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Chapter 6


severe personality issues. It is important that you are able to view these reactions as functions of the disorder, not evidence that you are ineffective as an RD. Discuss the specific situation with the mental health professional on the team to determine how to proceed. If the patient is not working with a mental health professional, review the case with a supervisor or trusted colleague. See Chapter 10 for more information.


CARDIOVASCULAR HEALTH


Nutrition assessment should include any heart condition that has special nutrition or fluid requirements, regardless of whether the condition is related or unrelated to the eat- ing disorder.


Eating Disorder–Related Heart Damage


Eating disorders may decrease cardiac function. The patient might experience “skipping beats,” shortness of breath, “heart pounding,” chest pain during exercise, weakness, light-headedness, edema, or none of these. Any patient who has rapidly lost weight or has lost a significant percentage of body weight should be evaluated for cardiac stability by a cardiologist or other physician knowledge- able about eating disorders (5).


Personal or Family History of Cardiovascular Disease


Following a diagnosis of cardiovascular disease, patients are usually given recommendations to decrease intake of fat and saturated fat, increase physical activity, and so on. Some people without cardiovascular disease choose to follow a restricted diet in an attempt to avoid becom- ing the next casualty of a family history of heart disease. When combined with a predisposition to anxiety or a sus-


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