Assessment and treatment of eating disorders in children and adolescents

Abstract

Feeding and eating disorders (FEDs) are serious mental health disorders that cause impairments in physical health, development, cognition and psychosocial function and can go undetected for months or years. They are characterised by disturbed eating behaviour associated with concerns about weight and shape or by disinterest in food, phobic avoidance or avoidance due to sensory aspects of food. Restrictive forms of FEDs lead to significant weight loss requiring intervention. Without specific knowledge of these conditions, they can evade detection, delaying time to diagnosis and treatment and potentially influencing outcome. This review article focuses on the key factors involved in the psychiatric assessment and treatment of four feeding or eating disorders (EDs): anorexia nervosa, avoidant-restrictive food intake disorder, bulimia nervosa and binge eating disorder. They have been chosen for discussion as they are most likely to be encountered in both a psychiatric and paediatric setting. It emphasises the importance of a family-focused, developmentally appropriate and multidisciplinary approach to care. It does not address aspects of medical assessment and treatment. Other feeding or EDs not included in this article are pica, rumination disorder, other specified feeding and eating disorder and unspecified feeding and eating disorder.

Treatment of eating disorders in child and adolescent psychiatry

“…However, patients with ARFID do not present with symptoms of body image disturbance and do not refuse weight gain. In the majority of patients, age of onset is earlier than that for anorexia nervosa, and there is a higher proportion of boys, although ARFID may develop into anorexia nervosa in a minority of cases [23].…”

“…Treatment approaches were based on behavioural interventions (escape extinction; reinforcement) and withdrawal of tube feeding ('provocation of hunger') and always involved the caregivers [43 && ]. Other studies indicate a similar intervention strategy; however, there are no further systematic investigations or RCTs [23,44]. Very little data exist on the use of medication.…”

“…In an outpatient setting, caregivers should be given help to support their child during the meal through a family meal, group psychoeducation for parents or personal instruction from the therapist [22,23].…”

Deep Brain Stimulation for Autism Spectrum Disorder: Current and Future Uses

“…The initial aim is to help the client to eat regular meals and snacks, and alleviate anxiety around where the next meal may come from [27]. Emotional support and psychotherapeutic intervention is highly recommended and it is noted that nutritional input alone comes with low attrition rates [27].…”

Dental Implications of Eating Disorders

“…Anorexia nervosa is a disease of a persistent character and a diversified course; it is also fraught with a high risk of death. It has been estimated that mortality indices among anorectic patients are at least 5 times higher than expected [2,3,8,9].…”