I am often asked: “do we really need to have all this treatment for our child’s eating disorder?  Can’t she/he just talk to someone once a week and not have it interfere with school/soccer/summer vacation/my work schedule?"

I imagine they could.  But then you’d get what people used to get: spotty and unreliable results.  In past decades, people with anorexia nervosa were ill for years, often long into adulthood.  Restricting eating disorders became more entrenched and soon purging was added to their symptomatic burden.  Infertility, relationship problems, depression, medication abuse…..

So I reply:  think what’s at stake.

In medicine we worry about two basic categories of consequences to people who have a given illness:  its burden of morbidity (disabling, progressive or painful symptoms) and its burden of mortality (death).

Other blogs have covered the spectrum of morbidity associated with anorexia nervosa: weak bones (osteopenia), cognitive impairment, social isolation, poor dentition, cardiac weakness, dizziness, fainting, hypothermia, etc.  But for now let’s focus on mortality, because the mortality associated with anorexia nervosa is high for a psychiatric illness in the 21st century: between 6-10%.  And because preventing unnecessary death is why we do what we do.

There are several ways to die from anorexia nervosa:

    1. sudden cardiac death
    1. terminal wasting (inanition) --- incredibly, Wikipedia keeps a list of “famous people” who died of anorexia—greatly understating the issue and a sad comment on those not-famous but deeply loved people who do not make such a list.  The same source also keeps a list of well-known people said to have died of hunger.  And in case you think it is not possible to die of hunger any more, look at this
    2. suicide--- it has been said that roughly half of all deaths from anorexia nervosa are from suicide, but there is conflicting evidence for this.
    3. unknown --- probably the largest category, given the lack of post-mortem data and the fact that many people do not die in hospital or on cardiac monitors.
    4. re-feeding syndrome --- oh, this is painfully sad--- a person can die of misinformed and misguided efforts to get them to eat once they have stopped.  Please, please be sure your child is re-fed somewhere where they know what they are doing.  Being in a hospital is no guarantee of this.

        The plethora of articles on death from eating disorders in the lay press and the professional press are confusing and sometimes contradictory.  What is the actual mortality rate?  How does treatment affect it (a very, very important question)?  Has it changed over the centuries? Who dies, who doesn’t?  All of these questions need addressing, but most of all we need to be aware of what’s really at stake:  our children.  And act accordingly.