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This paper presents the treatment of a lung transplant candidate suffering from an eating disorder who refused communication between the Eating Disorders Clinic and the transplant team. The importance of psychiatric evaluation in transplantation and the need for the free flow of information among all health professionals working with the transplant patient are discussed. Explanations are proposed for the role of dieting in the development of the eating disorder and the patient's continued food restriction, vomiting, and laxative abuse after transplantation.
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PMID:Development of an eating disorder in a 40 year-old male lung transplant candidate: a case study. 775 4

Patients consecutively referred for a clinical diagnosis of eating disorders to the Unit for Addictive Disorders at the University Hospital of Nantes were included in the study. The sample contained 95 patients (94 females, 1 male; mean age +/- SD: 24.1 +/- 6.5). All the patients were evaluated with the Computerized Multiple Diagnostic Instrument for Eating Disorders, which assesses diagnostic criteria for eating disorders from different international diagnostic classifications. Seven (7%) patients fulfilled the DSM III-R criteria for anorexia nervosa (AN) and 42 (44%) the DSM III-R criteria for bulimia nervosa. Two subgroups of bulimic patients were distinguished according to Body Mass Index [anorexia-bulimia (AB) if BMI was < 18 (n = 11, 12%) and normal weight bulimia (NWB) if BMI was > 18 (n = 31, 33%)]. Most patients (n = 46, 48%) did not fulfill DSM III-R criteria for AN or bulimia, and were given the residual DSM III-R diagnosis of eating disorder not otherwise specified (EDNOS). A comparison was made of the frequencies of the different weight control strategies displayed by the patients of the 4 subgroups. Vigorous exercise was more frequently used by AN patients than by patients of the 3 other subgroups. Vomiting was more frequent in bulimic patients, although this symptom was displayed by 29% of the AN patients and 24% of the EDNOS. Abuse of laxatives or diuretics was similar in the four subgroups. Use of diuretics was infrequent in the total sample of patients.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Clinical study of a population of patients hospitalized for eating disorders. Discussion of DSM III-R diagnostic criteria]. 778 90

This study examined the frequency of eating disorders in women with obsessive compulsive disorder (OCD). Letters were sent to area psychiatrists asking them to refer patients diagnosed with OCD to a research study. Subjects completed the Yale Brown Obsessive Compulsive Scale and a survey including history of eating disorders. Thirty-one women participated in the study. Forty-two percent (N = 13) had a past or current history of an eating disorder: 26% anorexia nervosa alone (N = 8); 3% bulimia nervosa alone (N = 1); and 13% both anorexia and bulimia (N = 4). Our study found a higher percentage of history of eating disorders than expected. Perhaps specifically asking about history of weight loss, binging, and vomiting allowed for fuller disclosure of eating disorders than other studies that relied on retrospective chart review or limited the survey to current eating symptoms. A past history of eating disorder may be more common than previously believed and may frequently precede the diagnosis of OCD.
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PMID:Eating disorder history in women with obsessive compulsive disorder. 813 42

We have reported a rather extreme instance in which achalasia was misdiagnosed as a primary eating disorder. Our patient spent 2 months in a psychiatric institution before the correct diagnosis was made. Misdiagnosis in this case could have been avoided (1) if the symptoms of dysphagia had been elicited as part of her history, (2) if it had been recognized that the vomiting (her dominant symptom) was involuntary and not self-induced, (3) if the absence of disturbed body image had been appreciated, or (4) if it had been recognized that she did not meet accepted criteria for anorexia nervosa or bulimia. Our case and others like it in the literature also illustrate that achalasia frequently remains an elusive diagnosis.
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PMID:Achalasia mistakenly diagnosed as eating disorder and prompting prolonged psychiatric hospitalization. 827 22

Typical DSM-III-R bulimia nervosa with self-induced vomiting was found in 2 women of Hong Kong Chinese origin and a Chinese man from Malaysia. All 3 cases had a family history of obesity. In 2 of the cases a period of weight gain and in the third case frank obesity preceded the onset of the eating disorder. Cultural transition seemed to play an important part in the onset and maintenance of the eating disorder.
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PMID:Bulimia nervosa in the Chinese. 829 34

The objective of this research was to investigate the weight control practices of lightweight football players. In addition, the importance of several variables was examined for their clinical importance and ability to identify individuals at high risk for pathogenic eating behaviors. Male college lightweight football players (N = 131) were administered a 45-item version of the Diagnostic Survey For Eating Disorders (9). Results revealed that 74% had experienced binge eating, and 17% had experienced self-induced vomiting. During the month preceding questionnaire administration, 66% had fasted, nearly 4% had used laxatives, while less than 2.5% had used diet pills, diuretics, or enemas for the purpose of weight control. Furthermore, the "teacher/coach" seemed to be the individual who motivated dieting behavior, and more than 20% of the sample reported that their weight control practices interfered with their thoughts and extracurricular activities "often" or "always." Most importantly, 42% of the sample evidenced a pattern of dysfunctional eating, while 9.9% of the sample engaged in binge-purge behavior to the degree that it might represent an eating disorder. Finally, discriminant the degree that it might represent an eating disorder. Finally, discriminant analysis yielded several variables that might be useful in identifying individuals at risk for pathogenic eating behaviors.
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PMID:Weight control practices of lightweight football players. 832 Nov 6

