What is MEED? Medical Emergencies in Eating Disorders

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Eating disorders are complex mental health disorders with physical, mental, and social consequences. In some cases, eating disorders can lead to medical emergencies that require urgent professional care. 

Medical emergencies in eating disorders are often related to malnutrition. Young people who don’t take in the nutrients their bodies need can experience different kinds of medical complications, some of which are very serious. Other emergencies are caused by eating disorder behaviours like purging or by psychological consequences such as self-harm.

Most young people with an eating disorder will not require emergency medical treatment. That said, eating disorders have some of the most serious medical complications of any mental health disorder. Anorexia nervosa, a type of eating disorder, has the highest mortality rate of any mental illness, and around 20% of people develop a severe form of the disorder.

While medical emergencies are frightening, with urgent medical care, young people can be kept safe and recover. Long-term treatment for eating disorders supports young people to recover physically, psychologically, and socially – and prevents medical emergencies in the future.

What Are Medical Emergencies in Eating Disorders?

Medical emergencies happen when medical complications of eating disorders require urgent medical care. This care is usually provided by emergency departments and may be continued in a general hospital setting.

Emergency medical care should always be accompanied by long-term treatment for eating disorders. Sometimes, medical emergencies can happen when a young person is already receiving eating disorder treatment. This might be a sign that they need alternative or additional forms of support or a higher level of care.

When medical emergencies happen before an eating disorder diagnosis or treatment, mental health professionals should start assessments, diagnoses, and collaborative treatment planning with family members as soon as possible. 

What Kinds of Medical Emergencies Occur in Eating Disorders?

Young people with eating disorders are at risk of several types of medical emergencies. These include emergencies that happen because of malnutrition, purging behaviours, and psychological distress.

Dehydration and Over-hydration

Eating disorders can lead to both dehydration and overhydration. Sometimes dehydration is caused by purging behaviours, a common symptom of eating disorders including both anorexia nervosa and bulimia nervosa. 

Purging behaviours usually happen as a response to a perceived ‘binge’ of food, when a person believes they have consumed a lot of calories in a short amount of time. This causes feelings of distress, shame, and guilt, which they try to alleviate by taking food or energy out of their body. They may induce vomiting, use laxatives, or exercise excessively. Frequent vomiting and use of laxatives can seriously dehydrate the body and lead to a loss of essential salts. 

Dehydration and overhydration can also happen alongside restrictive eating behaviours. Some young people may suppress or ignore their feelings of thirst, while others may drink far too much to suppress their hunger.

Eating disorders often cause the body to be in a state of permanent stress. This can disturb hormone balances, affecting water and electrolyte levels and making dehydration even worse.

Electrolyte Imbalances

Our bodies require a delicate balance of electrolytes (salts like potassium and magnesium) to function. Electrolytes are essential for vital organs and processes throughout the body. Eating disorder behaviours can cause imbalances of essential salts, sometimes leading to life-threatening conditions.

Low levels of electrolytes like phosphate and magnesium can cause serious medical complications in different parts of the body, including the heart, respiratory system, muscle function, brain function, and the immune system. 

Organ Failure

Severe malnutrition can cause organ failure, including liver, cardiovascular, and renal failure. Many medical emergencies in eating disorders are related to cardiovascular failure. Low energy intake over time leads to changes in the heart and its functions that can trigger life-threatening complications.

Self-Harm and Suicide Attempts

Eating disorders have psychological as well as physical consequences. Young people with eating disorders often experience serious psychological distress, such as feelings of self-worthlessness and self-criticism. People often describe the presence of an ‘eating disorder voice’ that is controlling, critical, dominant, and bullying. They may feel trapped by this voice and unable to escape their eating disorder.

Psychological distress is made worse by the physical symptoms of eating disorders, such as malnutrition and exhaustion. Psychological symptoms also complicate the treatment process.

Sometimes, the distress caused by eating disorders causes young people to self-harm or attempt suicide. This can lead to medical emergencies that may be life-threatening. These medical emergencies require psychological support from a psychiatrist or psychologist alongside medical care.

Keeping Young People Safe: Treating and Preventing Medical Emergencies

Medical emergencies in eating disorders can be very serious – and even life-threatening. However, immediate and effective medical care can keep young people safe and help them recover. 

With longer-term psychosocial support, young people can overcome eating disorders and prevent medical complications in the future.

Even in the first stages of an emergency medical response, doctors need to identify if the person receiving care may have an eating disorder. This helps them understand the causes of the emergency and the required treatment. Doctors should always be compassionate and non-judgemental towards young people with eating disorders.

Understanding how to treat medical emergencies in eating disorders is crucial. Treatment processes can involve risks if delivered incorrectly, such as during refeeding procedures. Doctors, researchers, carers, and people with eating disorders have produced guidelines for the management of medical emergencies in eating disorders to help ensure people receive the best care possible.

Because medical emergencies can arise quickly, parents and carers need to be aware of the signs that a young person requires urgent care. If mental health professionals think a young person is at a high risk of medical complications, they may advise that they receive inpatient (residential care). Residential treatment spaces should have the facilities and medical expertise required to intervene in medical emergencies and provide the urgent treatment a young person needs to stay safe.

Eating Disorder Treatment and Recovery

Eating disorders are severe mental health conditions that always require professional support. For families of a young person with an eating disorder, it’s normal to feel scared, frustrated, and unsure of what to do. However, it’s important to remember that recovery is possible with the proper support and families with eating disorders are not alone.

Eating disorder treatment can involve different levels of care and treatment modalities, depending on each young person’s needs. Some young people may require residential treatment to stay safe and recover, while others may benefit from outpatient care. 

Some eating disorder treatment modalities include:

  • enhanced cognitive behavioural therapy
  • cognitive processing therapy
  • family-based treatment
  • family therapy

Eating disorder treatment should also involve families in treatment planning and psychotherapy. Family therapy and other interventions can help families understand how best to support a young person. They also teach family members skills to build the supportive interpersonal relationships that are fundamental to eating disorder recovery.

The Wave Clinic: Specialised Recovery Programs for Young People

The Wave Clinic offers specialist mental health support for young people with eating disorders, borderline personality disorder, and other mental health concerns. Our programs provide a whole-person approach to mental health care, supporting young people to grow in self-confidence, discover new life paths, and develop the skills they need to follow their dreams.

We’re a Global Centre of Excellence for the treatment of eating disorders, drawing on expertise from around the world. We cater for young people in the highest need, with 24-hour medical support, ICU beds, and the medical facilities and equipment required to keep young people safe. Other young people live collectively in our main house, supported by a diverse team of professionals.

If you’re interested in our programs, get in touch today. We’re here to help.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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