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Re: Does an ED require a mental component? Racer

Posted by CareBear04 on January 21, 2008, at 18:24:26

In reply to Re: Does an ED require a mental component?, posted by Racer on January 19, 2008, at 21:55:29

thanks racer. at least i understand how the question can be answered both ways now.

yes, the question is based on a suggestion that i have an ED. my pdoc hasn't raised the issue again since. it actually wasn't his own observation. he was talking to my pcp who mentioned that he had hospitalized me for malnutrition and that he suspected an occult ED. i was surprised because i wasn't aware of a hospitalization for malnutrition. he has hospitalized me twice, and the first time had no connection to eating at all. the second time, i guess, could be tied to nutrition. i have a history of orthostatic hypotension not clearly tied to whether or not i'm eating a lot. i was walking into the clinic for a follow-up and passed out, slamming my chin into the ground. i got stiches and fluids in the ER, but when my blood sugar was still low later, he admitted me overnight for observation.

being stressed really messes me up-- can't sleep, can't eat, constantly tense and on edge. i think part of the weight loss has to do with being too busy to make time to eat properly and, consciously or not, putting nutrition last in terms of priorities. eating when i'm tense is just functionally unpleasant, too, in terms of quesiness, swallowing, disgestion... when depressed or manic, i tend to lose weight, too, either because getting food and eating it seeems to require too much effort or because i'm so all over the place doing a million things.

a few years ago, i had an upper endoscopy that resulted in esophageal lacerations. i was prescibed vicodin and percocet for pain, but they didn't help much and i couldn't eat or drink much at all. the painkillers caused my mood to plummet, but the weight loss threw off my metabolism so that i got lithium toxic. after a few days in the medicine unit, i was transferred to psychiatry to restart lithium safely with close monitoring. even though my family and my pdoc at the time affirmed that they didn't think i had an ED, the inpatient team was convinced i was anorexic. their diagnosis was based on very low weight and certain lab results like borderline-low potassium and very low prealbumin on admission. the whole hospitalization was a mess for a lot of reasons not relevant to this thread, but after i was discharged, i was able to regain a lot of the weight even though it took awhile. since then, i've been in the hospital several times for medical or psych reasons, and though i've had nutrition consults, but none of the drs have suggested or noted any suspicion of an ED.

what you said about factoring in intent as part of diagnosis was interesting. i guess if only objective standards are used, i would qualify as having an ED since my eating patterns and weight are troubling at times. but i'm not sure what the outcome would be under the objective + subjective intent standard. if intent is defined as purpose [of losing weight], i don't think i have that. but if it includes knowledge that weight loss is very likely, i do know that; i think i just don't consider nutrition to be as or more important that other commitments to shift time from them to eating.

any thoughts?

thanks,
cb


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Psycho-Babble Eating | Framed

poster:CareBear04 thread:807610
URL: http://www.dr-bob.org/babble/eating/20070820/msgs/808209.html