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Medical Aspects of Anorexia and Bulimia 15 Irregular or even absent menstrual periods occur in many women with bulimia, even those of adequate weight. Some studies show increased fetal risks to women afflicted with eating disorders during pregnancy. Such patients clearly require special care. Up to 20 percent of women with bulimia have problems with alcohol or drug abuse. Often patients are already in recovery by the time they come for eating disorder treatment. Obviously, however, those with active substance abuse as well as bulimia have a whole additional set of medical risks. Inhospital treatment can be especially useful in this situation. Both anorexia and bulimia have specific physical dangers. Both require careful medical monitoring. Some patients will feel quite ill, others deceptively well. All should have a physical examination, blood tests, usually an electrocardiogram, and other studies as appropriate. Although one hopes that this exam and all the tests will be normal, we know that this in no way shows the patient to be free of medical danger. Medical treatment is geared to averting some of these risks, lessening symptoms, and promoting recovery. References Abraham, S., M. Mira, and D. Llewellyn-Jones. 1990. “Should Ovulation Be Induced in Women Recovering from an Eating Disorder or Who Are Compulsive Exercisers?” Fertility and Sterility 53, no. 3: 566–68. Becker, A. E., S. K. Grinspoon, A. Klibanski, and D. B. Herzog. 1999. “Eating Disorders.” New England Journal of Medicine 340, no. 14: 1092–98. Cooke, R. A., and J. B. Chambers. 1995. “Anorexia Nervosa and the Heart.” British Journal of Hospital Medicine 54:313–17. Grinspoon, S., D. B. Herzog, and A. Klibanski. 1997. “Mechanisms and Treatment Options for Bone Loss in Anorexia Nervosa.” Psychopharmacology Bulletin 33, no. 3: 399–404. Greenfeld, D., D. W. Mickley, D. Quinlan, and P. Roloff. 1993. “Ipecac Abuse in a Sample of Eating Disordered Outpatients.” International Journal of Eating Disorders 13, no. 4: 411–14. Greenfeld, D., D. Mickley, D. M. Quinlan, and P. Roloff. 1995. “Hypokalemia in Outpatients with Eating Disorders.” American Journal of Psychiatry 152:60–63. Kamal, N., T. Chami, A. Andersen, F. A. Rosell, M. Schuster, and W. E.
16 Medical Aspects of Anorexia and Bulimia Whitehead. 1991. “Delayed Gastrointestinal Transit Times in Anorexia Nervosa and Bulimia Nervosa.” Gastroenterology 101:1320–24. Keys, A., J. Brozek, A. Henschel, O. Mickelsen, and H. L. Taylor. 1950. The Biology of Human Starvation. Vol. 1. Minneapolis: University of Minnesota Press. Mickley, D. W. 1988. “Eating Disorders.” Hospital Practice 23, no. 11A: 58–79. Swayze, V.W., A. Andersen, S. Arndt, R. Rajarethinam, F. Fleming, Y. Sato, and N. C. Andreasen. 1996. “Reversibility of Brain Tissue Loss in Anorexia Nervosa Assessed with a Computerized Talairach 3-D Proportional Grid.” Psychological Medicine 2, no. 2: 381–90.
Page 1 and 2: editor BARBARA P. KINOY EATING DISO
Page 4 and 5: Eating Disorders New Directions in
Page 6: To our patients’ children and gra
Page 9 and 10: viii Contents 3. Psychiatric Consul
Page 11 and 12: x Foreword Although serious deficie
Page 14 and 15: preface In 1994, in the first editi
Page 16 and 17: Preface xv psychological hazards to
Page 18 and 19: Preface xvii partial, complete, or
Page 20 and 21: acknowledgments We wish to acknowle
Page 22 and 23: contributors Debra Bader, CSW, BCD:
Page 24 and 25: Eating Disorders
Page 26 and 27: Introduction diane w. mickley I am
Page 28 and 29: Introduction 3 needs of patients wh
Page 30 and 31: Introduction 5 therapy or on medica
Page 32 and 33: 1 Medical Aspects of Anorexia and B
Page 34 and 35: Medical Aspects of Anorexia and Bul
Page 42 and 43: 2 Recovery Through Nutritional Coun
Page 44 and 45: Recovery Through Nutritional Counse
Page 46 and 47: Lesson 1: Daily Caloric Need and Me
Page 54 and 55: ical activity to a normal level. If
Page 56 and 57: patient who binges, it may be helpf
Page 58 and 59: and allowing herself to consume a l
Page 60 and 61: Figure 2.3 Typical Hunger and Food
Page 62 and 63: herself. She frequently feels hopel
Page 74 and 75: 3 Psychiatric Consultation with Eat
Page 76 and 77: Psychiatric Consultation 51 standab
Page 78 and 79: Psychiatric Consultation 53 difficu
Page 80 and 81: Psychiatric Consultation 55 Obsessi
Page 82 and 83: 4 A Family Systems Perspective on R
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she calls her mother and tells her
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A Family Systems Perspective on Rec
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5 Relationship to Food as to the Wo
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iors—somehow to integrate the fra
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treatment, Theresa wanted to see an
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Relationship to Food as to the Worl
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6 The Therapeutic Use of Humor in t
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The Therapeutic Use of Humor 91 Amy
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The Therapeutic Use of Humor 93 was
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The Therapeutic Use of Humor 95 ass
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The Therapeutic Use of Humor 97 Ron
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Jodie’s Story 99 capacity to make
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Jodie’s Story 101 house and a ter
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Jodie’s Story 103 She did not do
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adness. The dream also revealed tha
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8 Eating Disorders and Managed Care
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Eating Disorders and Managed Care 1
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Eating Disorders and Managed Care 1
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Cognitive-Behavioral Therapy and Ot
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10 The Nurse’s Role in a Pilot Pr
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The Nurse’s Role in a Pilot Progr
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The Nurse’s Role in a Pilot Progr
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11 Individual Psychotherapy: A Long
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Individual Psychotherapy 135 Such p
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Individual Psychotherapy 137 empath
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weight and shape, as well as change
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Individual Psychotherapy 141 vomiti
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Individual Psychotherapy 143 During
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Individual Psychotherapy 145 and re
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Individual Psychotherapy 147 Mitche
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Young Adult Women 149 to surface an
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Young Adult Women 151 with their at
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Young Adult Women 153 ing; in fact,
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Young Adult Women 155 doomed, and a
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part of a treatment team where the
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13 Recovery margaret goldkopf-woodt
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Recovery 161 I can appreciate both
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Recovery 163 meant. I certainly cou
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Recovery 165 ate other uncomfortabl
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Recovery 167 connection between my
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Recovery 169 safe place, and our ow
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Recovery 171 My pregnancies and mot
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Recovery 173 They seem to be living
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Recovery 175 Self-disclosure remain
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nel. All that I feared, the hurts I
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Afterword 179 surprisingly rapidly
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Afterword 181 With eating disorders
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Treatment helped me to face life, i
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AA/BA. See American Anorexia/Bulimi
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37; prevention of, 29-31; rigid die
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problems and, 19; events triggering
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Keel, P. K., 180 Keller, H., 133 Ke
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Psychoeducational group therapy, 12
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112-20; IPT, 121-22; psychoeducatio
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