Potomania and Eating Disorders: Understanding This Hidden Condition

English-Speaking Eating Disorder Specialist in Paris

If you're reading this, you might be experiencing something that few people talk about but that deserves recognition and specialized care. Potomania, also known as psychogenic polydipsia, is characterized by an irrepressible need to constantly drink large quantities of liquid, primarily water. This behavior, far from being trivial, is frequently observed in people suffering from eating disorders (ED), where it can constitute an atypical disorder evolving alone or in association with other eating disorders.

Living with an eating disorder is challenging enough, but managing potomania while navigating life as an expatriate or international student in Paris adds unique layers of complexity. Cultural differences around food and health, language barriers in the healthcare system, and being far from familiar support networks can intensify the isolation that often accompanies these conditions.

If you recognize yourself in these words, know that this suffering deserves to be addressed with kindness and expertise. This compulsion does not reflect a lack of willpower or character weakness, but reveals complex biological and psychological mechanisms that require specialized care.

As a bilingual dietitian-nutritionist specializing in eating disorders in Paris, I support people dealing with these challenges using a comprehensive, non-restrictive approach that respects your individual history. This article will help you understand potomania in all its complexity and identify possible support pathways.

The Expatriate Factor: Why This Matters for International Patients

Living abroad amplifies eating disorder challenges in ways that aren't always obvious. When you're managing potomania alongside an eating disorder in a foreign country, several factors compound the difficulty:

• Healthcare navigation: Understanding the French healthcare system (Carte Vitale, mutuelle, remboursements) while dealing with a health crisis can be overwhelming. Finding specialists who speak your language and understand your cultural background adds another layer of complexity.

• Cultural isolation: Far from family and childhood friends who know your history, you might feel that no one truly understands what you're going through. The shame and secrecy that often accompany eating disorders can be intensified by this distance.

• Different health beliefs: French and international approaches to mental health and eating can differ significantly. Understanding that drinking excessive water is a medical concern requiring treatment might conflict with messages you've received about hydration being universally healthy.

• Language barriers: Explaining complex emotional and physical experiences in a second language can be exhausting and frustrating, especially when precise medical terminology is involved.

• Academic or professional pressure: International students and professionals often face additional stress from visas, performance expectations, and the pressure to justify being far from home. These stressors can exacerbate eating disorder symptoms, including potomania.

You don't have to navigate this alone. Professional support is available in English, and understanding the French healthcare context becomes easier with guidance. My practice specifically welcomes international patients and expatriates, providing care in both English and French with sensitivity to the unique challenges you face.

What Is Potomania? Definition and Mechanisms

A Thirst That Exceeds Physiological Needs

The term "potomania" comes from Latin potare (to drink) and mania (strongly marked habit). The recommended average water consumption is around 1.5 to 2 liters per day for an adult. People with potomania can ingest up to 10 liters of water per day, or even more in extreme cases, sometimes exceeding 24 liters.

Beyond 3 to 4 liters per day on a regular basis, it is strongly recommended to consult a healthcare professional. This excessive consumption leads to compensatory polyuria (excessive urine production), as the body attempts to maintain hydroelectrolyte balance despite the massive fluid intake.

The Biological Mechanisms: When Your Body Tries to Compensate

When you drink large quantities of water, the extracellular compartment becomes diluted and osmotic pressure decreases. Your metabolism responds by decreasing the level of anti-diuretic hormone (vasopressin), which increases urine production to try to eliminate the excess fluid. This urine is highly diluted, with a low concentration of electrolytes.

However, when water intake far exceeds the kidney's elimination capacity, serious complications can occur. Hyponatremia (decreased blood sodium below 135 mmol/L) is the most concerning consequence. It can cause nausea, headaches, mental confusion, and in the most severe cases, seizures and potentially fatal cerebral edema.

Understanding these mechanisms helps demystify what's happening in your body. This isn't about willpower – it's about complex biological responses that require medical attention.

Potomania and Eating Disorders: A Close and Complex Link

Potomania rarely exists in isolation. It frequently appears alongside or within the context of various eating disorders. Understanding how potomania manifests differently across various ED presentations is crucial for effective treatment.

