Eating disorders are medical as well as psychiatric diseases. The disordered thoughts are the driving forces of the illness, but thorough clinical care during recovery also means diagnosing and treating the physical problems as well.
However, many physicians know little about the common medical problems associated with eating disorders. Chronic starvation and malnutrition are rarely seen in other situations in the first world. The medical effects of regular vomiting are also not conditions typically treated by physicians.
The result is that most doctors attempt to fit patients with eating disorders into incorrect categories because the conditions are largely unfamiliar, leading to routine misdiagnosis and incorrect treatment.
The most common specialty these patients see is the gastroenterologist. The stomach and intestines are directly affected by eating disorder symptoms and cause a plethora of problems most of which are reversible with recovery.
Patients who primarily restrict food experience nausea, bloating and constipation. The best way to understand what happens to the GI system for these people
is to envision their gut as a muscle. As they eat less food, they use the muscle less frequently and the muscle weakens and begins to atrophy. The entire digestive system then works so slowly when given food that it leads to the symptoms above, indicative of slowed digestion.
If the symptoms persist for years, then the diagnosis changes from slowed digestion to more chronic problems: gastroparesis (very slowed digestion in the stomach) and colonic inertia (very slowed intestinal function). These diagnoses can be slow to abate if present for many years.
Patients who purge or use laxatives regularly have a different set of GI symptoms, including stomach irritation, pain and bleeding and chronic constipation or diarrhea. The compensatory behaviors of their eating disorders cause constant trauma to their body which can lead to long lasting damage.
Chronic vomiting teaches the GI system to expect not to digest food but instead to expel it. The barrier between the stomach and esophagus loosens, allowing more acid to rebound into the esophagus and mouth called reflux. The acid production becomes irregular often causing irritation or an ulcer. Digestion is impaired from the constant trauma and the stomach has trouble functioning normally.
Laxative use causes similar trauma to the intestines which lose their ability to move food through the body and leads to chronic constipation. Excessive laxative use impairs the intestines enough that all food passes through undigested as diarrhea. The laxatives cause consistent fluid loss through diarrhea and forces a change in the mechanism the body uses to remaining hydrated often causing chronic fluid retention. Any break in laxative use can cause significant constipation. Last, laxatives are addictive and sudden cessation of use itself can be dangerous. So anyone stopping laxatives needs medical help to do so safely.
It's important to recognize that these symptoms are not a reason to blame the patient. No one asks to get sick with an eating disorder. These GI symptoms and illnesses are real problems that need attention, diagnosis and treatment. Getting all the medical help needed is an important part of recovery.