GPSolo Magazine - October/November 2004
A client you are preparing for court testimony is pale and thin. She seems agitated, unfocused, and has trouble remembering details. One of your colleagues is spending many hours working out at the gym and making excuses for why he cannot attend lunch appointments. A well-to-do client with no previous criminal offenses is arrested for shoplifting food.
What is the connecting thread among these people? All three could be struggling with an eating disorder.
According to the National Eating Disorders Association (NEDA), eating disorders affect 5 to 10 million American adolescent girls and women and approximately 1 million American boys and men. The three most common eating disorders are anorexia nervosa (self-starvation), bulimia nervosa (binge/purge), and binge eating disorder (bingeing). Onset typically occurs between 12 and 18 years of age.
Several eating disorder organizations estimate that one out of every 100 young women in America is anorexic and about 4 percent of college-age American women are bulimic. They further estimate that 10 to 15 percent of people with anorexia or bulimia are male and 2 to 5 percent of Americans have a binge eating disorder. However, because of the guilt and corresponding secrecy of eating disorders (especially with bulimia and binge eating), it is likely that many instances go unreported. Thus, a higher incidence of eating disorders is almost certain.
Eating disorders are serious illnesses that affect a person’s physical and emotional functioning. The death rate for eating disorders has been reported as high as 10 percent, and the risk of death is highest among people with both anorexia and bulimia. Medical complications from eating disorders can include:
• problems with concentration and memory
• bone density loss that leads to osteoporosis
• gastrointestinal problems
• loss of tooth enamel from purging
• kidney disease and/or failure
• fluid and electrolyte imbalances
• increased risk of seizures
• irregular heartbeat that can lead to cardiac arrest
People with eating disorders typically are obsessed with weight, counting calories and fat grams, and dieting. They often have excuses to avoid eating and steer clear of social situations involving food, restaurants, and eating in front of others. They may spend much of their free time over-exercising. They frequently have social anxiety disorder and obsessive-compulsive disorder and may become reclusive, anxious around others, or constantly count objects or repeatedly check that a task was done correctly.
As eating disorders become more severe, meal times can become extremely ritualistic, with the person insisting on eating from the same bowl, cutting food into tiny pieces, not letting the articles of food on the plate touch one another, and moving food around the plate to make it appear as if something has been eaten. Many people with eating disorders will cook or bake food for other people but refuse to eat the food themselves.
While women tend to develop eating disorders from a fear of weight gain and a desire to be thin, many men develop disordered eating and an obsession with exercise from a desire to become more muscular. However, women and men with eating disorders both share the same personality characteristics, which can include:
• low self-esteem
• inability to express emotions
• being a perfectionist overachiever
• a need to control
Males and females with eating disorders also share the same diminished abilities to think clearly. Eating disorders invariably lead to malnutrition, which produces fatigue, dizziness, hypoglycemia, and alterations in brain chemistry. People with eating disorders frequently engage in impulsive, self-destructive behaviors that can lead to legal issues. They may spend large amounts of money on binge food, creating high credit card debt or bankruptcy. They may steal money from family members or shoplift. Sometimes they are caught and arrested.
People with eating disorders also may require involuntary civil commitment for psychiatric treatment and guardianship for medical decisions. Such individuals are severely medically compromised, severely depressed, even suicidal and a danger to themselves and others.
These scenarios can require a lawyer. Hopefully, it will be one who is aware that eating disorders can be lethal and will assist the person in receiving help from a certified mental health professional specializing in eating disorders. With treatment, 60 percent of people with eating disorders recover.
Treatment should begin with a comprehensive psychiatric and medical examination by a certified therapist specializing in these disorders. The psychiatric assessment involves the accurate diagnosis of the specific type of eating disorder, with a focus on nutritional and weight symptoms such as food avoidance; fasting; frequency and character of binge/purge episodes; the abuse of laxatives, diuretics, and diet pills; anabolic steroid use; and a detailed history of weight changes.
Ongoing medical treatment should include monitoring medical stability, prescribing and monitoring medications, and identifying and treating co-occurring problems such as depression and anxiety. Treatment also should include a dietitian who specializes in eating disorders and can determine normal body weight, help the patient develop a healthy meal plan, and monitor that the plan is being followed. When compulsive exercising is an issue, a certified personal trainer experienced with eating disorder patients can be helpful.
It’s important for lawyers to recognize that the same personality factors that can make a person successful in a competitive, high-stress profession such as the law can increase a person’s risk of developing an eating disorder. People with eating disorders, especially anorexia, tend to be perfectionists with high expectations of themselves and others. Despite being overachievers, they can have low self-esteem and identity problems. They are prone to dichotomous thinking—seeing everything as good or bad, a success or a failure.
Whether dealing with a client or a colleague, lawyers need to be aware of the symptoms and seriousness of eating disorders, as well as local treatment resources. Most importantly, lawyers can help create a work environment that supports good mental health in general by promoting information and open discussion of a wide range of mental health disorders.
Theodore E. Weltzin, M.D., is medical director of eating disorders services at Rogers Memorial Hospital in Oconomowoc, Wisconsin, the only treatment facility with separate residential treatment for men. Treatment inquiries can be e-mailed to Beth Baus, national outreach representative for Rogers Memorial Hospital, at firstname.lastname@example.org.
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