| Primary care first to diagnose |
| Individuals with eating disorders often initially present to their primary care physician with non-specific complaints such as bloating, constipation, fatigue, swelling of the hands and feet or obesity. With the help of laboratory results, the astute clinician can pick up on these subtle clues, diagnose an eating disorder and begin a treatment plan. Philip Mehler, MD, recommends that primary care physicians have a brief but systematic set of questions to assess for the possibility of an eating disorder. He suggests:
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If a patient can be safely treated on an outpatient basis, a mental health referral is usually in order. To enhance follow through on referrals, patients need reassurance that the psychotherapist will not force or bully them into giving up their disorder. Instead they are encouraged to begin a study of their behavior, while the medical doctor ensures that physical health is protected. The job of the psychotherapist is to match interventions appropriate to the patients current motivation, and to slowly move her or him through the stages of change. |
| Self- induced vomiting related GI symptoms include: |
| Heartburn, Odynophagia, Dysphagia, |
| Sore throat |
| PPI, H2 Blockers Helpful with Bulimia |
| Acid reflux is a common complaint in patients who self induce vomiting. Bruce Waldholtz, MD, states that "cessation of self-induced vomiting without concomitant acid suppressing medication will generally not alleviate their symptoms:" He recommends a high dose H2 blocker or PPI. In severe cases, patients who have been bulimic for many years may develop tremendous laxity in the gastro-esophageal sphincter, and simply bending over can induce vomiting. This is terri |
| bly upsetting for someone who is making honest attempts to abstain from vomiting. The psychotherapist working with your patient should be able to tell you if sincere attempts to abstain from vomiting exist. If so, the addition of a PPI can provide welcome relief from this "spontaneous vomiting" and assist in the patients recovery. |
| Weight Restoration and Fertility |
| Eating Disorder therapists commonly work with women who report having undertaken intensive fertility treatments while maintaining an undetected eating disorder. This may be the combination of the hallmark secrecy of an eating disorder and the perception by physicians of a thin body as a healthy body. In women seeking infertility treatments, of |
| those with amenorreha or oligomenorrhea, approximately 60% have eating disorders. If your patient is slightly under or on the low range of her Ideal Body Weight, slight weight restoration may enhance fertility. If the patient is unable or unwilling to restore weight, it is wise to suspect some form of disordered eating or body image disturbance. |
