Eating Disorders: When to Seek Medical Help in Taiwan

Q: Eating Disorders: When to Seek Medical Help in Taiwan

Dear Miss Mo： Besides the need to consult an otolaryngologist for conductive hearing loss, based on your detailed description, the physician cannot rule out the possibility of a psychiatric disorder. <br>Therefore, I regret to inform you that I can only recommend you seek care at

Binge eating/Anorexia, etc., not sure which specialty to consult (some are long-term)?

Hello Doctor, I am Mo, 20 years old and a junior in college.
I suspect that I am unwell, but I am unsure which doctor to see (I do not want to see a psychiatrist).
Symptoms: 1.
Alternating between binge eating and anorexia.
2.
Sleep issues.
3.
Physical problems.

(1) When I was a child, my eating habits were normal and I was not picky.
However, during the transition from junior high school to high school, I developed cellulitis in my neck and cheeks, which required surgical debridement and resulted in a period of starvation (7 days with a nasogastric tube), leading to drastic changes in my eating habits.
After the surgery, I initially experienced binge eating for 1-3 months, followed by alternating periods of anorexia, with irregular timing.
During binge episodes, I eat whatever is available, eating at any opportunity, including snacks and meals, to the point of vomiting or experiencing stomach pain, feeling an overwhelming urge to eat.
During anorexic episodes, I can go over a month without eating, surviving on small amounts of sugar, pudding, and water/drinks.
I feel disgusted by food, and if forced to eat, I will vomit, expelling stomach acid or foam.
This cycle continues to repeat.
Currently, I eat whenever I am awake, and I have to vomit every night until I feel empty.
(2) I have had sleep issues since childhood.
Recently, I have noticed that it is affecting my daily life.
From junior high to high school, I had to exhaust all my energy to fall asleep, and now I either have very short sleep or sleep excessively.
Typically, I go to bed between 1 AM and 3 AM and wake up around 5 to 6 AM.
Recently, it has worsened: I suddenly have bursts of energy for long periods, needing only 1-2 hours of sleep, and this can last for a maximum of 3 days (during busy times in high school, it was up to half a month).
I can intermittently nap for 30 minutes at a time, 2-3 times a day, or suddenly sleep deeply, waking for less than 23 hours a day, only getting up to eat or for physiological needs.
The rest of the time, I am in a deep sleep and cannot be awakened, which can last for about a month (but I do remember my dreams).
The most recent occurrence was from late April to mid-May after a car accident.
Currently, I sleep more than 12 hours a day.
(3) I have had many health issues since childhood.
When they flare up, they significantly affect my life, and I have sought medical attention, but the test results are not severe, leading to misunderstandings that I am faking illness.
A school nurse once suggested I see a psychologist.
Doctor, I would like to know what is wrong with me.
Are these genuine physical illnesses, or are they psychological issues? Can I avoid seeing a psychiatrist or taking psychiatric medication? If I want to live a normal life, which type of doctor should I see or what should I do? Although my family can see that something is wrong, can I seek treatment without them knowing?
Since the surgical debridement was close to my ear and brain, will it affect my hearing? I started to notice in the third year of junior high that I could not hear what others could hear, but my family did not believe me, and I delayed seeking help until my senior year of high school.
I was diagnosed with sensorineural hearing loss, which often leads to emotional breakdowns, and I still cannot accept the permanent loss of hearing.
Does hearing loss gradually lead to unclear speech and difficulty pronouncing words correctly? Are there related specialties that can help correct this? Thank you for your hard work, Doctor! I appreciate your patience in reading this.

Mo, 20~29 year old female. Ask Date: 2018/07/19

Dr. Xiao Yongxun reply Family Medicine

Dear Miss Mo: Besides the need to consult an otolaryngologist for conductive hearing loss, based on your detailed description, the physician cannot rule out the possibility of a psychiatric disorder.
Therefore, I regret to inform you that I can only recommend you seek care at a psychiatric outpatient clinic as soon as possible.
They are more efficient and professional in handling such matters, which would be your best option.

Reply Date: 2018/07/19

More Info

It sounds like you are experiencing a complex interplay of physical and psychological symptoms that are significantly impacting your quality of life. Your concerns about eating disorders, sleep disturbances, and hearing issues are valid and deserve careful consideration.
Firstly, regarding your eating patterns, the alternating cycles of binge eating and restrictive eating can be indicative of an eating disorder, such as Binge Eating Disorder (BED) or Anorexia Nervosa. These disorders often stem from underlying psychological issues, including anxiety, depression, or trauma. It’s important to understand that these behaviors are not just about food; they often serve as coping mechanisms for emotional distress. The fact that you mentioned feeling compelled to eat until you vomit or that you can go for extended periods without eating suggests a significant level of distress and dysfunction in your relationship with food.

In terms of seeking help, while you may be hesitant to visit a psychiatrist or psychologist, it is crucial to recognize that mental health professionals are trained to address these kinds of issues. Cognitive Behavioral Therapy (CBT) is particularly effective for treating eating disorders, as it helps individuals understand and change their thought patterns and behaviors related to food and body image. You might also consider consulting with a registered dietitian who specializes in eating disorders. They can provide nutritional guidance and support while working alongside a mental health professional.

Regarding your sleep issues, it’s clear that your sleep patterns are irregular and affecting your daily life. Sleep disturbances can be linked to anxiety and depression, which may also be contributing to your eating disorder symptoms. A sleep specialist can help assess your sleep patterns and provide strategies to improve your sleep hygiene.
As for your physical health concerns, including the history of cellulitis and its impact on your eating habits, it’s essential to have a thorough evaluation by a healthcare provider. This could be a general practitioner or an internist who can assess your overall health, including any potential complications from your past medical history. They can also refer you to specialists if needed, such as an ENT for your hearing issues.

Your concerns about hearing loss and its potential impact on your speech are also significant. Sensorineural hearing loss can affect speech clarity and communication skills. An audiologist can conduct a comprehensive hearing evaluation and provide recommendations for hearing aids or other assistive devices if necessary. They can also guide you on speech therapy options to improve your articulation if you are experiencing difficulties.

In conclusion, while it may feel daunting, seeking help from a multidisciplinary team that includes mental health professionals, dietitians, sleep specialists, and audiologists is crucial for addressing the various aspects of your health. It’s understandable to want to keep your struggles private, but having a support system can be incredibly beneficial. If you are concerned about confidentiality, many clinics offer private consultations. Remember, taking the first step towards seeking help is a sign of strength, and it is essential for your journey towards recovery and a healthier, more balanced life.

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