Medical Crises in Eating Disorders

Cover
Endorsements
Half Title
Title Page
Copyright Page
Dedication
Contents
About the Author
Preface
No Warning ... Usually
All Suicides are Medical Deaths
Statistics
Eating Disorders Are Conditions of Extremes
Extremes of Body Image Dissatisfaction and Control
Extreme Physical Goals
Extremes of Eating Disorder Behaviors
Extremes of Medical Risks
Extremes of Social Incapacitation
Extremes of Mental Health Decline
Extremes of Financial Stress
Extremes of Resistance to Care
About This Book
About Myself
Acknowledgments
Chapter 1: Introduction
Mary's Story
Discussion
Crisis is in the Mind of the Beholder ..... Sort Of
What Is a Medical Crisis?
What Is Not a Medical Crisis
Running on Empty
Expect the Unexpected
Put Drug and Alcohol Abuse at the Top of Compounding Risks
Minor Signs and Symptoms May Be a Harbinger for Catastrophe
Seemingly Predictable Behavior Patterns Cannot Be Trusted to Not Change at Any Moment
Triggers-Trigger-Triggers
Roll-Over Effect
Eating Disorders Are Upside Down and Backward From Most Other Medical and Psychological Conditions
Individuals Are Typically Very Competent
Individuals are Often Very Physically Active Then Just Drop Dead
Signs and Symptoms Are Often Absent or Minimal Before Death
Individuals May Be Very Aware of Risks But Continue to Pursue a Destructive Course
Fear of Success
Fear of Failure
Fear of Losing Control
Perfectionism, People Pleasing, and Hypersensitivity
Control Anxiety and Other Emotions
Fear of Losing Their Identity
Fear of Losing All the Attention They Have Been Receiving Because of the Eating Disorder.
Denial
Fear of Being Normal
Desire to Not Be Deemed a Sexual Being
Fear of Becoming Fat
Desire to Be Punished
Guilt and Shame
Fear of Losing a Life-Line
Lack of Will, Mental and Physical Energy to Maintain Efforts
Lack of Success With Recovery Efforts
Anxiety, Depression, or Psychosis
Being Too "Drugged-up"
Fear of Growing Up and Becoming a Responsible Adult
Superstition or Fear Something Horrible Will
Continuing Abusive Relationships and Other Harsh Life Stressors
History of Sexual, Physical, or Emotional Abuse
Drug and Alcohol Abuse
Dementia
Peaceful Coexistence With Eating Disorder
Contributions to Risk
A Theory of Accumulative Risks
Intent
Eating Disorder Behavior Specific Risks
Multiple Eating Disorder Behaviors
Increased Use of Each Eating Disorder Behavior
Increasing Frequency
Increasing Volume
Increasing Number
Increasing Length of Time
Increasing Intensity
Extreme Use of Each Eating Disorder Behavior
Escalating Endpoints
Kinds of Eating Disorder Behaviors and Relative Risk
Combinations of Eating Disorder Behaviors to Create the Same Effect
Duration of Eating Disorder
Family History of Eating Disorders
Ever-Changing Risk Factors
Toxic Eating Disorder Peer Relationships
Pro-Ana and Pro-Mia Networking Sites
Disfiguration
Ongoing and Compounding Stressors
Not Believing In Recovery
Lack of Hope and Feelings of Hopelessness
Responsibility of Care for Others
Dependence on Eating Disorder to Cope With Life
A friend
Cope with Emotions
A Distraction From Life Tasks
"It's What I'm Good At."
"Must Knows" For Reducing Risks
Medical Considerations
Drug Reactions and Drug Interactions
Kinds and Degree of Symptoms or Signs
Coexisting Medical Conditions - Not Caused By Eating Disorder
Significant Weight Loss Regardless of Cause
Not Taking Medications
Medical Conditions That Imitate Eating Disorders
Mental Health
Some May Not Present With Evidence of Predictive Suicidal Risks
Accidental Overdose
Self-Harm
Clinician, Staff, and Treatment Considerations
Causes of Incorrect Diagnoses and Inadequate Treatment
Splitting
False Assumptions
Poor Understanding of Eating Disorders
Influence From Colleagues and Staff
Lack of Team Communication
Lack of Staff Training
Avoidance Because of Bad Experiences With Past Treatment
Lack of Treatment Resources
Lack of a Complete Set of Treatment Resources
Bed Availability
Lack of Skilled Clinicians
Treatment Programs Too Far Away
Lack of Financial Resources
Revolving Door
Falling Between the Cracks
Repeated Failure of Treatments
Ward culture
Drug and Alcohol Use
Negative Eating Disorder Culture and Contamination Amongst Patients
How Can Experts Make Mistakes?
