37 Some patients are unaware of the role that caffeine
and other stimulants play in their eating disorder. Other patients may consciously use stimulants for one or more of the following reasons:
• To depress or mask appetite • To maintain energy levels in the face of inadequate calorie intake
• To propel excessive exercise • To self-medicate for attention deficit disorder, anxiety, or chronic fatigue (if this is suspected, a physician evaluation should be recommended)
• To combat cold-intolerance by drinking hot (and caf- feinated) beverages
Excessive intake of caffeine can induce insomnia,
anxiety, and/or caffeine intoxication (see Box 3.4) (4). Caffeine dependence may require a weaning process to prevent physical symptoms of withdrawal (most notably severe headache) (4).
