It is a crucial part of the evaluation of every patient to consider the possibility that the symptoms are due to the direct or indirect physiological effect of a general medical condition. Determining that a general medical condition is responsible for the psychpathology has obvious treatment implications. Treatment of the medical condition often results in the remission of the psychaitric symptoms.
It is sobering to realize that all the behaviors associated with Anorexia Nervosa can be caused by medical illness. I could probably safely assume that this fact is not taught in most psych courses.
Before a diagnosis of Anorexia Nervosa can be made, it is imperative that all possible medical causes of appetite loss or weight loss be ruled out. This can only be done through extensive diagnostic testing (see medical tests).
The patient may exercise incessantly, perform what may seem like funny little rituals with their food at mealtimes, be preoccupied with food and cooking while refusing to eat herself, claim to feel fat, hide or hoard food, vomit after meals, use lots of laxatives, have lanugo hair, bradycardia, wear baggy clothes, seem manipulative, be a high acheiver, a perfectionist, yet all these behaviors may be a result of medical illness.
Medical illness can also precipitate all the behaviors associated with Bulimia Nervosa, so it is vital that the proper diagnostic tests are performed.
Although you may have experienced success at treating some patients, it is important to acknowledge that AN continues to have the highest mortality and morbidity rate of any psychiatric illness, and that many patients relapse or struggle with excessive weight loss for many years despite receiving continual psychotherapy and nutritional counselling. I believe this is mainly due to the failure of many eating disorder programs to acknowledge the effect medical disorders can have on appetite and absorption. Eating disorder clinics are a relatively new phenomenon, since Anorexia Nervosa and Bulimia Nervosa were almost unheard of until the last twenty years.
One should never assume that a patient's abdominal pains are fabricated or due simply to not eating enough. Neither should a patient who claims to be sticking to their meal plan but fails to gain weight be assumed to be purging in secret. She may not be absorbing nutrients from her food.
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