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The Informed Parent

Teens And Eating Disorders Part II

by Sandra Smith, Ph.D.
Published on Jul. 01, 2013

What Should An Assessment Of My Teen Include?

  1. A complete clinical interview by a psychologist or a psychiatrist is the first step in assessment. This will include an individual interview with your teen, a family interview, and possibly the use of some self-report questions focused on eating issues. Areas covered in a complete clinical interview include perception (of the teen and of her family) of the presenting problem, weight and body issues including weight loss strategies, the physical and emotional effects of weight loss, the effect of weight preoccupation/loss on the teen’s activities and relationships, a mental status examination and a family assessment.
  2. The treating psychologist or psychiatrist should insist on a complete medical evaluation of the teen. This is essential for several reasons, including the necessity to rule out the presence of any organic illness that might contribute to the teen’s symptoms and to assess whether there is an immediate need for medical treatment.
  3. The treating psychologist or psychiatrist should also encourage the teen and her family to work in tandem with a nutritionist in many cases, to ensure close nutritional monitoring. Overall, the initial assessment should include developing the expectation that a treatment contract will be developed with a medical team.

What Can I Expect The Treatment To Be Like For My Teen?

Much will depend on the course and severity of the disorder your teen is experiencing. Many teens require different levels of treatment over the course of their disorder. The following will serve as a brief overview of the types of treatments you may anticipate will be of help to your teen.

a) Outpatient Treatment:

Weekly individual and family therapy is usually recommended. Group therapy is often helpful as well. The form of therapy used will depend on the psychotherapist’s approach and should include discussion with the patient and her family regarding what treatment approach is being used, and why it is considered to be helpful.

Outpatient treatment may also include medical check-ins as frequently as needed to ensure the teen’s safety. Medical visits can be reduced in frequency as a reward for compliance, e.g., as in the case of the teen who agrees to gain a certain amount of weight each week.

b) Partial Hospitalization:

Often, teens with a serious eating disorder do not require an inpatient setting, but may require more intense treatment than that which is typically available in an outpatient setting. In those instances, an alternative treatment setting may be a day treatment or partial hospitalization program.

In this type of treatment, the teen generally participates in treatment throughout the day, but goes home in the evenings. This type of treatment should only be used for teens who are medically stable and who do not require nutritional supplements (i.e., they consume 100% of their calories from food intake). Some self-motivation  (to take in calories and work toward health) must be present for this type of treatment to be effective for the seriously ill teen.

c) Inpatient Treatment:

Teens with eating disorders sometimes become acutely unstable from a medical perspective. They can, in those instances, be at risk for loss of consciousness or even sudden death. There are specific indicators of significant medical instability which require hospitalization, including hypothermia, severe bradycardia (heartbeat is 45 beats/minute or below), hypotension or shock, severe malnutrition (defined as less than 75% of ideal body weight), arrested growth or development, acute food refusal, electrolyte disturbances, uncontrollable bingeing and purging, acute medical complications, acute psychiatric emergency (suicidal or psychotic thoughts) and failure to respoind to outpatient treatment.

Inpatient settings for the treatment of eating disorders are generally multidisciplinary, and include practitioners from adolescent medicine, nutrition, psychology, psychiatry and social work.

Treatment from a medical standpoint may include bed rest and heart monitoring, as needed. The nutritional expert will sometimes administer a liquid supplement as the patient stabilizes medically, and progress to food with stabilization. In the case of severe anorexia, the teen’s caloric intake is observed until she is able to take in the required calorie amount without observation. The teen who purges may be watched after meals to ensure that she retains the food. As the teen progresses in the hospital, she is gradually allowed to choose and consume her own food selections without monitoring as long as she continues to meet her weight maintenance or gain goal. This approach allows the teen to begin to eat on her own in preparation for discharge to either an outpatient or partial hospital program setting. 

Psychological treatment during hospitalization generally involves daily individual and group psychotherapy sessions, and family therapy sessions twice a week. The primary focus of psychotherapy during hospitalization is to allow the teen and her family the opportunity to explore the effects of the eating disorder, and to allow the teen to reclaim her life.   

Conclusion

A recent review of treatment outcomes for eating  disorders by the Americn Psychiatric Association found that for patients with Anorexia Nervosa four years after onset, 44% reported a “good” outcome (reaching to at least 15% of ideal weight), 24% had a “poor” outcome (never reaching to at least 15% of ideal body weight) and 28% had an “intermediate” outcome (between these two). In the treatment of bulimia 27% of previously hospitalized patients reported a ”good” outcome (binge/purge episodes fewer than 1X/month), 33% reported a “poor” outcome (daily binge/purge episodes),and 40% fell between the two (3). 

The treatment of teens with eating disorders is challenging. The effects of the disorder can be extremely serious, sometimes leading to acute medical instability, chronic disability, suicidality and even death. Despite the potentially dire consequences, many teens present, at least initially, as ambivalent about giving up the problem. There is often a pronounced tendency to deny the seriousness of their situation. The psychotherapist who works with teens with eating disorders often finds himself in the untenable position of attempting to support the teen’s health and self-reliance, while the teen attempts to hold onto the eating disorder despite it’s potential consequences. Treatment for teens with serious eating disorders tends to be lengthy. It is also quite rewarding to work with teens who are able to reclaim their lives and appreciate their own strength and competence.  

If your teen demonstrates the signs and symptoms of an eating disorder as described above, do not hesitate to consult your child’s pediatrician, or an adolescent/teen psychiatrist or psychologist. Early identification and treatment may go a long way toward ensuring your teen’s ability to effectively manage the disorder and lead a healthy life.

References:

Yalom, Irvin D., Ed. (1996) Treating Adolescents. San Francisco: Jossey-Bass Publishers.

Whitaker, A.H. (1992). An epidemiological study of anorectic and bulimic symptoms in adolescent girls: Implications for pediatricians. Pediatric Annals, 21, 752-759.

American Psychiatric Association (1993). Practice guideline for eating disorders. American Journal of Psychiatry, 150 (2) 212-228.




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