By Corinne O’Keefe Osborn, MS

 Anorexia nervosa is a dangerous mental health disorder characterized by an abnormally low body weight, an intense fear of gaining weight, and a distorted view of body weight. People struggling with anorexia will do almost anything to avoid gaining weight, including starving themselves. When people with anorexia look into a mirror, they do not see an accurate reflection. They believe they are fat, even when they are dangerously thin.¹

People with anorexia restrict the amount and types of food they eat and regulate calories closely. They maintain an intense fear of gaining weight and will employ any number of tactics to achieve weight loss.¹ To control calories, they might vomit after eating, exercise excessively, or misuse laxatives, diet pills, diuretics, and enemas. They might even binge and purge in a manner resembling bulimia nervosa.

Anorexia is a disorder that focuses on food, but it is about so much more. Researchers believe that anorexia is a way to manage emotional problems by gaining control over the body. People with anorexia often equate their self-worth with thinness.¹

Doctors diagnose anorexia nervosa in people of all ages and genders, but 90-95% of sufferers are women and girls.² Anorexia is most common among teens. Research suggests that as many as 3 in 100 teenage girls are struggling with anorexia.¹ It is one of the most common psychiatric disorders in young women, and one of the most dangerous.

Anorexia nervosa is one of the most dangerous mental health disorders in the United States.² As many as 5% to 18% of people with anorexia die from the disease. About half of these deaths are the result of malnutrition and half are the result of suicide.³

 

H2: How Does Anorexia Develop?

No one knows exactly what causes anorexia. Researchers believe that it is a complex combination of several factors, including psychological, biological, environmental, and social factors.³ Studies show that about 1/5 of people with anorexia have a relative with anorexia.¹ And yet, it is unclear whether this suggests a genetic component or a shared set of family values prioritizing thinness.³

People develop eating disorders for many reasons. Those at highest risk are young women in their teens. Certain temperaments and personality types can increase the risk of developing anorexia. People who tend to be perfectionistic, obsessive, anxious, and avoidant are at higher risk.^1,4 Some people with anorexia believe they need to be perfect if they want love and respect. Others have an intense fear of humiliation and ridicule. Mental health issues, including depression, oppressive compulsive disorder (OCD), and anxiety, are all common in people with anorexia.^1,4

For some people, a triggering event can raise the risk of developing anorexia. A history of trauma, such as sexual abuse or the death of a parent, increases the risk of developing an eating disorder.¹ A transitional event, like changing schools, moving, or ending a romantic relationship can also cause stress and trigger anorexia.⁴

Other high risk groups are athletes and those in the performance arts. Athletes, dancers, actors, and models are at higher risk. Pressure from coaches and parents can, even when it is unintentional, contribute to the problem. Many anorexia sufferers enjoy the positive reinforcement they get when they lose weight the first time, so they continue to restrict food.⁴

Finally, there is environmental and social pressure. In mainstream American culture, thinness is the ideal.⁴ It is easy for young women to infer from movies, magazines, and social media that thinness leads to popularity and love. Media is everywhere and it is impossible to avoid the messages it sends about beauty. Parents can help combat this risk factor by demonstrating healthy eating habits and teaching their kids that all bodies are beautiful.

 

H2:  Signs and Symptoms of Anorexia

 The primary sign of anorexia nervosa is extreme weight loss. The physical signs and symptoms of anorexia all relate to starvation. While the psychological signs relate to the distorted perception of body weight.

People with anorexia believe they are fat. To lose weight they might drastically reduce their food intake through dieting or fasting. They often exercise compulsively to burn calories, which can begin to look like an exercise addiction. People with anorexia might also make themselves vomit to get rid of calories, or use laxatives, diuretics, diet aids, or enemas. They may even binge and purge in way that resembles the primary symptom of bulimia nervosa.⁴

Anorexia nervosa and bulimia nervosa are both characterized by a distorted body image and abnormal eating behaviors, but they are different disorders. Among people diagnosed with anorexia, there are 2 subtypes: those who restrict food intake and those who binge and purge.³ What differentiates anorexia from bulimia is body weight. Clinicians will provide an anorexia diagnosis if the patient has a low body mass index (BMI). They will diagnose bulimia if the patient has a normal or above-normal BMI.³

Physical symptoms of anorexia nervosa:

