Eating disorders.(Women's Health Adviser)

Eating disorders affect about 1% of U.S. women and can be divided into two categories: anorexia nervosa and bulimia nervosa. Patients with anorexia purposefully restrict their caloric intake either by restricting food or purging after eating. Patients with bulimia experience repeated episodes of binge eating followed by purging.

The mortality rate associated with anorexia is 10%-20%. While some anorexic patients commit suicide or fall into fatal hypoglycemic coma, many others die from sudden cardiac arrhythmias. Anorexia typically develops during adolescence, with onset peaks at ages 14 and 18 years, frequently around the time of a stressful life event. Bulimia develops around age 18, typically during a diet.

There is a strong comorbidity between eating disorders and mood disorders. The physical starvation inherent in eating disorders, however, can perpetuate and exacerbate attending psychological symptoms such as depression, withdrawal, and obsessive-compulsive behavior.

Women with eating disorders are often not inclined to seek help. Anorexics don't view themselves as ill, and bulimics harbor deep and isolating shame about their eating patterns. Both groups are frequently wary of physicians. Ob.gyns., who form deep bonds of trust with their patients, are in an excellent position to help these women take the first steps toward recovery.

First, rule out other medical problems that could cause weight loss. Patients with a suspected eating disorder should have a complete blood count and blood urea nitrogen, creatinine, and electrolyte analysis; liver function tests; calcium, magnesium, phosphorus, and albumin levels; electrocardiogram; and a bone mineral density test.

Anorexia Nervosa

* Diagnosis. The Diagnostic and Statistical Manual of Mental Disorders IV cites four diagnostic criteria for anorexia nervosa: weight less than 85% of normal, amenorrhea of at least 3 months, intense fear of gaining weight, and disturbance in the patient's body image or denial of the seriousness of her current weight.