March 25, 2005 - One of the scariest things about the Terri Schiavo tragedy is that many, many women - right now - risk the same fate.
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?
"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.
"It is something family members only gradually become suspicious of. They may notice evidence of vomiting, they may see a pattern of someone always disappearing after a meal, someone who always has a reason not to eat with other people or with the family. They may see wrappers for diuretics or laxatives. They may see evidence of large quantities of binge food hidden in the trunk of the car or below all the other garbage. And they may notice large quantities of food missing and nobody is admitting what happened to it."
Kilmer says there may also be physical and emotional cues:
- Bloodshot, teary eyes
- A swollen face, particularly swollen jaws or throat
- Mood swings. "After someone has been through a binge or a purge they may be very isolative or moody or embarrassed," Kilmer says.
- Looking tired
- A preoccupation with food and/or dieting
- Body-image distortion. "The person is self-critical of their body or talking about wishing they could change or wishing they could have a certain plastic surgery, or a certain diet, or things that seem irrational or over-the-top to those around them," Kilmer says.
"If you suspect that you or one of your loved ones has an eating disorder, getting into treatment early is critically important," Redgrave says. "The earlier treatment is, the more chance there is for improvement. Without treatment, these things can be terrible."
Ignoring suspicious behavior or hoping it will go away won't work. Redgrave and Kilmer both advise telling a person you suspect of having an eating disorder that you know something is wrong. This should be done in a supportive way.
"Say, 'I am very concerned you may be hurting yourself,'" Kilmer advises. "Rather than confronting someone and telling them you think they have an eating disorder, it is better to say, 'I am concerned and wonder if you have some problems with food.' Tell them you love them and support them doing things in a healthy way. And tell them there are people that can help someone be happy and healthy without doing drastic and destructive things. Professionals can help them have a better relationship with food."