Medical questions & health advice by board certified doctors
"Are eating disorders reason to see a child psychiatry consultation?"
I think my 13 year old has an eating disorder. I have talked to her doctor and he think she needs to see a child psychiatrist. Should I schedule a consultation? What will they tell me at the consultation?
Eating disorders are a common and serious problem that can affect individuals at virtually any age, but are distinctly more common in adolescent and young women. Although there are actually a relatively wide range of psychiatric problems categorized as "eating disorders" the ones most familiar to the lay community are anorexia nervosa and bulimia nervosa. The common thread between both of these disorders is that they generally occur in previously healthy young women and adolescents who become overly concerned with body shape and image. Anorexia nervosa is characterized by the refusal to maintain a normal healthy body weight and typically begins in mid to late adolescence. Despite being underweight, individuals with anorexia nervosa are irrationally preoccupied with a fear of gaining weight. Although anorexic individuals often become quite emaciated as a result of both insufficient nutritional intake and obsessive, overly exuberant attempts at weight loss through other means, e.g. exercise, they tend to still hold the belief that their bodies as a whole or certain parts of their bodies are too "fat". Due to the severe malnutrition that often develops in anorexic individuals, there are very severe physical consequences that occur as a result of this disease. Individuals can suffer from anemia, electrolyte abnormalities, poor wound healing, osteoporosis, delayed growth and short stature, amenorrhea (cessation of normal menstruation) and infertility, cardiac arrhythmias and even heart failure or death. Early identification and treatment of this disease is crucial because, with treatment, one quarter to one half of all patients will fully recover with few or no long term physical or psychological problems, but, untreated, anorexia nervosa has one of the highest long term mortality rates of any psychiatric disorder, with approximately 5% of patients dieing per decade, primarily due to the physical effects of chronic malnutrition or by suicide. Bulimia nervosa is not as common as anorexia, and is characterized by frequent episodes of binge eating followed by abnormal compensatory behaviors, commonly self induced vomiting. Bulimic individuals are typically of normal weight or even slightly overweight and report binge eating followed by purging behavior at least 5-10 times per week. The disorder most commonly presents in late adolescence or early adulthood. Patient often follow a cycle of caloric restriction or dieting, which induces hunger, to which the individual responds by binge eating, and finally the individual engages in purging behavior such as self induced vomiting or laxative abuse out of fear of weight gain. Bulimic individuals are much less likely than anorexics to become malnutritioned or suffer any severe physiologic derangements, however the psychological toll on the patient and family can still be similarly tremendous. The prognosis of bulimia nervosa is much more favorable than anorexia; mortality is low and more than 50% of all patients will fully recover. Eating disorders, like all psychiatric disorders, are much more difficult to diagnose in younger adolescents and children. Children and young adolescents tend to less forthcoming regarding all the symptoms of their illnesses, as well as the emotions and beliefs the underlie them. Additionally, there are a wide variety of other psychological and physiological disorders in young people and adults alike that can impact eating behavior and it is important to discriminate these disorders from anorexia and bulimia because the treatments can be quite different. This makes consultation with a specialist, specifically a child psychiatrist, absolutely essential. In your case, only consultation with an experienced child psychiatrist will allow an accurate diagnosis to be made. In addition a child psychiatrist will be able to recommend treatment options such as medication, counseling, and nutritional interventions. The morbidity and mortality of eating disorders and other psychiatric disorders is substantial, and I cannot recommend strongly enough that you follow up promptly with an experienced child psychiatry specialist who can accurately diagnose and treat your daughter.
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