Migraine and the eating disorders, particularly bulimia nervosa, share some common demographics, phenomenology, psychopathology, and treatments. Bulimics also appear to be more sensitive to the induction of severe migrainous headaches than controls following challenge with the 5-HT agonist, m-chlorophenylpiperazine (m-CPP), but not placebo or L-tryptophan. This supports a common pathophysiological relationship involving postsynaptic 5-HT dysfunction between these disorders. In order to further explore the possible relationship between eating disorders and migraine, we administered a modified version of the Diagnostic Survey of the Eating Disorders (DSED) and the Eating Disorders Inventory (EDI) to a group of female migraine patients attending the Medical University of South Carolina (MUSC) Neurology Clinic (n = 34). Of the 34 migraine patients surveyed, 88% reported dieting behavior, 59% reported binge eating, and 26% reported self-induced vomiting during their lifetimes. Compared to the responses of a group of normal female controls (n = 577), patients with migraine had elevated scores on four of the eight subscales of the EDI: Body Dissatisfaction (p < or = .02), Perfectionism (p < or = .01), Interpersonal Distrust (p < or = .02), and Ineffectiveness (p < or = .06). These findings support the hypothesis that common pathophysiological mechanisms, perhaps involving 5-HT dysregulation, may be involved in these two disorders.
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PMID:Is migraine related to the eating disorders? 833 2

Anorexia nervosa is a chronic illness characterized by a severe loss of weight. It occurs in children and young adults and is seen more frequently in females. Some anorexic patients refuse to eat totally, while others may practice "binge eating." Patients who binge eat and employ postprandial purging are referred to as "bulimic." Anorexia nervosa and bulimia can produce multisystem abnormalities. Dysfunction of organ systems in anorexia is the result of self-induced vomiting, laxative abuse, and severe malnutrition. Diseases of the skeletal, gastrointestinal, pulmonary, endocrine, and cardiovascular systems may have an impact on the plan of anesthesia care. A thorough anesthetic interview and evaluation to assess the debilitation of each patient is essential so that appropriate preparation can be made for comprehensive anesthetic care. This paper focuses on the pathophysiology of anorexia nervosa, discusses a thorough preanesthetic assessment, and guides the appropriate anesthetic management of the anorexic patient. Anorexia bulimia is briefly mentioned, since it is an eating disorder with physiological derangements similar to anorexia nervosa.
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PMID:Anesthetic considerations with anorexia nervosa. 837 78

The results of a small pilot study using Fluvoxamine (Faverin) in the treatment of non-vomiting bingeing female patients and women with bulimia nervosa is presented. Ten non-vomiting subjects and six with bulimia nervosa were treated on an open basis with Fluvoxamine 100-200 mg daily. Assessment was made using established questionnaires for severity of eating disorder and abnormality of mood. Five non-vomiting patients and three with bulimia nervosa completed the study. Non-vomiters showed a significant weight loss; a significant reduction in number of binges; a significant reduction in the scores on the BITE and the EAT; and a significant reduction in anxiety. Those with bulimia nervosa had a significant reduction in hunger and a reduction in depression which tended towards significance. Firm conclusions cannot be drawn from this study as it is an open pilot study of a small number of women. However, the results indicate that Fluvoxamine may have a role in the treatment of eating disorders where bingeing is a prominent symptom and that further research would be valuable. Comments are also made on the usefulness of various questionnaires designed to assess eating disorders.
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PMID:Fluvoxamine: an open pilot study in moderately obese female patients suffering from atypical eating disorders and episodes of bingeing. 838 40

Anorexia nervosa (AN) and bulimia nervosa (BN) are potentially fatal eating disorders which primarily affect adolescent females. Differentiating eating disorders from primary gastrointestinal (GI) disease may be difficult. GI disorders are common in eating disorder patients, symptomatic complaints being seen in over half. Moreover, many GI diseases sometimes resemble eating disorders. Inflammatory bowel disease, acid peptic diseases, and intestinal motility disorders such as achalasia may mimic eating disorders. However, it is usually possible to distinguish these by applying the diagnostic criteria for eating disorders and by obtaining common biochemical tests. The primary features of AN are profound weight loss due to self starvation and body image distortion; BN is characterized by binge eating and self purging of ingested food by vomiting or laxative abuse. GI complications in eating disorders are common. Recurrent emesis in BN is associated with dental abnormalities, parotid enlargement, and electrolyte disturbances including metabolic alkalosis. Hyperamylasemia of salivary origin is regularly seen, but may lead do an erroneous diagnosis of pancreatitis. Despite the weight loss often seen in eating disorders, serum albumin, cholesterol, and carotene are usually normal. However, serum levels of trace metals such as zinc and copper often are depressed, and hypophosphatemia can occur during refeeding. Patients with eating disorders frequently have gastric emptying abnormalities, causing bloating, postprandial fullness, and vomiting. This usually improves with refeeding, but sometimes treatment with pro-motility agents such as metoclopromide is necessary. Knowledge of the GI manifestations of eating disorders, and a high index of suspicion for one condition masquerading as the other, are required for the correct diagnosis and management of these patients.
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PMID:Gastrointestinal and nutritional aspects of eating disorders. 840 9


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