Brief report: Correlates of inpatient psychiatric admission in children and adolescents with eating disorders

Abstract

Objective: To examine the prevalence and importance of psychological, behavioural, and situational correlates of impending psychiatric inpatient admissions in children and adolescents with eating disorders. Method:The sample consisted of 285 patients (8e17 years, M ¼ 14.4, SD ¼ 1.49) with DSM-5 eating disorders assessed between 2006 and 2013 from the Helping to Outline Pediatric Eating Disorders (HOPE) Project. The sample was split into two groups, those with (n ¼ 38) and without (n ¼ 247) impending psychiatric admission; Discriminant function analysis was used to examine correlates. Results:The prevalence of impending psychiatric admission was 13.3%. Suicidal ideation provided the greatest discriminating power, followed by eating pathology, depressive symptoms, anxiety, multiple methods of weight control, binge eating, and family functioning.Conclusions: Earlier recognition of comorbid symptoms in eating disorders in the community may reduce the number of young people with eating disorders who present needing critical psychiatric care.

Key stakeholder perspectives on primary care for young people with an eating disorder: A qualitative study

“…These contexts may elucidate how ED concerns become normalised and minimised (see also Malson & Burns, 2009) but they also clearly indicate the urgency with which we should address the shortfalls in primary care provision that are indicated by our findings. An urgency that is further underpinned by the growing evidence, as noted above, of, first, the additional systematic failure to recognise EDs in those who do not fit the stereotype that people with an ED are invariably underweight, White, middle class, cis ‐gendered, heterosexual, able bodied young women (Chowbey et al, 2012; Solmi et al, 2016; Wales et al, 2017) and, second, the importance of early intervention in facilitating positive outcomes for people with EDs (e.g., Hamilton et al, 2015; Schoemaker, 1997; Treasure & Russell, 2011; Zipfel et al, 2000).…”

“…The potential damage to young people's lives caused by delays in providing appropriate support and in referring patients to specialist ED services is well‐recognised (e.g., Hamilton et al, 2015; Schoemaker, 1997; Treasure & Russell, 2011; Zipfel et al, 2000). GPs play a central role in facilitating access to those services, particularly for older adolescents in the UK who cannot be referred through Child and Adolescent Mental Health Services.…”

“…However, this is often not the case: in the locality where GPs in this study were recruited, although waiting times between assessment and treatment are often lengthy, there are no BMI thresholds for children's or adults' services. Given the importance of early referral to specialist ED services in producing positive outcomes (e.g., Hamilton et al, 2015; Schoemaker, 1997; Treasure & Russell, 2011; Zipfel et al, 2000), this finding, and its convergence with young people's and carers' accounts of delayed referrals, is of particular concern, adding to the weight of evidence that training for doctors about EDs and readily available information is inadequate and urgently requires improvement (e.g., B‐eat, 2017; PHSO, 2019). With the growing evidence of a large surge in cases of EDs during the recent pandemic (RCPHC, 2020, see also Jayanetti, 2021) and reports in the press (Marsh, 2021), of people being denied treatment for EDs across the UK because they are not considered sufficiently thin, the need for improved primary care provision, for young people with an ED can be seen as all the more pressing.…”

Classifying binge eating‐disordered adolescents based on severity levels

“…Despite this and the fact that the whole study sample size ( N = 223) was larger than that used by prior adult research to examine differences in clinical variables between the four DSM‐5 severity groups (e.g., Dakanalis, Colmegna et al, 2017; Dakanalis, Riva et al, 2017), replication of the findings with larger adolescent clinical samples with BED and other methods of data collection (e.g., ecological momentary assessment) and extension to different samples (i.e., community‐recruited young people with BED), would be beneficial. In addition to comparing the DSM‐5 severity approach with alternative ones (i.e., subtyping based on overvaluation of shape/weight or along dietary and negative/depressive affect dimensions; Masheb & Grilo, 2008; Stice et al, 2001), future studies should also track severity fluctuation across time and test whether the DSM‐5 severity groups of BED (APA, 2013) differ in additional clinical correlates and socio‐demographic variables (not considered here) such as parental educational, socio‐economic status and family structure/context and functioning, child abuse, psychiatric history, externalizing psychopathology, reward from high‐calorie food intake and behavioural impulse control (e.g., Caslini et al, 2016; Hamilton et al, 2015; Tsappis et al, 2016). It is also essential that future BED research examines the DSM‐5 (mild, moderate, severe, and extreme) severity groups of BED (APA, 2013) in terms of their prognostic significance for treatment outcome, as this will provide evidence for the predictive validity of the DSM‐5 (not evaluated in this study).…”

“I am the embodiment of an anorexic patient's worst fear”: Severe obesity and binge eating disorder on a restrictive eating disorder ward

“…Psychiatric comorbidities are important predictors of impending hospitalization for adolescents diagnosed with eating disorders 1 . Binge eating disorder (BED) is widely known to have severe consequences on physical health, but is also associated with significant adverse emotional outcomes 2 .…”