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Eating Disorder Underlies Schiavo Tragedy

Do You Know the Warning Signs of Bulimia?
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WebMD Health News

March 25, 2005 - One of the scariest things about the Terri Schiavo tragedy is that many, many women - right now - risk the same fate.

According to the Terri Schindler-Schiavo Foundation, Schiavo collapsed in her home not because she had a heart attack or stroke, but because her body chemistry was horribly out of balance.

Court documents state - and medical records suggest - that the then-26-year-old woman suffered from bulimia, an eating disorder.

In that, she is not alone. An estimated 1% to 4% of American women suffer from bulimia. The central symptom of bulimia is repeated cycles of binge eating followed by purging. Purging means self-induced vomiting and/or abuse of laxatives, diuretics (water pills), enemas, fasts, and/or excessive exercise.

And these people - the vast majority of them women - run a terrible risk. Terri Schiavo, for example, collapsed when her potassium levels dipped frighteningly low. Her heart stopped, which likely caused decreased blood flow to her brain, leading to her brain damage.

Johns Hopkins psychiatrist and eating disorder specialist Graham Redgrave, MD, has seen similar cases.

"I have known two people who died of electrolyte imbalance," Redgrave tells WebMD. "Neither were in treatment at the time. Both were actively engaged in disordered eating behavior. And I have treated patients walking around with a potassium level that, if you had it, it would be lethal. Their bodies had adapted. But it is not clear that this is a stable state. If life events become more stressful, and you engage in eating disorder behaviors, it is more likely you would decompensate and have one of these terrible events."

Nobody realized that Terri Schiavo might suffer from bulimia until it was far too late. How can we recognize bulimia in our own loved ones? How can we help?

Eating disorders are mental health problems. A person with a mental health problem starts to behave differently for no apparent reason, Redgrave says.

"It is really up to people who know the person well to notice those changing patterns of behavior," he says. "The reason is that eating disorders are conducted in secret. They are appropriately stigmatized. It is not normal to vomit after meals or to obsessively exercise or to not eat. People who engage in these behaviors will make excuses or lie. Sometimes it is very difficult to tell."

Most of us think we'd know if someone close to us was doing something as extreme as vomiting after every meal. But people with eating disorders aren't easily found out, says Rick Kilmer, PhD, clinical director of the Atlanta Center for Eating Disorders.

"People with bulimia find their behavior shameful or embarrassing and they will hide it at all costs and be very creative in hiding both bingeing and purging," Kilmer tells WebMD.

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