• Extreme weight loss
• Hair thinning, breaking, or falling-out
• Dry, yellowish skin
• Brittle nails
• Absence of menstruation
• Dizziness or fainting
• Bluish discoloration of the fingers
• Cold or swollen hands and feet
• Bloated or upset stomach
• Downy, soft, hair covering the body
• Fatigue
• Insomnia
• Intolerance to cold
• Constipation
• Dehydration
• Low blood pressure
• Abnormal heart rhythms
• Osteoporosis
• Swelling of arms or legs^1,4

 

Mental health and behavioral health signs

• Distorted self-perception (believing they are overweight when they are thin)
• Fear of gaining weight
• Refusing to eat
• Refusing to acknowledge the seriousness of the illness
• Denial of hunger
• Preoccupation with food
• Obsessive-compulsive behavior
• Depression
• Exercise addiction
• Lying about how much food has been eaten
• Social withdrawal
• Irritability
• Thoughts of suicide
• Flat mood (lack of emotion)
• Reduced interest in sex
• Inability to remember things^1,4

 

Warning signs

• Skipping meals or making excuses not to eat
• Constantly weighing themselves
• Eating only a few foods
• Refusing to eat in public
• Ritually cutting food into tiny pieces
• Compulsive exercising
• Planning and preparing elaborate meals for others, but not eating^1,4

 

H2: Complications and Side Effects of Anorexia

 Anorexia can cause severe, even devastating, complications. Anorexia can be fatal if left untreated. Death can result from the physical complications of starvation and malnutrition. It can happen suddenly, even if someone does not appear to be starving to death. Death often results from an irregular heart rhythm (arrhythmias) or an electrolyte imbalance.⁴

Electrolytes are minerals in the human body that have an electric charge. They are responsible for maintaining the healthy blood chemistry needed for muscle function and other processes. People get electrolytes, like sodium, calcium, potassium, and magnesium through the foods they eat. When people with anorexia practice self-starvation, they can develop a dangerous electrolyte imbalance. Because electrolytes are responsible for maintaining the water level in the body, an imbalance can cause severe dehydration and kidney failure.⁴

When the body does not have the essential nutrients it needs to function, it begins to slow down all its processes in an attempt to conserve energy. As the heartbeat slows and blood pressure levels lower, the risk of heart failure increases.² The more severely malnourished someone with anorexia is, the more dangerous it can be. Every organ in the body, including the brain, can be damaged. This damage might not be completely reversible, even when someone gets treatment.⁴

Other complications can include:

• Reduction of bone density (osteoporosis), which causes dry, brittle bones.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, and overall weakness.
• Dry hair and skin.
• Hair loss.
• Growth of a downy layer of hair all over the body.²
• In females, the absence of a period.

• In males, decreased testosterone levels.⁴

 In addition to the physical complications, people with anorexia can develop several psychological disorders. Around half of all anorexia-related deaths are from suicide.³ Developing co-occurring mental disorders can only increase the risk of death by suicide. Other disorders common in people with anorexia include:

 

• Obsessive-compulsive disorders (OCD).
• Alcohol and substance use disorders.⁴

 

H2: Treatment Options for Anorexia

 The best treatment programs for anorexia nervosa take a combined approach that includes psychotherapy, family therapy, medicine, and nutritional counseling. It is important that the patient be as invested as possible in her own treatment plan. This can be difficult, because many people with anorexia deny the seriousness of their problem. But, you can help someone with anorexia nervosa by learning about the different treatment options available.

• Hospitalization: In many cases patients are suffering from severe malnutrition. If they have reached a dangerously low BMI and are unwilling to eat, they may need emergency medical treatment. Doctors will monitor vitals, look for medical complications, and medically stabilize the patient.

• Inpatient Residential Treatment: This provides an alternative to full hospitalization, but has the benefit of medical supervision. Patients live at the facility and receive 24/7 medical care, psychotherapy, and nutritional support. This works well for patients who are medically stable but psychiatrically impaired and not ready for, or responding to, outpatient treatment.

• Outpatient Treatment: There are many different types of outpatient anorexia treatment programs ranging from intensive full-time outpatient programs to weekly therapy in a private office environment. This works well for patients who no longer require daily medical monitoring and need to work on their behavioral health by developing a healthy relationship with food.

• Luxury Treatment Programs: These are residential inpatient programs or intensive outpatient programs that offer high-end amenities in addition to conventional treatment. Amenities can include upscale lodging, swimming pools, spas, massage, yoga, acupuncture, and other alternative treatments.

