Why Someone with Anorexia Should See a Doctor

For people with anorexia, one irony is that getting medical help often reinforces the illness. I will frequently hesitate before referring these patients to their primary care doctor, and this conundrum presents a complex path towards getting better.

The anorexic thoughts repeatedly tell people that they just eat a little less than others and that their medical symptoms are exaggerated. The fact that they cannot see their bodies realistically means that they think they are fairly healthy when they are actually severely malnourished.

How else can people who wear very small clothing sizes or get weak and dizzy from walking down the street believe they are healthy?

As their health continues to deteriorate, the eating disorder thoughts strengthen and convince the person their health is normal. Even abnormal tests, worsening physical health and increasingly debilitating symptoms don’t change this delusional thought. 

A confusing factor for these patients is that the human body is programmed to adapt to periods of starvation. Centuries of intermittent famine have built this protective mechanism into our DNA. Accordingly, blood tests often remain normal even when someone is severely starving. This does not reflect health but instead the body’s resilience.

Also, modern medicine is not designed to diagnose the medical problems associated with starvation. Outside of anorexia and end-stage cancer, people don’t experience chronic starvation in the first world. Thus, doctors aren’t trained to treat malnutrition and modern medical tests don’t pick up on the problems associated with starvation, especially the common cardiovascular ones which look for heart problems of the elderly, not the starved.

Because of these complications, seeking medical help often reveals little: blood tests and imaging are usually negative. Instead of receiving useful medical attention, people with anorexia end up without any useful information which then reinforces the eating disorder thoughts and leads to further slips. Unfortunately, a medical work-up can just as often lead to a relapse and hospitalization as it can medical findings.