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Psychiatric - Eating Disorders

Dr Jules Eden, dive medicine specialist and founder of e-med, answers divers' questions - as published in Sport Diver magazine:
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Q - I have a query regarding one of my students who wants to do the Divemaster course but is concerned about her doctor giving her a medical to dive. She has suffered from Bulimia for about two years. From what I understand, this came to light relatively recently and she is undergoing treatment and counselling, which appears to be working. She appears to my untrained eye to be fit and healthy and has actually already attempted the Divemaster swims and achieved the required scores.

A - Anorexics donít eat. Bulimics eat then throw up after the guilt has hit them of what theyíve stuffed in their mouth. They do have an appetite, whereas anorexics donít at times.

The interesting issue here is it is about Ďcontrolí. Sufferers may have had a life episode where they didnít have any as a result of abuse, poor parenting or bullying. They canít rationalise these, so end up in a feed-vomit cycle. They can end up with terrible reflux oesophagitis at times, all the vomit acid burning the oesophagus. This, though, could be OK to dive with.

The other issue sadly for the DMT, where there is a degree of in loco parentis underwater isÖ are they mentally fit for this? Most are. I have known doctors with this problem who were darn good. But I have also known absolute nutters where this problem was just the tip of their mental iceberg. So, my advice, from a gut feeling, is that your diver should be OK. To do the DMT they must have logged forty dives, so they have experience. And for you to feel they are fine is good. I assume that if you saw them weeping dramatically in the changing room, after ramraiding the Coke machine then flirting with the thirty stone barman, you would have raised an eyebrow as to their competence.

Cover yourself, though, with them getting a dive medical first.

Q - I'm writing to ask if I would be allowed to scuba dive with an asthma condition. I have an average peak flow metering of 450 and take Terbutaline sulphate 500 microgram turbohaler and Pulmicolt Turobhaler 200.

I also have an eating disorder which I keep on binge eating at the moment and I have found that my breathing as become a lot shorter than before would this affect me at all?

A - The asthma here is the least of your problems. As discussed many times in the past, a well controlled asthmatic, with no exercise inducement of the problem, is OK to dive. As long as they pass the medical that involves lung testing.

It's your eating disorder that worries me. These normally fall into 3 categories. Anorexia, where you don't eat. Bulimia where you do too much. And bulimia nervosa where you eat and throw up.

Yours obviously falls into the latter 2 categories. The problem with over-eating and vomiting, is that there is a risk of inhaling some of the acid in the vomit. This can cause spasm in the lung tubes, and shortness of breath. It could be what is happening to you. And made worse by pre-existing asthma, where these tubes are prone to spasm anyway.

So, where does that leave you? I think you really need to address the eating disorder. It is often caused by subliminal issues, often from childhood, and often centred around "control". If you are on the edge and bingeing, you may well have psych problems underwater and be a risk to yourself and others.

Get to a psychologist and get control of the problem. When this is sorted, getting the asthma passed, should be a breeze.

(other dive medical questions)


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