Background: Treating patients with eating disorders is associated with a plethora of medical/psychological problems-from medical and functional gastrointestinal issues to psychological distress and emotional dysregulation. It takes a multidisciplinary team to provide evidence-based care for such ill and fragile patients and the collaboration between a physician and the psychologist plays a vital role in the successful treatment of the physical and emotional complications of patients with eating disorders. Nourishing eating disorder patients is the first step in their recovery journey but is usually associated with physical discomfort and a host of medical complications which the astute physician can recognize and treat.
Objectives:
- Identify the common gastrointestinal complaints of patients with severe malnutrition
- Understand the pathophysiology of common gastrointestinal complications of severe malnutrition
- Understand the medical treatment of gastrointestinal complications
- Identify somatic symptoms and understand the psychological mechanisms behind them
- Understand the gut-brain relationship and how it manifests in eating disorder patients
- Develop skills to treat somatic symptoms
- Distinguish between organic medical conditions and somatization and how to treat both
Case 2: Gastroparesis. Weight loss of even 20 pounds can lead to slowed intestinal motility and slowed gastric emptying (gastroparesis) which manifests as fullness, bloating, flatus, early satiety, nausea, and abdominal pain. Unfortunately, anxiety and depression are also known to promote delayed gastric emptying. The role of corticotropin releasing factor (CRF) on gut physiology will be discussed.
Case 3: Dysphagia. Severe malnutrition can lead to loss or atrophy of muscles needed to swallow. These patients often present with difficulty swallowing ranging from coughing while swallowing to frank aspiration into the lungs which can lead to multiple medical complications such as pneumonia. Difficulty with swallowing can also be associated with past trauma, choking phobia, or anxiety. Eating disorder patients are thought to have an increased risk of swallowing problems. Phagophobia, a psychological form of dysphagia, will be discussed.
Case 4: Hepatitis and Hypoglycemia. Starvation hepatitis is common in severely malnourished patients and is a sign of impending multi-organ failure. About 30% of patients with severe malnutrition that present with starvation hepatitis have associated hypoglycemia due to depleted hepatic glycogen stores.
Case 5: Constipation. One of the adaptive mechanisms to malnutrition is slowed colonic transit/intestinal motility.
Case 6: Irritable Bowel Syndrome (IBS). The symptoms of IBS and the gastrointestinal symptoms of severe malnutrition often overlap and patients with an eating disorder are often misdiagnosed and treated for IBS.
As Chief Medical Director at Alsana, Margherita Mascolo, leads the medical component of Alsana’s Adaptive Care Model™. Margherita brings over 10 years of hands-on experience and extensive knowledge in the treatment of eating disorders. After completing her undergraduate work at the University of St. Thomas in Houston, Texas, Margherita earned her medical degree at the University of Texas Health Sciences Center. Her residency was completed in Internal Medicine at the University of Colorado in Denver. Margherita is board certified in Internal Medicine, has published multiple peer reviewed articles on the medical complications of eating disorders, travels nationally and internationally to speak on these complications, and has earned her certified eating disorder specialist certification.
Dr. Nicole Siegfried is the Chief Clinical Officer for Alsana Eating Recovery Communities. She is a Certified Eating Disorder Specialist (CEDS) and a licensed clinical psychologist. She also serves as an Adjunct Associate Professor of Psychology at University of Alabama at Birmingham. She has treated eating disorders for over 20 years. She is an international speaker and has published research, magazine articles, and book chapters in the field of eating disorders and suicide. Dr. Siegfried is president of the Alabama Regional Chapter of IAEDP. She is chair of the Research Committee for the Residential Eating Disorder Consortium (REDC). She is a member of the Academy of Eating Disorders (AED) and former Co-Chair of the Eating Disorders and Suicide Prevention AED Special Interest Group.
