Anorexics and Bulimics Wear Unique Versions of Medical Alert IDs

Medical alert medallions and bracelets come in all shapes and sizes. Some, like a steel medallion labeled ‘Diabetes,' are easy to spot. Others, like a red beaded bracelet, may symbolize something much more sinister.

There are a number of medallions that individuals wear to show that they have diabetes, epilepsy or other serious medical problems. These alerts are extremely beneficial to EMS providers and can speed up delivery of services, often preventing coma or death.

But there's a unique new medical alert that can be easily missed, unless it's understood. Individuals who have or are recovering from an eating disorder are now wearing a dragonfly pendant, either on a bracelet or as a lavaliere on a necklace. Additionally, a red, beaded bracelet may indicate an individual who is anorexic.

Eating disorders are medical illnesses, usually prolonged in nature, which have psychological, behavioral and physiological characteristics. The three most commonly presented eating disorders include anorexia (nervosa), bulimia (nervosa) and EDNOS (eating disorders not otherwise specified). These eating disorders are becoming more prevalent, with an estimated 3.2% of all females between 18 and 30 having some version of an eating disorder.

Anorexia is essentially self-starvation, and anorexics display an overwhelming desire to be thin and extreme fear of weight gain. These individuals may look anywhere from thin to skeletal in appearance. Individuals suffering from bulimia lack control of their eating habits, which leads to binging on large quantities of food then purging with use of laxatives, pills, exercise or vomiting. The appearance of the bulimic is not thin; rather, bulimics may be normal to overweight. Individuals with EDNOS don't fit neatly into either category, but may still need help. The EDNOS sufferer may be a night eater who occasionally consumes large amounts of food, or non-food items that may be poisonous.

Patients with eating disorders will most often be young women; however, about 5% of eating disorder patients are now men. The patient is usually from an industrialized nation--particularly the United States, Canada or Western Europe-- where societal pressure to be thin is highly valued. There may be a history of emotional, physical or sexual abuse, and the individual may have had numerous traumatic experiences or a negative family dynamic. Although both eating disorders have individuals who are extremely emotional, the bulimic tends to be more impulsive while also showing great remorse, guilt or anxiety. Self-injury is often associated with anorexia but may also be seen, infrequently, in bulimia.

"Cutters" is a term that is used when the individual commits self-injury. There is a pattern to this behavior: The individual usually starts with self-inflicted wounds with a fork, then over time begins to self-inflict wounds with a knife. The cutting starts on the stomach or other fleshy tissue easily hidden by clothing. As the patient becomes bolder they often move to cutting the lower leg or arm. Upon examination older scars and new wounds can be seen.

For immediate treatment, EMS providers should calm the patient and treat any bleeding wounds and other general problems. However, the EMT should bear in mind that this is a psychiatric patient who requires long-term therapy involving antidepressants (fluvoxamine is reportedly effective) and cognitive behavior therapy.

For many individuals with eating disorders this is a recurring problem. Even though the person may be in therapy and pharmacotherapy, they can still become hysterical and repeat all of the problem behaviors. These individuals often feel isolated and alone. The eating disorder brings them self-gratification and attention. There are self-help websites for individuals in recovery. Those individuals recovering from an eating disorder may wear a dragonfly emblem.

Unfortunately, there are now pro-anorexia (ana) and pro-bulimia (mia) websites. The anonymity of the Internet allows for little risk of being discovered by family or friends until the individual is in medical trouble.The pro-anorexia bracelet is called the "ana bracelet" and is bright red. Other eating disorder sufferers may wear bracelets of different colors denoting their disorder. The individual wears the bracelets as a sign to other anorexics or bulimics, increasing their sense of community and to remind the wearer that they are on a journey with their eating disorder.

These bracelets or pendants are outward signs of eating disorders, as are the signs given in Table 1 and Table 2. For EMTs, paramedics and other first responders, these emblems should be considered as strongly as a diabetes or heart medallion symbol.

Table 1: Characteristics of Individuals with Eating Disorders: Anorexia

• Gender: Usually women
• Appearance: Thin to skeletal
• Suicidal: Often
• Alcohol Use: Often
• Hysterical: Often
• Self Mutilating: Often cutting
• Obsessive Compulsive Spectrum Disorders: Often
• Inappropriate Attention To Details: Often
• Esophagitis: Rare
• Drug Use: Often
• Level of Anxiety: High
• Depression : Always
• GI Bleeding: Rare
• Swollen Glands: Rare
• Edema: Rare
• Dental Caries: Rare
• Tooth Erosion: Rare

Characteristics of Individuals with Eating Disorders: Bulimia

• Gender: Usually women
• Appearance: Normal to heavy
• Suicidal: Rare
• Alcohol Use: Often
• Hysterical: Often
• Self Mutilating: Rare
• Obsessive Compulsive Spectrum Disorders: Not often
• Inappropriate Attention To Details: Rare
• Esophagitis: Often
• Drug Use: Frequently
• Level of Anxiety: High
• Depression: Always
• GI Bleeding: Often
• Swollen Glands: Often
• Edema: Often
• Dental Caries: Often
• Tooth Erosion: Often

Table 2: Accompanying Medical Conditions: Anorexia

• Hypokalemia: Often
• Hypotension: Often
• Arrhythmias: Often
• Abdominal Pain: Frequently
• Constipation: Often
• Endocrine Imbalances: Often
• Menstruation Irregularities: Often
• Pregnancy: Rare
• Osteoporosis: Often
• Muscular Wasting: Often
• Poor Concentration: Often
• Arrested Growth: Often
• Arrested Maturation: Often
• Dysmorphia Disorder: Often
• Very Strict Diets: Often
• Exhaustive Exercise: Often

Accompanying Medical Conditions: Bulimia

• Hypokalemia: Often
• Hypotension: Infrequently
• Arrhythmias: Often
• Abdominal Pain: Often
• Constipation: Often
• Endocrine Imbalances: Rare
• Menstruation Irregularities: Rare
• Pregnancy: Rare
• Osteoporosis: Infrequently
• Muscular Wasting: Rare
• Poor Concentration: Often
• Arrested Growth: Often
• Arrested Maturation: Often
• Dysmorphia Disorder: Infrequently
• Very Strict Diets: Rare
• Exhaustive Exercise: Rare

Diana Spillman is a medic with the Oxford Fire Department in Ohio and the head of Nutrition and Dietetics at Miami University. She holds a PhD and is a registered dietitian. Contact her at spillmdm@muohio.edu.