Ep 202 Eating Disorders: Common, Commonly Missed, Mismanaged and Misunderstood
Feb 18, 2025
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Samantha Martin, a pediatrician specializing in adolescent medicine, and Jennifer Tomlin, an emergency medicine clinician, discuss the often-overlooked signs of eating disorders in emergency settings. They reveal the high mortality rates associated with these disorders and the common misdiagnoses due to vague symptoms. The conversation emphasizes the importance of early detection, the role of family dynamics in recovery, and critical screening techniques like the SCOFF questionnaire. They also cover the medical complications of eating disorders and the vital need for clinicians to probe deeper into patient histories.
Eating disorders have the highest mortality rate of any psychiatric illness, yet they are often missed in emergency settings due to vague symptoms.
Early identification and timely treatment of eating disorders are critical in improving long-term outcomes and preventing irreversible health issues.
Effective communication with patients and families is essential in managing eating disorders, fostering support, and enhancing treatment adherence.
Deep dives
Prevalence and Mortality of Eating Disorders
Eating disorders affect approximately 2-3% of North Americans, translating to around a million individuals in Canada and 10 million in the U.S. Alarmingly, these disorders have the highest mortality rate of any psychiatric illness, with a mortality rate of 10-15 percent. Emergency medicine providers often overlook the significance of eating disorders in their practice despite their severity and prevalence. It's crucial for emergency physicians to recognize the importance of understanding and identifying these disorders in presenting patients.
Challenges in Diagnosis
Emergency departments frequently miss eating disorders due to a lack of education and awareness among healthcare providers. Statistics show that 30-50% of eating disorders go undiagnosed, often because symptoms are vague or atypical, especially in males, young people, and racial minorities. Many patients present with common complaints, such as gastrointestinal issues, which can obscure the underlying eating disorder. Factors such as denial, shame, and cultural biases surrounding body image contribute to the difficulty in identifying these conditions.
Importance of Early Identification
Early identification of eating disorders is crucial, as prompt treatment can significantly improve outcomes and potentially reverse adverse medical complications. Delays in treatment can lead to more entrenched psychopathology and serious irreversible health issues, including growth stunting and bone health problems in adolescents. Emergency physicians have a vital role in recognizing red flags that suggest eating disorders, even if patients do not present with obvious weight loss or typical symptoms. By simply asking the right questions and maintaining a high level of suspicion, emergency providers can facilitate quicker access to appropriate care.
Assessment and Management Strategies
Accurate assessment of patients suspected of having eating disorders involves gathering a thorough history, performing vital signs, and conducting targeted physical examinations. Vital signs should be taken with caution, often requiring a supine position for proper readings, and additional diagnostic testing can help clarify risks such as electrolyte imbalances and cardiac complications. For patients who may need hospitalization, criteria such as bradycardia, hypotension, and significant weight loss are critical indicators. Emergency providers should keep in mind that normal lab results do not rule out the presence of an eating disorder, and continuous monitoring is essential.
Compassionate Communication with Patients and Families
Effective communication with both patients and their families is paramount when dealing with eating disorders. Practitioners must strive for a compassionate approach, addressing fears while firmly establishing the seriousness of the situation. Externalizing the disorder can help patients and families understand that the challenges stem from the eating disorder, not the individual. Providing clear expectations about treatment and the recovery process, along with validating concerns, can foster a supportive environment critical for encouraging treatment adherence and achieving long-term recovery.
Eating disorders have the highest mortality rate of any psychiatric illness, yet they are frequently missed in the Emergency Department as they can be elusive. Only one in 246 patients who screen positive for an eating disorder at triage have a chief complaint suggesting it. These patients don’t always fit the stereotype—many appear “healthy,” have normal BMI, or present with vague GI, cardiac, or neurological symptoms. Missing the diagnosis has important consequences. The earlier an eating disorder is identified and the earlier that appropriate treatment is initiated the better the long term outcomes. In this episode, with the expertise of Dr. Samantha Martin and Dr. Jennifer Tomlin, we’ll break down the essential clinical clues, screening questions, red flags, and subtle exam findings that can help Emergency Physicians diagnose eating disorders early and initiate treatment to decrease mortality and long term morbidity in these young patients. Eating disorders need to be thought of as both a psychiatric condition and medical condition to optimize the pick up rate and appropriate management. Missing or mismanaging eating disorders in the ED means missing an opportunity to save a life and prevent long term morbidity...
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