Helping People with Eating Disorders: A Clinical Guide to Assessment and Treatment

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If you feel nervous about what might happen during the appointment you can talk to your doctor about this at the start. You might find it helpful to write down the points you would like to talk about before your appointment, and any questions that you might have. You can also ask someone you trust to come along with you to the appointment. You can still ask to speak to the GP alone for parts of the appointment.

Anything a patient tells their doctor remains confidential, unless:. Remember, you should get treatment as quickly as possible. They outline the best practice that healthcare professionals should follow when treating eating disorders. There are many different treatment pathways, and not every type of treatment will work for everyone. Binge Eating Treatment. Search HelpFinder. We welcome your feedback on our information resources. Cancel Ok. Most patients can be effectively treated in the outpatient setting by a health care team that includes a physician, a registered dietitian, and a therapist.

Psychiatric consultation may be beneficial. Patients may require inpatient care if they are suicidal or have life-threatening medical complications, such as marked bradycardia, hypotension, hypothermia, severe electrolyte disturbances, end-organ compromise, or weight below 85 percent of their healthy body weight. For the treatment of binge-eating disorder and bulimia nervosa, good evidence supports the use of interpersonal and cognitive behavior therapies, as well as antidepressants.

Limited evidence supports the use of guided self-help programs as a first step in a stepped-care approach to these disorders. For patients with anorexia nervosa, the effectiveness of behavioral or pharmacologic treatments remains unclear.

Definition

Lifetime prevalence estimates for anorexia nervosa, bulimia nervosa, and binge-eating disorder are 0. Screening for eating disorders should be considered in the routine care of at-risk patients.

How should we treat eating disorders?

Most patients with eating disorders do not have signs on physical examination. Clinical signs of advanced eating disorders are listed in Table 1. Interpersonal or cognitive behavior therapy should be offered to patients with bulimia nervosa and binge-eating disorder. A self-help program may be considered as the first step in the treatment of bulimia nervosa and binge-eating disorder. Most patients with anorexia nervosa should be treated as outpatients in a tertiary care setting by a multidisciplinary team.

A trial of an antidepressant may be offered as a primary therapy or in combination with psychotherapy in patients with bulimia nervosa.

Anorexia nervosa - causes, symptoms, diagnosis, treatment & pathology

Emaciated, sunken cheeks, sallow skin, flat affect; may be normal weight or overweight. Dry skin, lanugo, dull or brittle hair, nail changes, hypercarotenemic, subconjunctival hemorrhage. Sunken eyes, dry lips, gingivitis, loss of tooth enamel on lingual and occlusal surfaces, dental caries, parotitis. Edema, calluses on dorsum of hand Russell's sign , acrocyanosis, Raynaud's phenomenon. It is performed by inflating a blood pressure cuff to a pressure greater than the systolic blood pressure for three minutes and observing for carpal spasm, manifested as flexion at the wrist and metacarpophalangeal joints, extension of the distal and proximal interphalangeal joints, and adduction of the thumb and fingers.

Information from reference 4. Refusal to maintain body weight at or above a minimally normal weight for age and height.

Gynecologic Care for Adolescents and Young Women With Eating Disorders - ACOG

Disturbance in the way one's weight or body shape is experienced; undue influence of body weight on self-evaluation or denial of seriousness of current weight. Restricting type: during current episode, the person has not regularly engaged in eating or purging behaviors. Binge-eating and purging type: during current episode, the person has regularly engaged in eating or purging behaviors.

Eating, in a discrete period of time, an amount of food that is definitely larger than what most persons would eat in a similar timeframe under similar circumstances. Binge eating and inappropriate behaviors occur, on average, at least twice a week for three months. Purging type: during current episode, the person has regularly engaged in self-induced vomiting or misuse of laxatives, diuretics, or enemas.

Nonpurging type: during current episode, the person has used inappropriate compensatory behaviors, such as fasting or excessive exercise, but has not regularly engaged in self-induced vomiting or the misuse of laxatives, diuretics, or enemas. This category is for disorders of eating that do not meet the criteria for any specific eating disorder. Examples include:. For females, all of the criteria for anorexia nervosa are met, except the person has regular menses.

