Professional Documents
Culture Documents
EATING DISORDERS
Beth Gargaro, MD
Triple Board Chief Resident
beth.gargaro@hsc.utah.edu
PCH, 7/16/18
BUT I’M NOT A PSYCHIATRIST…
PEDIATRICIANS ARE ON THE
FRONT LINE
Requires multidisciplinary
approach:
Pediatrician
Dietitian
Psychotherapist
Anorexia Nervosa
Restricting type
Binge/Purge Type
Bulimia Nervosa
Binge Eating Disorder
ARFID
OSFED
Pica
Rumination disorder
Unspecified Feeding or Eating Disorder (only use if not enough info to diagnose;
usually NOT billable/reimbursed by insurance)
QUICK PRIMER ON ETIOLOGY
OF EATING DISORDERS
environmental triggers
Eating Disorder
IF YOU SUSPECT AN EATING
DISORDER…
Adapted from “Eating Disorders” by Rome & Strandjord. Pediatrics in Review, Vol. 37 No. 8, August 2016
CASE #1-CONTINUED
You now look at her full growth chart
rather than just today’s measurements and
realize she has dropped from 61.2 kg to 50
kg (60th %ile to 28th %ile) over the past 6
months.
Celiac disease
Malabsorption
Hyperthyroidism
Addison Disease
Occult malignancy
Adapted from “Eating Disorders” by Rome & Strandjord. Pediatrics in Review, Vol. 37 No. 8, August 2016
DIAGNOSIS??
DDX FOR VOMITING
Migraine
Pseudotumor cerebri
Hydrocephalus
CNS malignancy
GI disease
Cyclic vomiting
DSM 5 DIAGNOSTIC CRITERIA
Bulimia Nervosa
A. Recurrent episodes of binge eating. Episode of binge eating characterized by both
of the following:
1. Eating, in a discreet period of time (e.g., within any 2-hour period), an amount
of food that is definitely larger than what most individuals would eat in a
similar period of time under similar circumstances
2. A sense of lack of control over eating during the episode (e.g., a feeling that
one cannot stop eating or control what or how much one is eating).
B. Recurrent inappropriate compensatory behaviors in order to prevent weight gain,
such as self induced vomiting; misuse of laxatives, diuretics, or other medications;
fasting; or excessive exercise
C. The binge eating and inappropriate compensatory behavior both occur, on
average, at least once a week for 3 months
D. Self-evaluation is unduly influenced by body shape and weight
E. Disturbance does not occur exclusively during episodes of anorexia nervosa.
TREATMENT
Adapted from “Eating Disorders” by Rome & Strandjord. Pediatrics in Review, Vol. 37 No. 8, August 2016
CASE #4 CONTINUED
Obesity
Kleine-Levine syndrome
DSM 5 DIAGNOSTIC CRITERIA
Binge Eating Disorder (BED)
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both:
A. Eating, in a discreet period of time (e.g., within any 2-hour period), an amount of food that is
definitely larger than what most individuals would eat in a similar period of time under similar
circumstances
B. A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating
or control what or how much one is eating).
B. The binge eating episodes are associated with three (or more) of the following:
A. Eating much more rapidly than usual
B. Eating until uncomfortably full
C. Eating large amounts of food when not feeling physically hungry
D. Eating alone because of feeling embarrassed by how much one is eating
E. Feeling disgusted with oneself, depressed, or guilty afterward
C. Marked Distress regarding binge eating is present
D. The binge eating occurs, on average, at least once a week for 3 months
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in
bulimia nervosa and does not occur exclusively in the course of bulimia nervosa or anorexia nervosa.
TREATMENT APPROACH
Anorexia = most lethal psychiatric disorder (50% of deaths 2/2 AN due to medical
complications, 50% due to suicide)
Bulimia- twice as likely to die as general population; high suicide rates and co-morbid
substance abuse
MOST patients with eating disorders will recover, but it can take years (some studies
of anorexia in adults have shown as long as 15-20 years until full recovery)
Adolescents and those caught earlier in disease course = much better outcomes than
adults
CLINICAL RESOURCES
UNI and Wasatch Canyons can manage eating disorders locally either inpatient or in
Day Treatment/IOP; UNI can take NGs on their inpatient unit.
UNI call center (801-585-1212, option #1): have access to a referral database that can
be searched by insurance, location, ages served, specialty/type of therapy offered
REFERENCES
Rome ES and Srandjord SE. Eating Disorders. Pediatrics in Review. 2016; 37(8). Accessed April 2018
Phalen, J. Managing Feeding Problems and Feeding Disorders. Pediatrics in Review. 2013; 34(12). Accessed April 2018.
Golden NH, Schneider M, Wood C, AAP Committee on Nutrition. Preventing Obesity and Eating Disorders in Adolescents.
Pediatrics. 2016; 138(3):e2016161649; Accessed April 2018.
Rosen D, AAP Committee on Adolescence. Identification and Management of Eating Disorders in Children and Adolescents.
Pediatrics. 2010; 126(6). Accessed April 2018. http://pediatrics.aappublications.org/content/pediatrics/126/6/1240.full.pdf