Gut Feelings. Trust Them or Not?
Anticipating Medical Crises in Eating Disorders. Really?
Redundancy and Preventive Maintenance
Redundancy
Preventive Maintenance
Chapter 2: Stories of Critical and Lethal Medical Scenarios
Angel's Story
Discussion
Lesson Points
Erica's Story
Holter monitor report
Coroner's Comments
Summary of events
Medical history
Post mortem and toxicological examinations
Conclusions
Discussion
Lesson Points
Maryanna's Story
Discussion
Lesson Points
Elizabeth's Story
Discussion
Lesson Points
Maya's Story
Discussion
Lesson Points
Brenda's Story
Discussion
Lesson Points
Marissa's Story
Discussion
An Anorexia Nervosa Persona
We Believe the "Experts"
Absence of Detailed Body Image Dissatisfaction, Weight Control Drive, or Diet History
Abdominal and Pelvic Pain Was Atypical
Marissa's Case Was Not Reevaluated After Each Admission
Enter Dr. Bryan Lask!
Ward Politics
So, What Did We Finally End Up Knowing About Marissa?
Lesson Points
Donna's Story
Discussion
Lesson Points
Gillian's Story
Discussion
Lesson Points
Leah's Story
Discussion
Lesson Points
Esther's Story
Discussion
Lesson Points
Sharon's Story
Discussion
Lesson Points
Rosemary's Story
Discussion
Lesson Points
Janet's Story
Discussion
Lesson Points
Alita's Story
Discussion
Lesson Points
Danika's Story
Discussion
Lesson Points
Carol's Story
Discussion
Lesson Points
Peggy's Story
Discussion
Lesson Points
Fran's Story
Discussion
Lesson Learned
Annette's Story
Discussion
Lesson Points
Medication Complications and Eating Disorders
Lorrianne's Story
Discussion
Lesson Points
Norma's Story
Discussion
Lesson Points
Sherry's Story
Discussion
Lesson Points
Stories of Suicide Attempts and One Suicide
Fiona's Story
Discussion
Lesson Points
Pat's Story
Discussion
Lesson Points
Sonja's Story
Coroner's Comments
Discussion
Lesson Points
Summary
Chapter 3: Critical Medical Conditions in Eating Disorders
Lethality
Statistics and More Damn Lies
Cardiovascular Risks
Cardiac Risks
Other Cardiovascular Risks
Cardiovascular Effects of Eating Disorders
Mitral Valve Prolapse
Definition of MVP
Potential Mitral Valve Prolapse Risks
The Mitral Valve Unit
Left Ventricle and Atrium
Ventricular Arrhythmias
Arrhythmic Complications of MVP
Nonarrythmic Complications of MVP
Mitral Valve Prolapse and Sudden Cardiac Death
Mitral Valve Prolapse and Anorexia Nervosa
Sudden Death in Eating Disorders
Cardiovascular Complications and Sudden Death
Hypoglycemia and Sudden Death
Asphyxia, Gastric Dilatation, and Gastric Rupture
Emetics
Sepsis
Brain and Spinal Cord Findings at Postmortem
Refeeding Syndrome
Minnesota Starvation Experiment
The Psychological Expression of Starvation
Deanna's Story
Discussion
Lesson Points
Starvation Can Lead To Lasting Physiological and Psychological Change
Insulin-Dependent Diabetes Mellitus
Obstetric and Gynecologic Concerns Associated With Eating Disorders
References
Chapter 4: Eating Disorder Behaviors
Purging Behaviors
Vomiting
Reasons for Vomiting
Methods of Inducing Vomiting
Fingers
Spoons, Spatulas, and Other Utensils
Emetics
Spontaneous Vomiting Without Stimulating Gag Reflex
Involuntary Vomiting
Vomiting While Sleeping Or Unconscious
What Do Individuals Vomit?
Ending Vomiting Sessions - Endpoints
Where Do Individuals Vomit?
