1st Edition

Sick Enough A Guide to the Medical Complications of Eating Disorders

By Jennifer L. Gaudiani Copyright 2019
    276 Pages 1 B/W Illustrations
    by Routledge

    276 Pages 1 B/W Illustrations
    by Routledge

    Patients with eating disorders frequently feel that they aren’t "sick enough" to merit treatment, despite medical problems that are both measurable and unmeasurable. They may struggle to accept rest, nutrition, and a team to help them move towards recovery. Sick Enough offers patients, their families, and clinicians a comprehensive, accessible review of the medical issues that arise from eating disorders by bringing relatable case presentations and a scientifically sound, engaging style to the topic. Using metaphor and patient-centered language, Dr. Gaudiani aims to improve medical diagnosis and treatment, motivate recovery, and validate the lived experiences of individuals of all body shapes and sizes, while firmly rejecting dieting culture. 

    Table of Contents



    Part One: Not Enough Calories

    Chapter 1: 30,000 Foot View: What Happens When You Starve Yourself?

    Box: The "Perfect Child"

    Chapter 2: Going Into Hibernation

    Box: The House on Fire, a.k.a. Combatting "I’m Fine"

    Chapter 3: Hormones and Bones

    Box: Exercise During Recovery

    Chapter 4: The Empty Tank

    Box: The Subterranean Aquifer, Checklists, and Reframing Expectations

    Chapter 5: Extreme Presentations

    Box: The Parables of The Fortress and the Nuclear Wasteland and The Perfectionist and the Appreciative Achiever

    Chapter 6: Starting to Eat Again

    Box: The Balloon Metaphor and "Fear Foods"

    Part Two: Purging

    Chapter 7: 30,000-Foot View: What is Purging? Why Does it Cause Medical Issues?

    Box: The Two-Sided Coin

    Chapter 8: How Does Purging Physically Affect the Body?

    Box: Comparing Yourself to Your Sickest Day

    Chapter 9: Electrolytes and Stopping Purging

    Box: The Sponge Metaphor and Finding Self-Compassion


    Part Three: Patients in Larger Bodies

    Chapter 10: Binge Eating Disorder (BED) and Weight Stigma

    Box: Naming Privilege and Challenging the Narrative

    Part Four: The Unmeasurables (a.k.a. The Very Real Medical Problems that Modern Medicine Can’t Measure)

    Chapter 11: Irritable Bowel Syndrome (IBS) and Associated Conditions

    Box: The Dog in the Street

    Chapter 12: Postural Orthostatic Tachycardia Syndrome (POTS) and Associated Conditions

    Box: Bearing Witness

    Part Five: Special Populations

    Chapter 13: Type 1 Diabetes Mellitus and Concurrent Eating Disorders (ED-DMT1)

    Chapter 14: Avoidant Restrictive Food Intake Disorder (ARFID)

    Chapter 15: Orthorexia and Food Intolerances

    Chapter 16: Elite Athletes

    Chapter 17: Male Patients

    Chapter 18: Gender and Sexual Minorities

    Chapter 19: Women’s Sexual and Reproductive Health

    Chapter 20: Older Patients

    Chapter 21: Substance Use Disorder

    Chapter 22: Caring for the Patient Who Declines Treatment: The Spectrum from Mandated Treatment to Hospice Care

    Figure 1: Flow Chart for the Patient Declining Recommended Treatment

    Conclusion: How We Can Each Make a Positive Contribution



    Jennifer L. Gaudiani, MD, CEDS, FAED is a Board-Certified internal medicine physician, known nationally and internationally for her work on the medical complications of eating disorders. Her outpatient medical practice, the Gaudiani Clinic, cares for individuals of all genders, shapes, and sizes, from around the United States.