Menu
Video Chapters
Click on the three lines in the upper left corner to see chapter information or reference the chapter table of contents below to navigate to specific chapters.
Natalie Prohaska, M.D., Child & Adolescent Psychiatrist, University of Michigan
Eating disorders are psychiatric conditions characterized by persistent disturbances in eating behaviors associated with distressing thoughts and emotions. These conditions often impact physical, emotional, cognitive, and social health factors and can range from mild to severe to life-threatening. Eating disorders often co-occur with other psychiatric disorders, most commonly mood and anxiety disorders, obsessive-compulsive disorder, and alcohol and substance use disorders. A combination of genetic risk, family values, stressors related to body image or nutrition, psychiatric or psychological values that impact self-esteem or self-image, and other modeled behaviors related to eating, activity, or physical health all can play a part in elevating risk of developing an eating disorder among youth.
There are six types of eating disorders with the more common disorders being anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant restrictive food intake disorder (ARFID). It is important to distinguish these conditions as they may involve different treatments, potential complications, and diagnostic considerations.
Initial assessment of eating disorders involves a comprehensive patient history, review of other potential psychiatric and physical comorbidities, vitals including height, weight, and body-mass index, as well as a physical exam with particular focus on potential sequelae of restricted eating behaviors. Initial laboratory assessment includes review of electrolytes, hepatic and renal function, markers of protein loss and nutritional deficiency, as well as any additional diagnostic studies guided by history and physical examination. These assessments are often more extensive on initial examination but should be done iteratively with regular reflection and judicious evaluation as indicated with evolving symptoms.
The most evidence-based treatment for eating disorders in adolescents is Family Based Treatment (FBT). Through FBT, the family is central in helping restore an adolescent’s weight as well as regulating eating. For more ego dystonic disorders, such as bulimia, binge eating, and sometimes ARFID, the patient may be more responsive to Cognitive Behavioral Therapy (CBT). The evidence for pharmaceutical support for eating disorders is limited and often augments management of the eating disorder symptoms or co-occurring mental health conditions and may include the use of aripiprazole, olanzapine, and SSRIs in some populations. When youth and young adults are struggling with outpatient care, higher levels of care are available, including intensive outpatient therapy, partial hospitalization, medical and psychiatric hospitalization, as well as residential care.
Resources
Screening Tools
Couturier, J., Isserlin, L., Spettigue, W., & Norris, M. (2019). Psychotropic Medication for Children and Adolescents with Eating Disorders. Child and adolescent psychiatric clinics of North America, 28(4), 583–592. https://doi.org/10.1016/j.chc.2019.05.005
Kalm LM, Semba RD. They starved so that others be better fed: remembering Ancel Keys and the Minnesota experiment. The Journal of Nutrition. 2005; 135(6):1347–1352.
Hornberger LL, Lane MA; COMMITTEE ON ADOLESCENCE. Identification and Management of Eating Disorders in Children and Adolescents. Pediatrics. 2021 Jan;147(1):e2020040279.
Lock, J., La Via, M. C., & American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI) (2015). Practice parameter for the assessment and treatment of children and adolescents with eating disorders. Journal of the American Academy of Child and Adolescent Psychiatry, 54(5), 412–425.
Maguen, S., Hebenstreit, C., Li, Y., Dinh, J. V., Donalson, R., Dalton, S., Rubin, E., & Masheb, R. (2018). Screen for Disordered Eating: Improving the accuracy of eating disorder screening in primary care. General hospital psychiatry, 50, 20–25.
Morgan, J., Reid, F., & Lacey, J. (2000). The scoff questionnaire: A new screening tool for eating disorders. Western Journal of Medicine, 172, 164-165.
Peebles R, Sieke EH. Medical complications of eating disorders in youth. Child and Adolescent Psychiatric Clinics of North America. 2019; 28(4):593–615.
Test your knowledge with an optional 5-question quiz below. (Note: If you wish to receive a certificate of completion for this MC3 Clinical Pearl, you must receive a passing score of 80%.)