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
- Frequent trips to the bathroom during or after meals
- Laxatives or diuretics lying around Excessive exercising
- 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
© 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.