All of the criteria for anorexia nervosa are met except, despite significant weight loss, the person's current weight is in the normal range. All of the criteria for bulimia nervosa are met, except the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for less than three months' duration.

General principles of care

Regular use of inappropriate compensatory behavior by a person of normal body weight after eating a small amount of food. Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of bulimia nervosa. Once a person is diagnosed with an eating disorder, psychosocial and clinical factors should initially be considered Table 5 2 , followed by periodic reassessments. The role of the physician is to assess medical complications, monitor weight and nutrition status, assist in the management strategies of other team members, and serve as the care coordinator.

Dietitians provide information on a healthy diet and meal planning, and may assist the team in identifying appropriate weight goals. Behavioral health care professionals perform cognitive behavior, interpersonal, or family therapy, and may assist with pharmacotherapy. Medically stable to the extent that more extensive monitoring, as defined in Levels 4 and 5, is not required. Medically stable not requiring IV fluids, NG tube feedings, or multiple daily laboratory tests. If suicidality is present, inpatient monitoring and treatment may be needed depending on the estimated level of risk.

Specific plan with lethality or intent; admission may also be indicated after suicide attempt depending on the presence or absence of other factors modulating suicide risk. Motivation to recover i. Very poor to poor motivation; patient preoccupied with intrusive, repetitive thoughts; patient uncooperative with treatment or cooperative only in a highly structured environment.


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Some degree of external structure beyond self-control required to prevent patient from compulsive exercising; rarely a sole indication for increasing the level of care. Can greatly reduce incidents of purging in an unstructured setting; no significant medical complications suggesting need for hospitalization. Can ask for and use support from others or use cognitive behavior therapy skills to inhibit purging. Needs supervision during and after all meals and in bathrooms; unable to control multiple daily episodes of purging that are severe and disabling, despite appropriate trial of outpatient care, even if routine laboratory test results are normal.

Severe family conflict or problems, or absence of family so unable to receive structured treatment in home, or patient lives alone without adequate support system. A therapeutic relationship between the physician and patient is central to the treatment of an eating disorder. These behaviors may serve critical functions for them, such as helping to manage their stressors, difficult emotions, and boredom.

Eating disorders also reinforce patient beliefs that their lives are structured and self-controlled, that they are safe and special, and that they must be thin to be worthwhile. A baseline general medical and psychiatric assessment should be performed at the time of diagnosis and periodically thereafter, as clinically indicated. Medical complications to be managed in patients with eating disorders are listed in Table 6.

Patients with binge-eating disorder may require management of complications associated with being overweight or obese. Even with successful treatment of the eating disorder, osteoporosis may remain as a medical concern, primarily for patients with anorexia. Dental erosions are most often seen in patients with bulimia, but remain a concern for any patient who purges by vomiting.

Comprehensive care

Arrhythmias Bradycardia Conduction defects e. Arrhythmias Diet pill toxicity e. Carotenosis Dry skin, brittle nails Lanugo Starvation-associated pruritus. Amenorrhea Hypoglycemia Irregular menses Mineralocorticoid excess Osteopenia. Acute gastric dilation Cathartic colon Constipation from laxative abuse Dental erosion Esophageal rupture Esophagitis Gastroesophageal reflux Mallory-Weiss syndrome Parotid gland swelling Post-binge pancreatitis.

Anemia normocytic, normochromic Decreased erythrocyte sedimentation rate Mild leukopenia with relative lymphocytosis Thrombocytopenia. Dehydration Electrolyte imbalance Increased serum carotene Refeeding syndrome. Cognitive impairment Pseudoatrophy i. Cognitive impairment Cortical atrophy, ventricular enlargement Peripheral neuropathy. Aspiration pneumonitis Pneumomediastinum precipitated by vomiting Pneumothorax or rib fractures. Increased blood urea nitrogen concentration Renal stones.

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How should we treat eating disorders?

Information from references 2 and 4. To evaluate for osteoporosis, dual-energy x-ray absorptiometry is recommended, particularly in patients who have had amenorrhea for longer than six months. The effectiveness of calcium and vitamin D supplementation, estrogen therapy, and growth factors insulin-like growth factor I has been mixed.