Potomania in Anorexia Nervosa: A Control Strategy

In the context of anorexia nervosa, potomania can manifest as a strategy to reach a certain weight without caloric intake, or to appease the hunger caused by severe food restriction. Water becomes a means to "fill" the stomach and create a temporary feeling of satiety, without the feared calories.

This excessive consumption can also serve to manipulate weight during medical weigh-ins, with people drinking large quantities of water before appointments to mask weight loss. This behavior reflects the intensity of the fear of gaining weight and the need for control characteristic of anorexia.

Conversely, we sometimes observe water restriction in prepubertal anorexia nervosa, where children stop hydrating completely. This rarer but equally serious form requires immediate medical intervention.

For international students: The pressure to perform academically while managing anorexia and potomania can be particularly intense. You might find yourself drinking excessive water during long study sessions as a way to suppress hunger and maintain focus, creating a dangerous cycle that compounds both conditions.

In Bulimia: When Water Replaces Food

Potomania can coexist with bulimia or even replace it in certain recovery journeys. When someone with bulimia tries to stop binge-purge cycles, they may transfer this compulsion to water. The addiction to water then replaces the addiction to food, but the underlying problem – regulating emotions through substances – hasn't been genuinely resolved.

As specialized literature emphasizes, this substitution reveals the necessity for care that doesn't focus solely on visible behavior, but addresses the underlying emotional and psychological mechanisms.

This pattern is particularly common among expatriates who might have left behind binge foods from their home country, only to find that the compulsion transfers to something universally available: water.

Binge Eating Disorder and Potomania: Emotional Regulation Through Liquid

In binge eating disorder, potomania can also manifest as a means to fill an emotional void or soothe anxiety. The repetitive act of drinking becomes a self-soothing strategy, similar to food compulsions but directed toward a non-caloric liquid. This apparent "solution" actually masks a deeper suffering that needs to be recognized and supported.

Many international patients report that potomania intensifies during periods of cultural adjustment stress or homesickness. The act of constantly drinking water provides a rhythmic, controllable activity that temporarily distracts from difficult emotions.

Orthorexia and the Quest for Water "Purity"

Orthorexia, characterized by an obsession with "pure" and "healthy" eating, can extend to water consumption. People concerned develop rigid beliefs around "detoxification" and eliminating "toxins," leading to excessive consumption of water or herbal teas. This quest for purity paradoxically becomes harmful to health.

The wellness culture prevalent in many expatriate communities can reinforce these beliefs, with constant messaging about "flushing toxins" and "staying hydrated" creating a perfect storm for developing potomania.

ARFID and Oral Sensory Issues: Special Cases

In certain cases of ARFID (Avoidant/Restrictive Food Intake Disorder) or oral sensory disorders, potomania can appear as compensation for difficulty accepting certain textures or foods. Water, neutral and reassuring, then becomes the only source of comfort, while solid food is avoided.

Beyond Eating Disorders: Other Contexts of Potomania

Psychogenic Potomania: Psychiatric Contexts

Psychogenic potomania is also found in other psychiatric contexts:

• Schizophrenia: Some patients with schizophrenia may present polydipsia in response to delusions or hallucinations commanding them to drink excessive water.

• Childhood neuroses and psychoses: Potomania can appear as a behavioral disorder in children, requiring specialized child psychiatric evaluation.

• Intellectual disability: Difficulties regulating physiological needs can lead to excessive water consumption.

Organic Potomania: Distinguishing the Causes

It's crucial to differentiate psychogenic potomania from organic causes:

• Diabetes insipidus: Dysfunction of anti-diuretic hormone (ADH) leading to polyuria and compensatory intense thirst.

• Kidney disorders: Inability of kidneys to concentrate urine, requiring high fluid intake.

• Hyperaldosteronism: Overproduction of aldosterone disrupting hydroelectrolyte balance.

• Medication side effects: Certain medications (diuretics, phenothiazines) can cause dry mouth or increased urine production, prompting increased drinking.

