Eating disorder

Disease Description (Causes and Symptoms)

• Definition: Eating disorders are a group of conditions in which serious problems develop with food intake and weight control due to mental and behavioral factors. Representative disorders include anorexia nervosa (anorexia) and bulimia nervosa (bulimia).
• Main causes and pathophysiology:
  • Multifactorial: Interaction among genetic predisposition; changes in neurotransmitters in the brain (such as serotonin) and the mechanisms regulating appetite and satiety; changes in energy metabolism; and psychological and social factors (social pressure regarding body shape and weight, low self-esteem, desire for control, etc.).
  • Persistent nutritional deficiency (anorexia) can lead to endocrine abnormalities (amenorrhea, changes in the thyroid and growth hormone), decreased bone density, and brain atrophy. Repeated vomiting or laxative abuse can cause electrolyte imbalance and cardiac complications.
• Main symptoms:
  • Weight loss or an intense fear of gaining weight, restriction of food intake, distorted body image (perceiving oneself as overweight)
  • Binge eating (consuming a large amount of food in a short period) followed by self-harming compensatory behaviors (vomiting, use of laxatives or diuretics, excessive exercise)
  • Amenorrhea in women, fatigue, hypothermia, bradycardia and hypotension, increased risk of osteoporosis
  • Mental symptoms: depressed mood, anxiety, obsessive behavior, and possible self-harm or suicidal thoughts

Treatment Methods

• Treatment principles: A multidisciplinary approach (including psychiatry, dietitians, internal medicine/emergency medicine, and psychotherapists) combines nutritional stabilization, psychotherapy, and management of medical complications.
• Acute care and indications for hospitalization:
  • Hospital treatment is indicated in cases of severe malnutrition (very low body weight), severe electrolyte abnormalities, cardiovascular or neurological abnormalities, or severe risk of self-harm or suicide.
• Nutritional and medical management:
  • Nutritional support for gradual weight restoration (rapid nutritional replenishment carries a risk of refeeding syndrome → monitoring is necessary)
  • Electrolyte tests (potassium, magnesium, etc.) and electrocardiograms (heart rhythm), with correction as needed
  • Bone density assessment and testing for hormonal abnormalities when necessary
• Psychotherapy:
  • Cognitive behavioral therapy (CBT): Modifies beliefs and behaviors related to weight and eating
  • Family-based treatment (FBT): Effective in adolescents
  • Motivational enhancement therapy, group therapy, self-help groups, etc.
• Medication treatment:
  • In cases involving binge eating and vomiting, antidepressants (e.g., SSRIs) may have some effect (prescribed at the physician’s discretion).
  • Medications may be used to treat symptoms when depression or anxiety is also present.
• Lifestyle management and precautions:
  • Observation after meals and prevention of vomiting (a structured environment is recommended initially)
  • Restriction of exercise and establishment of a safe weight-gain plan
  • Follow medical staff’s instructions regarding medications and nutritional supplements
  • Emergency signs (fainting, chest pain, severe dizziness, severe abdominal pain, sudden severe electrolyte abnormalities, suicidal thoughts) require an immediate visit to the emergency room

Outpatient Visit Checklist (Including Preparation Items and Sample Questions)

• Items to prepare before the visit:
  • Records of recent weight changes (over the past 6–12 months) and a food diary (if possible)
  • List of medications and supplements currently being taken
  • Menstrual history (for women) and whether pregnancy is possible
  • Past medical history (mental health and medical test results, history of hospitalization)
  • Recent blood test and electrocardiogram results (if available), and bone density test results (if available)
  • Records of changes related to self-harm or suicide risk (whether thoughts or plans are present)
• Symptoms to tell the medical staff about in advance during the outpatient visit:
  • Frequency and methods of vomiting or laxative use, whether excessive exercise is performed, and intentional weight-control methods
  • Recent fainting, dizziness, hypothermia, or symptoms of arrhythmia
• Sample statements (it may be helpful for the patient to write these down and bring them):
  • "I will bring records showing my weight changes over the past six months."
  • "I have recorded how many days and how many times I vomit after meals."

General Sample Questions to Ask the Doctor

• "What is my condition (diagnosis), and how severe is it?"
• "What is my target treatment weight, and what is the recovery plan?"
• "What are the expected effects and side effects of the medication you plan to prescribe?"
• "What are the criteria for determining whether I need hospitalization or can be treated as an outpatient?"
• "What support should be provided at home to reduce the risk of relapse?"
• "When can menstruation and the risk of osteoporosis recover?"

Customized Sample Questions by Condition

• Regarding anorexia nervosa (anorexia):
  • "What is the safe target rate for weight gain (kg per week), and how will monitoring be conducted to prevent refeeding syndrome?"
  • "Should my current bone density or hormonal (menstrual) status be evaluated? If necessary, what tests should I have and when?"
• Regarding bulimia nervosa (bulimia):
  • "What combination of medication treatment (e.g., SSRIs) and psychotherapy is recommended to stop binge eating and compensatory behaviors?"
  • "How will electrolyte and cardiac problems caused by vomiting or laxative use be tested for and managed?"

Note: If symptoms are severe or there is a risk of self-harm or suicide, seek emergency medical care immediately. Treatment varies from person to person, so please consult your medical provider regarding specific prescriptions and treatment plans.