It happened to me. One of my favorite patients, whom I had been seeing for a few years, sat nervously in the room. I remember bursting in the room with my usual loud "hello" and noticing she looked pale, drawn and hesitant.
After careful prodding, she finally told me her real story -- not the one I had heard the last three years. She was bulimic and haunted by a binge-purge cycle that would take over her nights and ruin her days. Her stomach ached, she hated herself and her husband just wanted her to get help.
How did I miss this? Did I not spend enough time with her, did I not make her comfortable enough to confess this to me years ago? After blaming myself, I realized that I should be thankful that she opened the door to this conversation and for every patient after her, I would ask the tough question: "Do you think you have an eating disorder?"
The story of women loathing themselves is not a new one and often takes on many forms and faces. Eating disorders are the silent self hate for many women, a secret life, an underworld of sorts, as they wrestle with deeper wounds. After all the average American women is 5 feet 4 inches and 165 pounds, while the average Miss America is 5 feet, 7 inches and 121 pounds. As physicians, we have to ask the question and we have to create a safe space for discussion, without judgement or contempt. (1)
Almost 30 million people suffer from eating disorders. While this particular patient was female, eating disorders cross gender and age profiles, becoming a universal disease. In fact, almost 10 million men suffer from an eating disorder. Anorexia, bulimia and purging are all signs and symptoms of an eating disorder. (1)
Eating disorders are considered a mental health condition, but one with the highest morbidity of any other mental health condition. Some of the health consequences of an eating disorder include osteoporosis, muscle weakness, dehydration, hormone irregularity and kidney failure. (2)
In an eating disorder, the chemistry of the brain alters from chronic self abuse. The cycle perpetuates and many women and men have trouble breaking free. Eating disorders will not be cured with a medication, or a few sessions of counseling. A full, comprehensive plan of care has to be established, helping the patient understand the connections between emotional wounds, the biochemistry of the brain and gut and proper nutrition. As the treatment of eating disorders evolves, there is new understanding that the whole family needs to be involved in the treatment process. (3,4)
I know my patient will get better and if she is reading this, I hope she knows I am rooting for her and know she will get through this. Meanwhile, she has made me a better doctor and I know to ask the tough question.
References:
---
If you're struggling with an eating disorder, call the National Eating Disorder Association hotline at 1-800-931-2237.