When Individuals Can't Vomit
Medical Risks From Vomiting
Vomiting Frequency
Consumption Volume
Force of Vomiting
Number of Single Vomiting Events and Vomiting Sessions
Patterns of Vomiting
Duration of Vomiting Events
Shifting Vomiting Endpoints
Toxicity
Prevention of Medication Absorption
Choking
Aspiration and Asphyxiation
Tearing of Esophagus and Stomach
Hyperability to vomit
Metabolic Abnormalities
Laxatives
Enemas
Suppositories
Diuretics
Withholding Insulin
Diabetic Coma
Inadequate Glucose Monitoring
Random Insulin Injections Without Monitoring
Brittle Insulin Dependent Diabetes Mellitus
Medical and Legal Consequences
Breastfeeding and Pregnancy
Self-Phlebotomy
Rumination
Binge Eating and Related Behaviors
Binge Eating
What Foods Do Those Who Binge Eat Actually Eat?
Where Do Binges Occur?
Other Dangers With Binge Eating
Grazing
Trap-lines
Subjective Binges
Hoarding
Stealing
Dumpster Diving
Catered Events
Calorie Burning and Metabolism Altering Behaviors
Exercise
Why Is Exercise Used?
Injuries
Other Exercise Interfering Causes
Assessing Exercise Use
Metabolism Boosters
Heating Blankets
Nonchemical Methods of Altering Metabolism
Negative calorie foods
Body Gauging Behaviors
Scales
Mirrors
Clothing
Tight Clothes
Clothing Sizes
Belt Size
Measuring Tape
Photographs
Grabbing Body Parts
Body Calipers
Surgery and Other Cosmetic Altering Methods
Body Shaping as Well as Weight Reducing Surgery
Breast Reduction
Liposuction
Non-Weight Loss Cosmetic Surgical Procedures
Risks Associated With Cosmetic Plastic Surgery
CoolSculpting or Cryolipolysis
Makeup
Gastric Bypass Surgery
Restricting Eating Behaviors
Factors That Affect Weight
Calorie Assessing Behaviors
Measuring Food Volume
Weighing Food
Reading Labels on Food Containers
Calorie Counting
Counting Servings
Guessing
Calorie Reducing Behaviors
Skipping Meals and Snacks
Meal and Snack Reduction
Reducing the Volume or Size of Food
Reducing the Weight of Food
Reducing the Percentage of Food
Vegetarian Diets
Fad Diets
Safe Foods
Fear Foods
Medication Avoidance
Offering Food to Others
Ordering Sauces on the Side
Declining Side Orders Including Desserts
Picking Apart Food
Gum and Candy Calories
Throwing Food Away
Chewing and Spitting
Licking Chopsticks or a Fork
Dark Plates
Sugar Substitutes
Selective Eating
Fluid Restriction
Eating Various Foods With Different Flavors
Delaying Eating
Chewing Several Times
Set Utensils Down Between Bites
Paint Nails or Whiten Teeth
Chopsticks
Eat With the Opposite Hand
Hunger Reduction
Fluid Loading
Foods With Fiber
Peppermint to Decrease Hunger
Cigarettes
Cotton Ball Diet
Chemical Appetite Suppressants
Spoiling Food
Put Strong-Tasting Substances on Food
Other Substances That Can Ruin the Taste or Desire for Food
Food Associations
Microwave Food Too Hot to Eat
Motivating Behaviors
Mantras
Write Your Weight on One Hand and Goal Weight on the Other
Sleep Over Six Hours a Night Will Increase Metabolism
Find an Eating Disorder Buddy
Eating in Front of the Mirror
Wear a Rubber Band
Stack Magazines and Remove Them
Time Rules
Eat By a Certain Time
Eat at a Certain Times
Eat During a Given Time Period
Consequences of Meeting or Not Meeting Time Rules
Time Rules May Be Created in Conjunction With Non-Eating Disorder Objectives
Rules Aiding Restricting
Eat Nothing White
Never Eat Out
A Glass of Water Every Hour
Weigh Yourself Twice a Day or More
Stop Eating in Your Bedroom or Car
Only Eat in Front of Others
Never Eat in Secret
Never Eat Out of Food Containers
Rituals
Cutting Food
Specific Cutlery
One Particular Bowl, Plate, Glass or Cup
Eating Clockwise or Counterclockwise
Not Allowing One Food To Touch Each Other
Food is Eaten in a Specific Order
Superstitious or Religious Meaning
Not Eat Mixed Foods
Distracting Behaviors
Being Busy
Drugs and Alcohol
Aversion Behaviors
Avoiding Behaviors
Reference
Index