For the majority who develop eating disorders, onset occurs during the period of adolescent growth and maturation. As such, eating disorders carry profound hazards for interrupting somatic and physiological development, especially in females Lifshitz & Moses, 1988). Young women who engage in eating disordered behaviors may experience a delay in meeting typical physiological milestones. Menstruation can be adversely affected by dieting and weight loss due to hormonal changes as well (Russell, 1985). This holds true even for women who maintain adequate body fat while losing weight. For example, young women need a body fat percentage of at least 17% to begin menstruating (Rintala & Mustajoki, 1992). The link between eating disorders and fertility has begun to receive increasing attention in the literature. Although this research is in its early stages, it appears that the impact of eating disorders may have far-reaching consequences. This is where a trusted medical professional comes in.

I am not exaggerating here; a competent medical who can sufficiently emphasize the medical consequences psychologist, I can say these things over and over, like "Well what does she know, she is just a psychologist" and see what my doctors says". To that I commend phone with their doctor. The importance of finding underscored sufficiently. Further, educating the patient more effective than dismissing them as "O.K.".

I have had a few patients who come to me in an Anorexic state who want to get better and try very hard during the re-feeding process. Similar to Anorexia, they feel very full and uncomfortable during the re-feeding and have to be reminded that it is simply their stomach stretching and their metabolism awakening. The difference is that, on occasion, an "Anorexic" fails to gain weight. As long as a significant other is supervising their meals (and the hour or two afterward), there is a chance that there is actually an active physical illness underlying the weight loss and difficulty gaining. Questions regarding whether the physical illness caused the weight loss or whether it was truly a clinical eating syndrome can only be gleaned from a thorough clinical interview. Regardless, a thorough physical examination and consultation with a medical professional is essential. In short, there is a specific pattern of weight gain that is most typical of Anorexics. When that pattern doesn't emerge (after the family is supervising the patient), there is a chance that a medical illness, such as intestinal malabsorption or an overactive thyroid, may be to blame. When the intestines fail to absorb nutrients and calories, glucose never enters the bloodstream, thus causing weight loss. An overactive thyroid increases overall metabolism so that the energy requirements of the body are unreachable with normal food intake, thus resulting in weight loss. Sometimes a person may look "Anorexic" but they truly have a medical problem and are in need of professional attention. If you are wondering if a person has Anorexia, rather than approach them with that idea, let them know about these medical illnesses. Approaching them with a non weight-related concern could (at least) get them into a doctor's office. From there it is the physicians determination.

NAVIGATING AROUND PRIVACY LAWS

HIPPA laws prevent just about everyone from gleaning information about a loved one from a provider of medical services. Whereas this is a wonderful way to protect privacy, it can sometimes unintentionally discourage significant others from contacting the physician with relevant concerns. Anyone can contact a service provider and give the professional information about the patient. Professionally, I prefer to be contacted with information. Service providers cannot, however, offer any information about the patient to the concerned significant other. Confidentiality is breeched as soon as the professional even acknowledges to the significant other that they know the person. Difficult thing to do; being on the phone with a frantic parent of a 22 year old and not being able to outline the treatment plan or even acknowledge that their child is (or is not) attending sessions. Involving family early on in treatment is helpful here. In order to minimize this discomfort and be sure that the provider is in receipt of this important information, I suggest that significant others write a letter directly to the medical provider. Phone messages are easily forgotten or misplaced in a busy doctor's office. A letter is a legally binding source of medical information, which, if lost or overlooked, could result in malpractice charges.

HIPPA laws mandate that the medical professional provide each patient a copy of any part of their medical chart, upon request, including blood work results. Blood panels are relatively easy to read and with the help of websites such as http://www.nlm.nih.gov/medlineplus/ency/article/003642.htm you can gain a good understanding about what exactly is going on in your body metabolically. Keep in mind that the only professional that can offer an interpretation of these results is a person trained as a medical professional (e.g., M.D., P.A., R.N.,& L.P.N.) Professionals like myself cannot offer interpretations about the blood work results, but can encourage the patient to receive a copy of the results and attempt to educate themselves about it's meaning. Conversely, if a mental health professional fails to collaborate sufficiently with a medical professional and determine if the recommended medical procedures were completed, malpractice charges can ensue against the mental health worker. Mental health workers are caught in a conundrum of sorts: they are held liable for inappropriately interpreting medical test results, yet can also be deemed negligent if they fail to acknowledge the importance of the blood tests actually being completed. Requesting that the medical professional forward a copy of the results to the mental health provider appears to be the best standard of treatment.

INVOLUNTARY HOSPITALIZATION

Another "grey area" that needs to be carefully managed is when an involuntary hospitalization is impending. Involuntary in this case means "against the patients will"; they are unwilling to agree to an inpatient stay. In general, mental health professionals are only allowed to mandate that a patient go to the hospital with the assistance of the police or in accordance with the recommendation of an M.D. Even in that case, the patient is likely to only be admitted if he or she is imminently dangerous to his or herself or others. So what does this mean when it comes to eating disorders? First, unless actively suicidal, an eating disordered patient is only in imminent danger when a medical professional deems that the patient is medically unstable. Since the patient will then be admitted to a medical unit until medically stable, there is no guarantee that the patient will subsequently be forced to enter eating disorder treatment against their will. This underscores, again, that collaboration with a medical professional is essential to successful treatment of eating disorders. This, however, leaves the mental health professional, at times, helpless if the patient is uncooperative and resisting needed in-patient services. Involving family and partners of the patient is critical here. Increasing the frequency in which blood is drawn can also be important to "catching" the transient fluctuations in electrolytes and other blood levels.

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