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Eating DisordersEating Disorders   
 

Eating Disorders GP|Solo Magazine - October/November 2004 - ABA General Practice, Solo and Small Firm Section

".... women and men with eating disorders both share the same personality characteristics, which can include:
• low self-esteem
• depression
• anxiety
• inability to express emotions
• being a perfectionist overachiever
• a need to control

Males and females with eating disorders also share the same diminished abilities to think clearly. Eating disorders invariably lead to malnutrition, which produces fatigue, dizziness, hypoglycemia, and alterations in brain chemistry. People with eating disorders frequently engage in impulsive, self-destructive behaviors that can lead to legal issues. They may spend large amounts of money on binge food, creating high credit card debt or bankruptcy. They may steal money from family members or shoplift. Sometimes they are caught and arrested.... "

 

A client you are preparing for court testimony is pale and thin. She
seems agitated, unfocused, and has trouble remembering details. One of
your colleagues is spending many hours working out at the gym and making
excuses for why he cannot attend lunch appointments. A well-to-do client
with no previous criminal offenses is arrested for shoplifting food.

What is the connecting thread among these people? All three could be
struggling with an eating disorder.

According to the National Eating Disorders Association (NEDA), eating
disorders affect 5 to 10 million American adolescent girls and women
and approximately 1 million American boys and men. The three most common
eating disorders are anorexia nervosa (self-starvation), bulimia nervosa
(binge/purge), and binge eating disorder (bingeing). Onset typically
occurs between 12 and 18 years of age.

Several eating disorder organizations estimate that one out of every
100 young women in America is anorexic and about 4 percent of college-age
American women are bulimic. They further estimate that 10 to 15 percent
of people with anorexia or bulimia are male and 2 to 5 percent of Americans
have a binge eating disorder. However, because of the guilt and corresponding
secrecy of eating disorders (especially with bulimia and binge eating),
it is likely that many instances go unreported. Thus, a higher incidence
of eating disorders is almost certain.

Eating disorders are serious illnesses that affect a person’s
physical and emotional functioning. The death rate for eating disorders
has been reported as high as 10 percent, and the risk of death is highest
among people with both anorexia and bulimia. Medical complications from
eating disorders can include:


• problems with concentration and memory
• bone density loss that leads to osteoporosis
• gastrointestinal problems
• loss of tooth enamel from purging
• kidney disease and/or failure
• fluid and electrolyte imbalances
• increased risk of seizures
• irregular heartbeat that can lead to cardiac arrest

People with eating disorders typically are obsessed with weight, counting
calories and fat grams, and dieting. They often have excuses to avoid
eating and steer clear of social situations involving food, restaurants,
and eating in front of others. They may spend much of their free time
over-exercising. They frequently have social anxiety disorder and obsessive-compulsive
disorder and may become reclusive, anxious around others, or constantly
count objects or repeatedly check that a task was done correctly.

As eating disorders become more severe, meal times can become extremely
ritualistic, with the person insisting on eating from the same bowl,
cutting food into tiny pieces, not letting the articles of food on the
plate touch one another, and moving food around the plate to make it
appear as if something has been eaten. Many people with eating disorders
will cook or bake food for other people but refuse to eat the food themselves.

While women tend to develop eating disorders from a fear of weight
gain and a desire to be thin, many men develop disordered eating and
an obsession with exercise from a desire to become more muscular. However,
women and men with eating disorders both share the same personality characteristics,
which can include:


• low self-esteem
• depression
• anxiety
• inability to express emotions
• being a perfectionist overachiever
• a need to control

Males and females with eating disorders also share the same diminished abilities to think clearly. Eating disorders invariably lead to malnutrition,
which produces fatigue, dizziness, hypoglycemia, and alterations in brain
chemistry. People with eating disorders frequently engage in impulsive,
self-destructive behaviors that can lead to legal issues. They may spend
large amounts of money on binge food, creating high credit card debt
or bankruptcy. They may steal money from family members or shoplift.
Sometimes they are caught and arrested.

People with eating disorders also may require involuntary civil commitment
for psychiatric treatment and guardianship for medical decisions. Such
individuals are severely medically compromised, severely depressed, even
suicidal and a danger to themselves and others.

These scenarios can require a lawyer. Hopefully, it will be one who
is aware that eating disorders can be lethal and will assist the person
in receiving help from a certified mental health professional specializing
in eating disorders. With treatment, 60 percent of people with eating
disorders recover.

Treatment should begin with a comprehensive psychiatric and medical
examination by a certified therapist specializing in these disorders.
The psychiatric assessment involves the accurate diagnosis of the specific
type of eating disorder, with a focus on nutritional and weight symptoms
such as food avoidance; fasting; frequency and character of binge/purge
episodes; the abuse of laxatives, diuretics, and diet pills; anabolic
steroid use; and a detailed history of weight changes.

Ongoing medical treatment should include monitoring medical stability,
prescribing and monitoring medications, and identifying and treating
co-occurring problems such as depression and anxiety. Treatment also
should include a dietitian who specializes in eating disorders and can
determine normal body weight, help the patient develop a healthy meal
plan, and monitor that the plan is being followed. When compulsive exercising
is an issue, a certified personal trainer experienced with eating disorder
patients can be helpful.

It’s important for lawyers to recognize that the same personality
factors that can make a person successful in a competitive, high-stress
profession such as the law can increase a person’s risk of developing
an eating disorder. People with eating disorders, especially anorexia,
tend to be perfectionists with high expectations of themselves and others.
Despite being overachievers, they can have low self-esteem and identity
problems. They are prone to dichotomous thinking—seeing everything
as good or bad, a success or a failure.

Whether dealing with a client or a colleague, lawyers need to be aware
of the symptoms and seriousness of eating disorders, as well as local
treatment resources. Most importantly, lawyers can help create a work
environment that supports good mental health in general by promoting
information and open discussion of a wide range of mental health disorders.


Additional Resources
National Eating
Disorder Association


Eating Disorder Referral
and Information Center

Something Fishy


Academy for Eating Disorders
National Association of Anorexia
Nervosa and Associated Disorders

Theodore E. Weltzin, M.D., is medical director ofeating disorders services at Rogers Memorial Hospital in Oconomowoc, Wisconsin, the only treatment facility with separate residential treatment for men. Treatment inquiries can be e-mailed to Beth Baus, national outreach representative for Rogers Memorial Hospital, at bbaus@rogershospital.org

The text of this article may be reproduced for classroom use in an institution of higher learning and for use by not-for-profit organizations, provided that such use is for informational, non-commercial purposes only and any reproduction of the article or portion thereof acknowledges original publication in this issue of GPSolo, citing volume, issue, and date, and includes the title of the article, the name of the author, and the legend, “©

Copyright 2004 by the American Bar Association. Reprinted by permission.”

 
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