying the Root Problem
Other common complaints of patients suffering from an eating disorder include fatigue, lack of energy, dizziness, near-fainting, and feeling cold. As the body becomes more malnourished, one of the compensatory and protective mechanisms it sets into place is to down-regulate its metabolism in an effort to burn as few calories as possible and still maintain vital functions.
This state of hibernation results in a slowed heart rate (bradycardia) as well as a low blood pressure (hypotension) which can make patients feel tired and fatigued. The body also drops its core temperature which can make patients feel very cold, especially in their hands and toes; this is aggravated by the decrease in body fat and thus insulation that goes along with malnutrition. Dizziness and near-fainting can be due to a combination of low blood pressure, low heart rate, and bradycardia.
On physical exam, some of the most common findings in patients with anorexia nervosa are: dry skin with a yellow hue, brittle nails, thin scalp hair, lanugo hair which is fine, furry hair found on the face, neck, arms, back, and legs, and purplish-blue hands and feet. All these findings are very non-specific but should certainly alert the clinician that there is an underlying eating disorder and perhaps guide them to ask more specific questions.
Community Discussion – Share Your Thoughts Here!
At what point in your treatment from anorexia did you begin to see a resolution of your symptoms?
About the Author: Margherita Mascolo, MD is a Board-Certified Internal Medicine Specialist, Medical Director at ACUTE Center for Eating Disorders and Assistant Professor of Medicine at the University of Colorado.
Dr. Mascolo is the Interim Medical Director of ACUTE Center for Eating Disorder and a hospitalist at Denver Health. She completed her undergraduate work at the University of St. Thomas in Houston, Texas and earned her medical degree at the University of Texas Health Sciences Center. She completed her residency in Internal Medicine at the University of Colorado in Denver. She is board certified in Internal Medicine and is an Assistant Professor in the Department of Medicine at the University of Colorado. Dr. Mascolo is also proud to serve as Medical Liaison Chairperson for the IAEDP Denver Chapter.
References:: Mehler, PS and AE Anderson. Eating Disorders. Baltimore: Johns Hopkins UP, 2010. Print.
: Mehler, PS. Diagnosis and Care of Patients with Anorexia Nervosa in Primary Care Settings. Ann Int Med. 2001; 134:1048-1059.
: Mehler, PS, Cleary, B, and Gaudiani, JL. Osteoporosis in Anorexia Nervosa. Eat Disord. 2011; 19:194-202.
The opinions and views of our guest contributors are shared to provide a broad perspective of eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer discussion of various issues by different concerned individuals.
We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.
Reviewed By: Jacquelyn Ekern, MS, LPC on February 8, 2017.
Published on EatingDisorderHope.com