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Bulimia: The Other Terri Schiavo Tragedy

by Jennifer Wider, MD

(Washington DC April 21, 2005):  As Terri Schiavo became a national symbol of the impassioned "right to die" debate, the country argued over whether or not Congress had the right to intervene and reinsert the tube that sustained her life. The debate lasted for weeks while Schiavo slowly deteriorated. Some felt she was being starved to death; others said she should be able to die in peace. Very few, however, realized the heartbreaking irony. Schiavo's vegetative state was the result of an eating disorder, one in which she forced food to come back up her throat. 

Schiavo suffered from bulimia, an eating disorder characterized by episodes of binge-eating, followed by attempts to rid the body of the calories through purging, which usually takes the form of vomiting or laxative abuse.   This then caused her to have a heart attack. Schiavo had a heart attack, which was caused by a severe electrolyte imbalance due to chronic vomiting. Electrolytes are a combination of minerals essential for hydration of the body and nerve and muscle function.

Terri was not alone in her struggle with bulimia. An estimated one to four percent of females suffer from bulimia during their lifetime, according to the National Institute of Mental Health. But the numbers may be higher, especially in women who may not meet the diagnostic criteria, but display signs of the disorder. "

Sub-clinical bulimia is far more common, with estimates ranging from 10 to 20 percent of females," said Stephen Stotland, Ph.D., a clinical research psychologist who specializes in eating disorders and obesity at McGill University in Montreal, Canada.

Adolescents and young women seem to be most at risk for developing bulimia.

"There are two peak 'age of onset' risk periods for the development of bulimia," according to Anne M. Slocum McEneaney, Ph.D., a clinical psychologist and eating disorders coordinator at Columbia University in New York City. "These are ages 15-16 and 20-23."

One of the more serious complications of bulimia is an electrolyte imbalance, which is caused by dehydration and the loss of potassium and sodium from chronic purging. Electrolyte imbalances can lead to an irregular heart rhythm and potentially a heart attack and death. Electrolyte imbalances are not rare.

"I become very concerned when my patients report symptoms that may be related to electrolyte imbalances, such as undue fatigue, muscle spasms, heart palpitations, or paresthesia," Stotland said. Paresthesia is a sensation of tingling or numbness of the skin with no apparent physical cause, often known as the feeling of pins and needles.

"But symptoms may be vague," according to Mary O'Brien, M.D., of Columbia University.

Physicians and patients must be on the lookout for red flags. In addition to counseling, Stotland recommends that patients with bulimia be followed by a physician, who can monitor signs of significant medical risk.

Warning signs of bulimia include:

  • Frequent trips to the bathroom during or after meals
  • Laxatives or diuretics lying around Excessive exercising after meals
  • Vomit odor on breath or clothes
  • Vomit on or near the toilet from splatter
  • Tooth decay from chronic vomiting
  • Calluses or scrapes on knuckles or hands
  • Mood swings
  • Depression or withdrawal from social activities
  • Guilt after eating and/or self-criticism

If you or someone you care about suffers from bulimia, it's time to get help. Because bulimia affects the mind and body: treatment may involve medical doctors, mental health professionals and dieticians.

© March 31, 2005 Society for Women's Health Research

The Society for Women's Health Research is the nation's only not-for-profit organization whose sole mission is to improve the health of women through research. Founded in 1990, the Society brought to national attention the need for the appropriate inclusion of women in major medical research studies and the resulting need for more information about conditions affecting women. The Society advocates increased funding for research on women's health, encourages the study of sex differences that may affect the prevention, diagnosis and treatment of disease, and promotes the inclusion of women in medical research studies. Dr. Donnica Moore has been a member of the Society since 1990 and is a past member of its Board of Directors.


American Psychiatric Association Work Group on Eating Disorders. Practice guideline for the treatment of patients with eating disorders (revision). American Journal of Psychiatry, 2000; 157(1 Suppl): 1-39.

Created: 4/21/2005  -  Jennifer Wider, M.D.
Reviewed: 4/23/2005  -  Donnica Moore, M.D.

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