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Eating Disorders in Children and Adolescents

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Are undiagnosed eating disorders keeping your patients sick?

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Psychiatrists, psychologists, and other graduate-level mental health professionals would find this a valuable book. It enhances the reader's knowledge and expertise by bringing together leading experts across the globe This book is well-written. Clinical psychologists, psychiatrists, social workers, counselors, nurses, dieticians, and other health professionals will find it a useful resource. It offers a thought-provoking and thorough overview of the state of our knowledge in the treatment of eating disorders Readers will find that this book discusses many issues that are crucial to their clinical practice and research.

Grilo and Mitchell have recruited an internationally renowned group of authorities…. The 35 chapters cover all aspects of treatment…. Well-chosen authors contribute 35 chapters and over pages of well-referenced text. In the world of systematic reviews and electronic literature searching, there is still an important role for a high-quality reference that offers not only data, but also perspective. This volume fills that role. It deserves to do well. This practical volume informs the reader about state-of-the-art empirically based and promising treatments, and it provides a uniquely effective guide on how to deliver these treatments.

A 'must-have' for clinicians, researchers, and students in the field. It is a top-rate presentation of all the needed information. Brownell, PhD, Robert L. Don't want the mobile site? We combined the categories in order to limit the number of queries added to this lengthy interview. Administrators were asked about intake assessments and admission policies for patients with eating disorders. Among programs admitting patients with eating disorders, information was collected on the percentage of patients with eating disorders, whether patients can be admitted solely for eating disorder treatment, and whether the program has access to eating disorder treatment services.

Programs providing on-site services were asked about staff training in treatment of eating disorders and how eating disorder services are delivered. Analyses were conducted with SPSS statistical software and included descriptive statistics means, standard deviations, and percentages to describe the sample.

The initial analyses consisted of determining the proportion of programs that did or did not assess or treat eating disorders. All programs were classified as not admitting patients with eating disorders does not admit , admitting patients with eating disorders but not treating the eating disorder admits but does not treat , or admitting patients with eating disorders and treating the eating disorder admits and treats.

A Levene test for homogeneity of variances showed no statistically significant differences in these variances for these three groups, despite large differences in group sizes. These categories were compared on a number of variables selected from the larger set of NTCS items to identify distinguishing characteristics of programs that provide eating disorder services.

The selected variables reflect organizational, clinical, and patient characteristics that may be related to eating disorder treatment. For example, use of selective serotonin reuptake inhibitors SSRIs and use of gabapentin were selected as variables because these medications may be beneficial in treatment of eating disorders. Analyses of variance ANOVAs were conducted to determine differences among the three treatment categories.

Some of the cases had incomplete data and were not available for all analyses, resulting in totals of fewer than cases. Eating disorder treatment services were also compared by the gender composition of programs. Finally, qualitative analyses identified treatment practices and barriers to eating disorder treatment. The remaining programs do not offer any services to address eating disorders.

Results indicated that the three types of programs are organizationally very similar Table 1. The primary differences were between admit-and-treat programs and the other programs.

Are undiagnosed eating disorders keeping your patients sick?

Also, admit-and-treat programs had significantly lower caseloads of African-American patients. Comparison of addiction treatment programs based on admission and treatment of patients with eating disorders. The 51 admit-and-treat programs provided additional information on how they addressed eating disorders. Qualitative data showed three distinct ways in which the treatment of patients with co-occurring eating disorders differs from standard addiction treatment.

First, patients with eating disorders tend to receive individual therapy, often with a mental health counselor or licensed clinical social worker trained in treatment of eating disorders.

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Second, treatment emphasizes food-consumption behaviors, such as the development of a specific meal or nutrition plan, the keeping of food-intake journals, and so on. Third, patients with eating disorders tend to be monitored for bulimic behaviors, such as their activities at mealtime, trips to the bathroom, and so on.

Admit-and-treat programs reported having at least one staff member trained in eating disorder treatment. Only two programs employed a certified eating disorder specialist. The four most frequent reasons were that no staff were trained in eating disorder treatment, that there was inadequate medical staff or medical resources, that eating disorder treatment requires a more intensive level of care than the program provides, and that there was insufficient demand for these services relative to the resources required.

