Laxative abuse
Laxative abuse refers to the repeated and often excessive use of laxatives to achieve weight loss, manage bowel movements, or address constipation. This practice can involve different types of laxatives, with stimulant and bulk laxatives being the most commonly misused. Individuals may develop a reliance on these substances due to misconceptions about their role in calorie absorption and health, particularly the belief that regular bowel movements are essential for well-being. Various groups are at heightened risk for laxative abuse, including individuals with eating disorders such as anorexia nervosa and bulimia nervosa, athletes needing to maintain specific weight classes, and older adults experiencing chronic constipation. Symptoms of laxative abuse can manifest as gastrointestinal issues, dehydration, and psychological traits like low self-esteem and anxiety. Diagnosing this behavior can be challenging due to the secretive nature of abusers, but clinicians may use blood tests and personality assessments to identify it. Treatment typically requires a comprehensive approach, including medical care, psychological therapy, and dietary guidance, emphasizing the importance of hydration and a balanced diet. Preventative measures include education on the risks of laxative use and fostering supportive environments for individuals at risk.
Laxative abuse
DEFINITION: Laxative abuse is the repeated and routine use of laxatives to lose weight, shed unwanted calories, feel thin, feel empty, manage bowel movements, or treat constipation. There are different types of laxatives, but stimulant and bulk agents are the most common. Stimulant laxatives and osmotic laxatives physically alter the bowel’s ability to function, and with excessive use can cause permanent damage. Bulk agents do not have the same physical effects as stimulant laxatives if taken as directed, but the user may become psychologically dependent on these laxatives.
Causes
There are several causative factors associated with the abuse of laxatives. One is the mistaken belief that laxatives will prevent the absorption of calories and help with weight reduction. Another factor is the mistaken belief that daily bowel movements are a necessary part of good health and that laxative use is a harmless remedy to ensure this occurs. A third factor is the repeated use of laxatives to relieve constipation.
Risk Factors
There are four groups of people at risk for laxative abuse. The largest group to abuse laxatives includes persons who have an eating disorder, such as anorexia nervosa and bulimia nervosa. Adolescents and young adults with low self-esteem or poor body image are particularly prone to disordered eating and laxative abuse. Anorexia nervosa is the severe restriction of food intake to bring about drastic weight loss, which in turn causes dehydration and subsequent constipation. Bulimia nervosa is characterized by a cycle of binge eating followed by behaviors such as vomiting or laxative abuse to compensate or reverse the effects of binge eating.
A second group to abuse laxatives includes athletes who need to stay within a specific weight range. These athletes include wrestlers, boxers, and jockeys. A third group is made up of middle-aged and older people with frequent bouts of constipation. In this group, excessive use often comes with the misperception that daily bowel movements are part of good health. The fourth group includes persons with a factitious disorder, wherein they abuse laxatives to intentionally cause diarrhea.
Because laxatives are availabe over the counter and are sold in drug and grocery stores without age restrictions, monitoring purchases is nearly impossible. Because of the ease of purchase, the risk for abuse rises.
Symptoms
Several physical warning signs and personality traits indicate laxative abuse. The physical signs include a history of alternating diarrhea and constipation or chronic diarrhea of an unknown origin; physical signs also include gastrointestinal complaints such as cramping or pain, dehydration, and retention of fluids that cause severe bloating and the feeling of being fat.
Certain personality traits are characteristic of those who abuse laxatives. These traits include an obsession with weight and body shape, low self-esteem, impulsiveness, and anxiousness. Exhibiting one of these traits does not mean a person is a laxative abuser, but having a combination of traits may increase the risk of laxative abuse. For example, if a person is obsessed with weight and has low self-esteem, they may binge eat. When this behavior does not make that person feel better, he or she may turn to laxatives to get rid of the calories they consumed.
Finally, people with diagnosed or known eating disorders, like anorexia nervosa or bulimia nervosa, are also more prone to abuse laxatives.
Screening and Diagnosis
Screening and diagnosis of laxative abuse is difficult because many abusers attempt to hide the behavior. The best screening tool is a clinician’s suspicion. Once a clinician suspects laxative abuse, he or she can order blood tests to check for an electrolyte (potassium, magnesium, sodium, and chloride) imbalance, as chronic diarrhea will remove electrolytes through the stool and will prevent them from being absorbed into the body. Clinicians can also perform barium enemas to assess the radiographic findings in a patient's colon.
People with eating disorders typically have low potassium levels in their blood (a condition called hypokalemia). Clinicians can check urine for the presence of a laxative. Another screening method is to perform a personality assessment by having the person complete surveys or questionnaires related to body dissatisfaction, low self-esteem, and level of drive to stay or be thin.
Treatment and Therapy
To overcome laxative abuse, users will need the medical expertise of a general physician, therapy with a psychologist or psychiatrist, and a consultation with a registered dietician. The most immediate treatment is to stop taking laxatives and to seek a physician’s care.
Many people will experience withdrawal symptoms that usually last from one to three weeks. In rare cases, symptoms have lasted two days to two or three months. Side effects of withdrawal include constipation, fluid retention, feeling bloated, and temporary weight gain. To treat these side effects one should drink six to ten cups of water per day and decaffeinated beverages to hydrate one’s body. (Caffeine is a diuretic and promotes fluid loss, and dehydration causes constipation.) One should eat regular meals and foods that promote normal bowel functioning, such as whole-grain or wheat bran foods and plenty of fluids, vegetables, and fruits.
Routine physical activity also helps regulate the bowel, but a physician should be consulted first because intense exercise can worsen constipation. Physicians may start their patients on fiber and osmotic supplements to help the bowel function properly and to establish normal bowel movements.
Prevention
No guaranteed mechanism prevents laxative abuse. However, education can be a powerful tool in helping people understand that laxatives will not prevent the body from absorbing food or losing weight. Moreover, routine laxative use will have a reverse effect on the body, causing dehydration and constipation.
Social support from friends and family and being aware of the signs and symptoms of abuse are crucial, as intervention could prevent long-term laxative abuse and irreversible physical and psychological consequences. The National Alliance for Eating Disorders and The National Association of Anorexia Nervosa and Associated Disorders is also a resources individuals and family members can use if they have or suspect their loved one is suffering from an eating disorder. Another organization, Families Empowered And Supporting Treatment for Eating Disorders, or F.E.A.S.T., is a support group geared specifically toward family members of persons with eating disorders.
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