• Executive Treatment Programs: These are inpatient residential and intensive outpatient programs designed for working adults. They may offer flexible work/live schedules to allow professionals time for recovery.

• 12-Step Programs: People with anorexia and their families organize these peer-to-peer support groups to support one another’s recovery. They follow the same 12-step recovery protocol as Alcoholics Anonymous.

 

 

H3: Sources

 

1. University of Maryland Medical Center. (2015). Anorexia nervosa.

 

2. National Eating Disorder Association. Anorexia nervosa.

 

3. Lock, J., & La Via, M. C. (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 54(5), 412-425.

 

4. The Mayo Clinic. (2016). Anorexia nervosa.

 

 

 

 

Author: Corinne O’Keefe Osborn, MS

Hydrocodone is a legal medication prescribed by doctors to relieve severe pain. It is an opioid analgesic, a class of drugs that also includes oxycodone, morphine and methadone. These drugs work by changing the way the brain and nervous system respond to pain. Prescription opioids are generally safe when taken for a short time to relieve pain, but they are highly addictive and are often misused or abused.¹

In fact, over the past two decades, deaths related to overdose of opioid analgesics have been increasing steadily. From 1999 to 2013, the rate of drug overdose deaths involving opioid analgesics nearly quadrupled.²

Death related to drug overdose has become an alarming public health epidemic. Drug overdose, which occurs when a person takes more of a drug than their body can handle, is a serious, life-threatening problem. Overdose is now the leading cause of injury-related death in America.²

• Hydrocodone overdose can be fatal if not treated immediately.
• Learning to avoid certain risks can prevent overdose.
• You can help someone who is overdosing by calling 911 and getting them naloxone (Narcan).

Hydrocodone overdose is common, occurring both when someone takes too much of the drug and when they mix it with alcohol or other drugs. When a person overdoses on opioid analgesics, their breathing and heartbeat will slow and could eventually stop.³

Every day, more than 1,000 people are treated in American emergency rooms because they misused prescription opioids like hydrocodone.¹ If someone you know is overdosing on hydrocodone, emergency medical treatment can save their life. You can learn the signs and symptoms of an overdose here, but when in doubt call 911.

H2: Signs and Symptoms

Symptoms of a life-threatening overdose may include the following:

• The skin is cold and/or clammy to the touch
• There is muscle weakness or the body is limp
• Breathing is very slow or stopped
• Fingernails or lips have a blue or purple cast
• The person is vomiting or making gurgling noises
• The person cannot be awakened from sleep
• Extremely small “pin point” pupils
• The person is unable to speak
• The face is extremely pale
• The heartbeat is very slow or stopped³

A hydrocodone overdose requires immediate medical attention. If you or someone you know is experiencing any of the symptoms listed above, call 911 immediately.

Hydrocodone effects the brain receptors that are responsible for breathing. In an overdose situation, it is the lack of oxygen that will ultimately cause death.⁴ While waiting for the paramedics to come there are a few things you can do to help. If a person is not breathing, you can perform rescue breathing. The steps for rescue breathing are as follows:

1. Be sure the person’s airway is clear (check that nothing is inside the mouth or throat).
2. Place your hand on the person’s chin, tilt the head back and pinch the nose closed.
3. Place your mouth over the other person’s mouth to make a seal
4. Give 2 slow breaths and make sure you see the chest rise (if it doesn’t rise, try tilting the head back more).
5. Give 1 breath every 5 seconds.³

People who are breathing are still at risk of chocking on their own vomit. It is best to stay with a person until the paramedics arrive, but if you have to leave them, even just to go call 911, put them in the recovery position.

1. Lay the person on their side.
2. Pull up one knee to prevent them from rolling over.
3. Rest the head on the hands facing sideways.⁴

Naloxone (Narcan) is an antidote to opioid overdose. It works almost immediately to reverse the effects of opioids by blocking the opioid receptor sites. Although it does not reduce the effects of other drugs like benzodiazepines, cocaine or speed, it may be helpful if a person has mixed opioids with another sedative.³

With quick access to naloxone, an opioid overdose does not have to be fatal. It is used by emergency responders, but can also be used by friends and family.³ If you are concerned that you or someone you know might overdose on hydrocodone in the future, talk to your doctor or pharmacist about getting naloxone for your home.

 

H2: Risk Factors for Overdose

Some people have an increased risk of overdosing on hydrocodone. Risk factors include:.

