Eating Disorders in the Emergency Department

Eating disorders cover a range of conditions that involve either too much or too little food intake. Many cases of eating disorders are associated with mental health and psychiatric conditions and eating disorders have the highest mortality rate among mental illnesses. Unfortunately, many eating disorders go unrecognized and undiagnosed – and untreated. Now, a new study sponsored by the National Institute on Alcohol Abuse and Alcoholism reports that teenagers and young adults with eating disorders present to the emergency department (ED) at higher rates than previously thought. This provides an opportunity for emergency physicians to identify risk factors and symptoms associated with eating disorders and offer early intervention and treatment.

The study was conducted at the University of Michigan Medical Center in Ann Arbor. Patients aged 14 to 20 years who presented to the ED were screened for behavior consistent with disordered eating by completing a 20-minute computerized survey. The survey evaluated the presence of eating disorders, depressive symptoms, and risky drinking behavior. In all, 942 patients, with an average age of 17.7 years, completed the survey. A total of 16% of the patients screened positive for an eating disorder; nearly three-quarters of these patients were female. There was no difference in the prevalence of eating disorders among different economic or ethnic groups.

The body mass index (BMI) was higher for patients with eating disorders than those without, and eating disorder patients were 3 times as likely to be obese. Patients with an eating disorder were also 3 times more likely to have symptoms of depression and 2 times as likely to engage in risky drinking behavior, smoke cigarettes and marijuana, and abuse stimulants and other drugs. Patients with an eating disorder were also 1.6 times more likely to use the ED compared to those without an eating disorder; the most common complaints on presentation to the ED were abdominal pain and gastrointestinal problems.

While descriptions of waif-like supermodels dominate the eating disorder conversation, the results of this study confirm the fact that, today, eating disorders associated with too little caloric intake (such as anorexia nervosa) represent a minority of disordered eating behaviors. Binge eating is the most common eating disorder, which causes weight gain and related physical and psychiatric comorbidities.

Eating disorders are complex and difficult for a physician — or even, sometimes, a patient — to recognize. And, in general, ED physicians provide incomplete and inconsistent documentation of mental health issues, particularly in younger patients. However, with the increasing prevalence of eating disorders, and associated mortality rates, every physician should be aware of the signs and symptoms of disordered eating and be prepared to offer further evaluation, screening, and treatment options.

References

Cappelli M, Glennie JE, Cloutier P, Kennedy A, Vloet M, Newton A, Zemek R, & Gray C (2012). Physician management of pediatric mental health patients in the emergency department: assessment, charting, and disposition. Pediatric emergency care, 28 (9), 835-41 PMID: 22929135

Crow SJ, Peterson CB, Swanson SA, Raymond NC, Specker S, Eckert ED, & Mitchell JE (2009). Increased mortality in bulimia nervosa and other eating disorders. The American journal of psychiatry, 166 (12), 1342-6 PMID: 19833789

Dooley-Hash S, Banker JD, Walton MA, Ginsburg Y, & Cunningham RM (2012). The prevalence and correlates of eating disorders among emergency department patients aged 14-20 years. The International journal of eating disorders, 45 (7), 883-90 PMID: 22570093

Dooley-Hash S, Lipson SK, Walton MA, & Cunningham RM (2012). Increased emergency department use by adolescents and young adults with eating disorders. The International journal of eating disorders PMID: 23044650

Grover CA, Robin JK, & Gharahbaghian L (2012). Anorexia nervosa: a case report of a teenager presenting with bradycardia, general fatigue, and weakness. Pediatric emergency care, 28 (2), 174-7 PMID: 22307188

Mascolo M, Trent S, Colwell C, & Mehler PS (2012). What the emergency department needs to know when caring for your patients with eating disorders. The International journal of eating disorders, 45 (8), 977-81 PMID: 22707235

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