• Specific diets: A diet high in salt or protein, or consumption of certain dietary supplements (especially in bodybuilding), can increase water needs.

A water restriction test under strict medical supervision can differentiate psychogenic potomania from diabetes insipidus. In psychogenic primary polydipsia, urinary osmolality increases and stabilizes above 280 mOsm/kg during this test, unlike diabetes insipidus.

Consequences and Risks: Why Potomania Is Concerning

Hyponatremia: The Silent Danger

Hyponatremia constitutes the major risk of potomania. When sodium concentration in blood plasma drops below 135 mmol/L, the body's osmotic balance is disrupted, leading to intracellular hyperhydration. Symptoms progress according to severity:

• Mild symptoms: Nausea, headaches, fatigue, slight mental confusion

• Moderate symptoms: Disorientation, memory problems, muscle cramps

• Severe symptoms: Seizures, cerebral edema, coma, life-threatening situation

These aren't abstract medical terms – they're real dangers that can develop surprisingly quickly. If you're experiencing frequent headaches, confusion, or unusual fatigue alongside excessive water drinking, please seek medical attention promptly.

Edema and Water Retention

Water accumulation in the body causes edema (swelling), usually starting in the extremities (hands, feet, ankles). In extreme cases, cerebral edema can develop. Limited by the skull's rigidity, the brain cannot expand freely, creating potentially fatal intracranial pressure requiring emergency care.

Multiple Electrolyte Imbalances

Beyond sodium, other electrolytes can be affected:

• Hypokalemia (potassium drop): Can lead to cardiac rhythm disturbances

• Hypochloremia (chloride decrease): Disrupts acid-base balance

Neurological Complications and Mortality Risk

Brain disorders can be triggered either by nerve cell implosion (due to intracellular hyperhydration) or cerebral edema. The risk of epilepsy is increased due to severe hyponatremia. Numerous deaths have been reported related to water intoxication, particularly when large quantities are absorbed in a short time.

Diagnosis and Detection: Identifying Potomania

Warning Signs and Clinical Questions

Detection relies on several elements:

• Quantity of fluid ingested: Beyond 3-4 liters per day regularly

• Urinary frequency: Polyuria with very clear and diluted urine

• Psychological context: Presence of ED, anxiety, psychiatric disorders

• Nycturic behavior: People with psychogenic potomania generally drink a lot during the day but little at night, unlike organic potomania

For expatriates: You might notice these patterns but hesitate to seek help due to language barriers or uncertainty about navigating the French healthcare system. Please don't let these practical concerns prevent you from getting the evaluation you need.

Necessary Medical Evaluations

Diagnosis requires a comprehensive medical evaluation:

• Detailed history: Disorder history, quantities ingested, psychological context

• Biological workup: Natremia, kalemia, plasma and urinary osmolality, creatininemia

• Water restriction test: Performed under strict medical supervision to differentiate psychogenic potomania and diabetes insipidus

• Psychiatric evaluation: Search for comorbidities (ED, depression, anxiety, psychotic disorders)

According to recommendations from the French Health Authority (Haute Autorité de Santé, HAS) and the French Federation for Anorexia and Bulimia (Fédération Française Anorexie Boulimie, FFAB), any emergency room visit by a patient with an eating disorder justifies a dual medical and psychiatric evaluation, including a comprehensive biological workup.

Treatment Approach: Toward Compassionate Multidisciplinary Care

Treating the Underlying Disorder: The Key to Recovery

Managing psychogenic potomania requires first and foremost treating the underlying psychiatric disorder or eating disorder. Appropriate psychotherapy (cognitive-behavioral therapy, acceptance and commitment therapy, psychodynamic psychotherapy) is essential to address the emotional and psychological mechanisms underlying the compulsive behavior.

For international patients, finding a therapist who speaks your language and understands your cultural context is crucial. The expatriate experience itself – with its unique stresses and isolation – needs to be part of your treatment plan.