• Using hydrocodone in combination with other sedating drugs (benzodiazepines, ketamine).
• Existing opioid dependence and addiction.
• Combing hydrocodone with alcohol.
• Chronic pain.
• History of substance abuse.
• History of mental health problems.
• High tolerance and high daily dose and subsequent reduction of tolerance (haven’t used in a while).
• Injecting the drug. ^5,6

 

H2: Hydrocodone Overdose Treatment

Hydrocodone overdose requires immediate medical treatment. The first step medical professionals take is to determine if there is respiratory arrest. Because death and serious complications can result from a lack of oxygen, ventilation is extremely important.³

Once the person has been given a steady supply of oxygen, they will be given a dose of naloxone (Narcan). In an emergency situation, the quickest way to administer naloxone is through an interventions injection. It can also be injected into the muscle or inhaled through a nasal spray.³

 

H2: Can You Die From a Hydrocodone Overdose?

In 2014 alone, there were about 19,000 deaths resulting from prescription opioid analgesics like hydrocodone.¹ While people often assume that prescription opioids are safer than illegal opioids (heroin), this is not the case. Today, at least half of all opioid overdose deaths involve a prescription medication.¹

People who have been prescribed hydrocodone for long periods of time can inadvertently develop a dependence on the drug. It is normal for the body to become accustomed to a drug after repeated exposure, so it may take higher and higher doses to achieve the same pain-relieving effects. The immediate aftermath of an overdose is not going to be pleasant for people who have developed a hydrocodone dependence.

People being treated for hydrocodone overdose will receive at least one dose of naloxone. (If they have been taking extended release hydrocodone, they may need repeated doses to counteract the long-acting effects of the drug). Because naloxone blocks the opioid receptors in the brain, it will send people into immediate withdrawal.⁷

The sudden onset of withdrawal symptoms after a dose of naloxone can be quit jarring. People might experience sweating, chills, body aches, vomiting and diarrhea. While withdrawal symptoms are not usually life-threatening, a person might choose to stay in the hospital for medically supervised detox.⁷

 

H2: Recovering From an Overdose

A hydrocodone overdose is an extremely traumatic event that also leads to emotional consequences—guilt, shame, gratitude. Survivors may have to apologize for worrying the ones they love and they might be asked to explain why the overdose happened.

Surviving an overdose can be an enlightening experience; a wake up call to address the underlying problems that led them to overdose. In most cases of hydrocodone overdose, the underlying problem is physical or emotional pain. If physical pain is at the root of the problem, the person should try to find a pain specialist in the area, who can help them find safer ways to manage pain. If the underlying cause is a substance abuse problem caused by emotional problems, then it is time to seek substance abuse treatment.

A life-threatening overdose is a sign that a substance abuse problem has gotten out of control; a sign that it is time to get treatment before it happens again. Treatment for drug abuse and dependence is offered in a variety of settings that use a number of different behavioral and medical treatments. Treatment options include:

 

• Detoxification: sometimes uses medicines like methadone and Suboxone to make withdrawal easier.
• Out-patient treatment: includes a variety of programs involving behavioral counseling on both an individual and group level.
• In-patient treatment: residential programs that provide 24-hour structured treatment, counseling and medical care.
• Community-based treatment: this includes peer-to-peer programs like Narcotics Anonymous, as well as church groups and other support programs.

 

H2: Find an Overdose Recovery Center

Finding the best treatment program for you or a loved one may feel overwhelming at first, but we are here to help. Call our hotline at XXX-XXX-XXXX anytime to speak with a treatment advisor about your options. Don’t put it off any longer, pick up a phone and give us a call, we are ready to help.

 

Sources:

 

1. Centers for Disease Control and Prevention., National Center for Injury Prevention and Control (2016). Injury Prevention and Control: Opioid Overdose.
2. U.S. Department of Health and Human Services (2015). Opioid Abuse in the U.S.
3. Substance Abuse and Mental Health Services Administration (2016). SAMHSA Opioid Overdose Prevention Toolkit. HHS Publication No. (SMA) 16-4742.
4. Massachusetts Department of Public Health. Opioid Overdose Education and Naloxone Distribution.
5. World Health Organization (2014). Fact Sheet on Opioid Overdose.
6. Paulozzi, L., MD (2012). Populations at Risk of Opioid Overdose. Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention.
7. National Institute on Drug Abuse (2016). Naloxone.
8. National Institute on Drug Abuse (2016). Prescription Drug Abuse.
9. 9. The American Society of Health-System Pharmacists, Inc. MedlinePlus: Hydrocodone.