Why So Many Laxatives?
Dear Dr. Belfer,
I am hopping mad. I was cleaning my 16 year old daughter's room this past week and found boxes and boxes of over the counter laxatives under her bed. Why would she be hiding those laxatives unless she was using them? So she must be taking them. Come to think of it, she has been spending enormous amounts of time in the bathroom lately. How could she be so stupid? That stuff can't be good for you. Her father and I raised her to think critically about things; she is certainly smart enough to realize that these will be harmful.
I want to talk with her. What do you think I should say? What are the risks? Right now I'm so mad I just want to shake her.
Sincerely,
Hopping Mad Mom
Dear Hopping Mad Mom,
I can certainly understand your reaction. You sound extremely disappointed that your daughter would be engaging in such extreme and self-harming behavior. While your disappointment is entirely understandable, it will be important for you to give yourself some time to calm down before you speak with your daughter. As I'm sure you know, your message will come across with more effect if your daughter hears the caring and concern and does not transform this into a struggle for independence from her parents, a stage adolescents need to go through but not using self-destructive behavior as the medium.
Laxative abuse, often a symptom of an eating disorder, is a much more common problem than we usually recognize. Even health care professionals who are fairly savvy about eating disorders minimize the frequency of this symptom. Perhaps because it is unpleasant to think about, eating disordered individuals will often deny this behavior even when they are commonly abusing laxatives.
Not only is laxative abuse common among eating disordered and some non-eating disordered persons, but it also can have serious health consequences. To alert you to just a few:
Electrolyte Imbalances: As with other methods of purging, laxative abuse can cause the electrolytes to be disordered. One of the most common problems is low potassium, hypokalemia, which can lead to muscle cramps, cardiac arrhythmias, and even death;
Dehydration: The main action of most common laxatives is lower down in the digestive tract than the area where food nutrients are absorbed. Thus, when individuals abuse laxatives and "feel" thinner or see a lower number on the scale, what they are actually noting is the loss of body fluid, not actual weight associated with food they eat. Water, which is lost, is necessary for normal functioning of every body system. Dehydration can have especially devastating effects on the kidneys. I have worked, over the years, with several otherwise healthy young women whose kidney function had been severely compromised by dehydration associated with laxative abuse.
Loss of Normal Bowel Function: As the digestive tract gets used to functioning by artificial means, where laxatives facilitate elimination, the bowel slowly stops functioning normally. First, the individual becomes dependant on the laxatives. Then they find that their digestive tract just doesn't work anymore without the laxatives. Most often this loss of function is reversible after laxative withdrawal, but not always.
It may be useful to express your concerns to your daughter directly and compassionately and inform her of the information noted above. Many young adults who abuse laxative really assume there will be no negative consequences to their actions. Letting them know the reality, in words they can hear, is often quite useful.
As there may be medical consequences to your daughter's laxative abuse, it would be wise to have her evaluated by her Primary Care Physician (PCP; often an internist, pediatrician or family practice physician). At that time, it would be important to check in with them about further steps to be taken, which might include consultation with a mental health professional experienced in working with eating disordered persons and young adults.
Best of Luck!
Sincerely,
Dr. Perry Belfer
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