Specialized Dietary Support: Progressive Water Re-education

As a bilingual dietitian-nutritionist specializing in eating disorders, my approach to potomania is part of a comprehensive and progressive process:

• Compassionate initial evaluation: Understanding the function of potomania in your life story, without judgment

• Progressive goal setting: Gradual reduction of water quantities ingested, with milestones adapted to each person's pace

• Psychoeducation: Explaining the biological mechanisms of hyponatremia and associated risks in language you can understand

• Relearning thirst signals: Reconnecting you with your authentic body sensations

• Coordination with multidisciplinary team: Working closely with psychiatrists, psychologists, general practitioners

The progressive approach can include providing a determined number of water bottles for a given period, then gradual reduction until reaching physiologically normal consumption (approximately 1.5 to 2 liters per day according to individual needs).

Language matters here. Being able to discuss your experiences, feelings, and challenges in English removes a significant barrier to effective treatment. You shouldn't have to translate your suffering.

Medical Follow-up and Biological Monitoring

Regular medical follow-up is essential, including:

• Regular weigh-ins: To monitor evolution of water retention

• Natremia monitoring: Regular biological checks to prevent severe hyponatremia

• Hydration status evaluation: Clinical examination and interpretation of biological data

In treatment-resistant patients, management similar to that of anorexia nervosa can be considered, with a therapeutic contract establishing clear and quantified goals.

Hospitalization: When Is It Necessary?

Hospitalization becomes necessary in several situations:

• Life-threatening emergency: Severe hyponatremia, cerebral edema, seizures

• Outpatient follow-up failure: Inability to reduce water consumption despite interventions

• Severe psychiatric comorbidities: Requiring care in a specialized setting

• Unfavorable family or social context: Absence of support or major isolation situation

In hospital or institutional settings, strict control of water intake by healthcare staff allows for limiting water access and supporting gradual reduction.

Practical Considerations for International Patients

Understanding the French healthcare system:

• Carte Vitale: If you're working or studying in France, you may be eligible for the French social security system. This card covers a portion of medical expenses.

• Mutuelle: This is supplementary private insurance that covers what the Carte Vitale doesn't. Many employers provide this, or you can purchase it independently.

• Direct billing: Some healthcare providers offer direct billing (tiers payant), meaning you don't have to pay upfront and wait for reimbursement.

• English-speaking network: I maintain connections with English-speaking psychiatrists, psychologists, and physicians who specialize in eating disorders, ensuring comprehensive care in your language.

• Teletherapy options: Video consultations can be particularly helpful for maintaining regular contact, especially if you're traveling or if in-person appointments are difficult to arrange.

Prevention and Education: Raising Awareness to Better Protect

Information Campaigns and Psychoeducation

Preventing potomania relies on clear and accessible dissemination of reliable information about hydration:

• Personalized advice: Hydration needs vary according to weight, physical activity, and climate conditions

• Recognizing signs: Raising awareness among the general public and healthcare professionals about hyponatremia symptoms

• Empathetic environment: Encouraging loved ones to recognize and support at-risk people without stigmatizing them

Monitoring Vulnerable Populations

Particular vigilance should be given to people suffering from:

• Eating disorders

• Psychiatric disorders (schizophrenia, severe anxiety)

• Intellectual disability

• Obsessions around "detoxification" and dietary purity

Regular consultations with specialized professionals enable early detection and rapid intervention.

Hope and Recovery: A Possible Path

Potomania, while potentially serious, can be effectively managed with an adapted multidisciplinary approach. Recovery requires time, patience, and compassionate support, but it is entirely possible.

Every small step counts in this journey: progressively reducing water quantities, reconnecting with authentic body sensations, understanding underlying emotional mechanisms. There's no shame in asking for help – on the contrary, it's an act of courage and self-compassion.

Studies show that prognosis is favorable when the disorder is identified early and the person benefits from coordinated specialized support. Recovery isn't linear, and relapses may occur, but they're part of the recovery process and in no way signify failure.

For international patients: Recovery might feel especially daunting when you're far from home. But please know that you're not alone. There's a community of English-speaking professionals and patients who understand both the eating disorder and the expatriate experience. Your dual challenge – managing potomania and navigating life abroad – doesn't make you weak; it makes you remarkably resilient.

