Should a patient with an eating disorder who vomits daily stop driving?

Driving Safety for Patients with Daily Vomiting from Eating Disorders

Patients with eating disorders who vomit daily should stop driving due to the significant risk of impaired cognitive function, physical weakness, and potential for dangerous driving behaviors. 1

Medical Risks Affecting Driving Safety

Daily vomiting in eating disorders presents several safety concerns that directly impact driving ability:

1. Electrolyte Abnormalities

   • Frequent vomiting can cause hypokalemia, hypochloremic alkalosis, and other electrolyte disturbances 1, 2
   • These imbalances can lead to:
     • Muscle weakness
     • Cognitive impairment
     • Cardiac arrhythmias
     • Seizures in severe cases

2. Physical Symptoms

   • Malnutrition-related complications including:
     • Bradycardia (heart rate < 40 bpm) 2
     • Hypotension
     • Dizziness and fainting
     • Impaired concentration and judgment

3. Behavioral Concerns

   • Research shows patients with eating disorders engage in risky behaviors while driving, including:
     • Eating or binge-eating while driving 3
     • Other distracting behaviors (changing clothes, reading, applying makeup) 3

Guidelines for Driving Safety

The European Association for the Study of the Liver and American Association for the Study of Liver Diseases practice guideline provides relevant guidance that can be applied to eating disorders:

"Medical providers are not trained to formally evaluate fitness to drive and are also not legal representatives. Therefore, providers should act in the best interests of both the patient and society while following the applicable local laws. However, doctors cannot evade the responsibility of counseling patients with diagnosed [conditions affecting cognition] on the possible dangerous consequences of their driving, and, often, the safest advice is to stop driving until the responsible driving authorities have formally cleared the patient for safe driving." 1

Decision Algorithm for Driving Safety

1. Assess Severity of Vomiting and Related Complications

   • Daily vomiting indicates severe eating disorder behavior 1, 2
   • Check for:
     • Electrolyte abnormalities (especially potassium, sodium, chloride)
     • Vital sign instability (bradycardia, hypotension)
     • Signs of malnutrition
     • Cognitive impairment

2. Recommend Driving Cessation When:

   • Vomiting occurs daily (as in this case)
   • Laboratory abnormalities are present
   • Patient shows signs of physical weakness or cognitive impairment
   • Patient engages in eating behaviors while driving

3. Duration of Driving Restriction

   • Until eating disorder behaviors are under control
   • Electrolytes have normalized
   • Physical symptoms have resolved
   • Cognitive function has been assessed as normal

Patient Counseling Points

• Explain that daily vomiting creates significant safety risks while driving
• Emphasize that this is a temporary restriction until medical stability is achieved
• Discuss alternative transportation options
• Connect driving privileges to treatment adherence as a motivational tool

Important Caveats

• Document your advice to stop driving in the medical record
• Consider formal reporting to driving authorities if patient refuses to comply and presents clear danger
• Recognize that driving cessation may impact the patient's independence and treatment access - address these barriers
• Reassess driving safety regularly as part of eating disorder treatment monitoring

Daily vomiting from an eating disorder represents a serious medical condition requiring comprehensive treatment including cognitive behavioral therapy, nutritional rehabilitation, and possibly medication 2, 4. Driving safety is just one component of the overall treatment plan, but an essential one for protecting both the patient and public safety.