This survey of a nationally representative sample of publicly funded substance abuse treatment programs explored the assessment and treatment of co-occurring substance use and eating disorders, types of eating disorder services provided in addiction treatment programs, and barriers to eating disorder treatment. However, this percentage is larger than that seen in the general population and warrants assessment for this disorder in addiction treatment. Given the low rate of assessment and unstandardized assessment techniques for eating disorders, it would not be surprising that programs underestimate their prevalence in treatment populations.

However, it also may be the case that these programs do not experience a high case mix of patients with co-occurring eating disorders. Caucasian women are more likely to experience anorexia or bulimia, whereas African-American women are more likely to experience binge-eating disorder, which is not fully recognized in DSM-IV As such, eating disorders among African Americans may be underdiagnosed.

In our sample, admit-and-treat programs were more likely to report a lower percentage of African-American patients than programs that do not provide eating disorder treatment, suggesting that assessment may be more focused on anorexia and bulimia. Despite the high prevalence of eating disorders among women, we found only insignificant trends for programs to provide eating disorder treatment services in relation to their proportion of female patients or by the female gender composition of the program.

Eating disorder treatment requires a multidisciplinary treatment approach 12 , which may be difficult for addiction treatment programs to provide. Also, patients with co-occurring eating and substance use disorders often have more severe eating disorder symptoms 5 , 6 as well as other co-occurring axis I and II disorders 5 , 7 — 9 that increase the complexity of treatment as well as the resources needed to provide adequate care. Admit-and-treat programs were more likely to provide psychiatric services and have the resources to provide individual therapy for eating disorders with trained professional staff.

Although evidence-based integrated treatment for eating disorders is not yet available, most of the programs attempt to integrate substance use and eating disorder treatment.

Admit-and-treat programs were also more likely to use medications such as SSRIs and gabapentin. SSRIs are commonly used to treat co-occurring depression, and gabapentin is used to treat anxiety disorders, and both depression and anxiety are common co-occurring psychiatric disorders that are common in this population. This survey was limited to publicly funded treatment programs and may not reflect the current assessment and treatment practices of private treatment facilities.

The results also were limited by the inability to accurately identify the actual proportion of patients with eating disorders admitted to the programs. It is possible that the populations served by the programs have a low prevalence of eating disorders and do not need additional, costly services for this condition. Alternatively, it is possible that these populations experience a high prevalence of eating disorders that are neither diagnosed nor treated. It is possible that programs did not consider patients with binge-eating disorder or other eating disorder conditions, which may have underrepresented the prevalence of eating disorders in their treatment populations.

The results also were limited by the self-report responses of the administrators, who may not have been aware of the practices and skill levels of staff.

Despite the high prevalence of co-occurring substance use and eating disorders, most publicly funded addiction treatment programs do not address eating disorders either through assessment or treatment, possibly because of limited resources and the perception of low need. Primary eating disorders are most often treated in psychiatric facilities with better resources.

However, there may be a substantial number of patients with co-occurring eating and substance use disorders admitted to addiction treatment programs.

Most eating disorder patients are adolescent girls or young women with pronounced body image dissatisfaction. Other patients include:. Atypical young women. Some young women—usually Asian—meet most criteria for anorexia nervosa but lack the characteristic drive for thinness. They tend to have less psychopathology and better prognosis than typical female patients.

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Boys and men. Female-to-male ratios are approximately for anorexia, for bulimia, and for binge eating disorder. Men and boys with eating disorders are similar to their female counterparts but are more likely to report:. Middle-aged to late-life. Midlife onset of eating disorders may be precipitated by losses or concerns about aging. In the elderly, eating disorders may be manifestations of complicated bereavement, and ruling out medical causes of weight loss is crucial in this age group.

Night-eating syndrome. They experience insomnia, morning anorexia, and sometimes amnesia for the nocturnal eating episodes. Anxiety, depression, or sleep disorders may be contributing factors. Skip to main content.