My Practice in Paris: A Comprehensive and Compassionate Approach

As a bilingual dietitian-nutritionist specializing in eating disorders in Paris, I support people with potomania through comprehensive and individualized care. My approach rests on three fundamental pillars:

• Compassion and non-judgment: I create a safe space where your suffering is recognized and validated

• Scientific and humanistic approach: Understanding biological mechanisms while respecting your uniqueness

• Multidisciplinary coordination: I work closely with psychiatrists, psychologists, physicians, and other healthcare professionals

I see patients in Paris in the 6th arrondissement (59 rue de Seine) and in the 20th arrondissement (11 rue Saint-Blaise), as well as in Le Raincy. Video consultations are also available to ensure regular and accessible follow-up.

Specific support for international patients:

• Bilingual consultations: All sessions available in both English and French

• Cultural sensitivity: Understanding that eating disorders manifest differently across cultures and that your expatriate experience influences your relationship with food and water

• Healthcare navigation support: Guidance through the French healthcare system, including insurance matters and specialist referrals

• Flexible scheduling: Understanding that international work and study schedules may require evening or weekend appointments

• Network of English-speaking specialists: Connections with psychiatrists, psychologists, and physicians who provide care in English

You deserve care adapted to your needs. Don't hesitate to get in touch to discuss your situation and explore possible support pathways together.

Conclusion: Recognition Leads to Better Support

Potomania remains an under-recognized and underestimated disorder, yet it's frequently associated with eating disorders. Its early recognition and specialized care are essential for preventing serious complications and promoting recovery.

Whether potomania manifests in the context of anorexia nervosa, bulimia, binge eating disorder, or orthorexia, it reveals profound suffering that deserves to be heard and supported with empathy and expertise. Behind this compulsive need to drink lie survival mechanisms, attempts at emotional regulation, control strategies that must be understood in their global context.

The path to recovery exists. It involves recognizing suffering, comprehensive medical evaluation, appropriate psychotherapy, and specialized dietary support. Everyone deserves to regain a peaceful relationship with water, with food, with their body, and with themselves.

For international patients in Paris: Your journey is doubly challenging, but help is available in your language. You don't have to face this alone. Professional support that understands both eating disorders and the expatriate experience is here for you.

Living and eating are two sides of the same coin. Lighten your relationship with food and free yourself from what hinders you!

📚 Further Resources: Useful Links

Related articles on the website:

Anorexia Recovery: Understanding and Treatment

Bulimia Treatment: Breaking the Cycle

Binge Eating Disorder: Understanding Food Compulsions

ARFID: Avoidant/Restrictive Food Intake Disorder

Eating Disorders and Neurodiversity (ASD, ADHD)

Can You Recover from a 10-Year Eating Disorder?

Official external resources:

French Federation for Anorexia and Bulimia (FFAB)

French Health Authority (HAS) - Eating Disorder Guidelines

SOS Anor - Specialized Care Network

Eating Disorder Helpline: 0810 037 037

📖 Scientific Sources and References

This article was written based on the following scientific and official sources:

• French Health Authority (HAS). "Anorexia nervosa: management." 2010. www.has-sante.fr

• HAS & FFAB. "Bulimia and binge eating disorder - Detection and general management elements." 2019. www.has-sante.fr

• FFAB. "Emergencies and eating disorders." 2019. www.adomed.fr

• Desanorexie. "Water consumption disorders sometimes associated with eating disorders." 2021. desanorexie.com

• Swiss Medical Review. "Psychogenic polydipsia: a (still) little-known somato-psychiatric entity." 2020. www.revmed.ch

• Quebec Office of the French Language. "Potomania - Terminological file." 2019. vitrinelinguistique.oqlf.gouv.qc.ca

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Alexis Alliel

Bilingual Dietitian-Nutritionist Specialized in Eating Disorders

Paris 6th | Paris 20th | Le Raincy | Video Consultations

RPPS: 10007258733 | ADELI No: 75 95 0878 1

Tel: +33 6 22 41 55 21

Book an appointment on Doctolib

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