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Treatment of eating disorders: physical examination, eeg tracings and psychological tests TREATMENT OF EATING DISORDERS: PHYSICAL EXAMINATION, EEG TRACINGS AND PSYCHOLOGICAL TESTS
Physical examination
If the patient's primary physician hasn't already done so, I order a detailed medical workup, including complete blood count, blood chemistries, thyroid-function tests, urinalysis, and electrocardiogram. Even though a problem may appear to be psychological in origin, I have to rule out potentially treatable physical causes, such as a brain tumor.
For example, many anorexics suffer from intolerance to cold. They shiver all the time, despite the fact that they wear several layers of clothes, drink hot liquids constantly, and keep the heat turned up. Such sensitivity can also be a sign that the thyroid isn't up to par. I thus order thyroid-function tests to rule out this cause of a common anorexic symptom. It is important to distinguish between thyroid abnormalities that result from the body's attempt to compensate for the eating disorder from those that cause disordered eating, hyperactivity, or weight loss.
I also look for signs of possible vitamin and mineral deficiencies. A recent study by Dr. Richard Hall and associates at the University of Florida showed that a phenomenal 25 percent of hospitalized eating disorder patients, regardless of their diagnosis, have severely low levels of magnesium. Patients with low magnesium may develop difficulties with cardiac arrhythmias (posing the risk of sudden death), restlessness, diminished concentration and memory, hypertension, muscle weakness, leg cramps, and decreased feelings in the arms and legs. It's not necessarily hard to correct a magnesium deficiency-a few days or weeks of oral magnesium preparations should do it. But if the problem isn't corrected, it can result in fatal cardiac difficulties.
Electroencephalogram Tracing
EEG tracings have some value in the eating disorders workup. However, such tracings measure the patient's brain waves only at one point in time. They can thus fail to detect a seizure disorder even if one is present. If I strongly suspect a seizure disorder, I may order a twenty-four-hour continuous recording. Contrary to previous speculation, there doesn't seem to be a higher incidence of seizure disorders among patients with anorexia or bulimia than in the general population. A recent study by Dr. Harrison Pope and his colleagues at Harvard University showed no significant differences in the brain-wave abnormalities spotted on the EEGs of bulimic patients compared to depressed patients.
Psychological Tests
These broad-ranging tests reveal how the patient's mind works and may provide clues to the thinking patterns that contribute to the disorder. Such tests are certainly useful for inpatient treatment, where the expense and intensity of treatment calls for as rapid and complete a workup as possible. They may also be useful for an outpatient when there are questions about her cognitive functioning or the dynamics of her personality.
Each component - interviews, physical exam, tests-adds to understanding and reveals the direction treatment should take. However, it's not necessary, and may even be harmful, to wait for all the pieces to fall into place before treatment begins.
Developing the treatment plan is a collaborative effort involving the doctor, patient, and family. Together we look at the problem from many angles, decide on the goals, and develop the approach that stands the best chance of working. Sometimes this involves drawing up a treatment contract that explicitly spells out goals and methods.
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