Medically Hospitalized Patients With Eating Disorders and Somatoform Disorders in Pediatrics: What Are Their Similarities and Differences and How Can We Improve Their Care?

Abstract

A B S T R A C T OBJECTIVES:The purpose of the current study is to describe the demographic and clinical characteristics and health care use of medically hospitalized patients with eating disorders (ED) and somatoform disorders (SFD) in a pediatric setting and to use the findings to explore opportunities for improved care. METHODS:Retrospective chart reviews of 125 patients with SFD and 125 patients with ED (N 5 250) seen at a tertiary pediatric facility over a 12-and 19-month period, respectively. RESULTS:Patients in both groups were predominantly girls, white, came from households with above average incomes, and had academic pressures, internalizing coping styles, and high rates of anxiety disorders. Compared with SFD patients, ED patients had longer medical admissions (P , .001), more depressive disorders (P , .01), higher lifetime rates of suicidal ideation and self-injurious behaviors (P , .05), and were more frequently discharged to intensive psychiatric treatment programs (P , .001). SFD patients were referred later to psychiatry (P , .001), had more emergency department visits (P , .001) and more visits to other hospitals (P , .05) and also had higher rates of learning difficulties (P , .001), bullying (P , .05), and trauma (P , .01) compared with ED patients. CONCLUSIONS:Identifying overlapping features and key differences in the clinical characteristics and health care use of patients with primary psychiatric disorders like ED and SFD, who are frequent users of medical services, is the first step toward developing innovative, integrated hospital-based care approaches and clinical pathways that can reduce service utilization and improve patient outcomes.

Disordered eating among adolescents with chronic pain: the experience of a pediatric rheumatology subspecialty pain clinic

“…Our cohort had a median age of 14 years and was predominantly female (80.3%) and Caucasian (77.6%). This is analogous to the characteristics of a typical patient hospitalized for eating disorders or somatoform disorders (adolescent, white female) [29]. We found that 22.4% of our cohort had disordered eating, corroborating previous findings that chronic pain and disordered eating commonly co-occur in adolescents [1][2][3][4][5][6].…”

Developing a Clinical Pathway for Somatic Symptom and Related Disorders in Pediatric Hospital Settings

“…The treatment of SSRDs can be initiated within the hospital setting with the goal of improving functionality and successfully transitioning to outpatient care. 35 Children with more profound and pervasive functional impairment, with or without other comorbid conditions, may need more intensive treatments, including admission to medical-psychiatric programs or physical rehabilitation units. 6 Disposition planning is multidisciplinary with a focus on promoting active engagement with the primary care provider (PCP), establishing follow-up care with outpatient mental health providers who are familiar with SSRDs, ongoing monitoring by subspecialty pediatric providers as indicated, using continued outpatient rehabilitative services if needed, and providing guidance to families and schools.…”

“…6 Disposition planning is multidisciplinary with a focus on promoting active engagement with the primary care provider (PCP), establishing follow-up care with outpatient mental health providers who are familiar with SSRDs, ongoing monitoring by subspecialty pediatric providers as indicated, using continued outpatient rehabilitative services if needed, and providing guidance to families and schools. 10,32,33,35,36 Scheduled and frequent follow-up visits with a PCP are important to maintain the alliance and investment in treatment and provide ongoing medical education and reassurance. 33 Limitations and Future Directions…”

Pediatric Avoidant-Restrictive Food Intake Disorder and gastrointestinal-related Somatic Symptom Disorders: Overlap in clinical presentation

“…A retrospective chart review comparing pediatric patients with SSRD and eating disorders found that patients with EDs had longer medical admissions, more depressive disorders, suicidal ideation, and self-harm, whereas patients with SSRDs had greater utilization of emergency department and hospital services, and higher rates of learning difficulties and trauma ( Ibeziako et al, 2016 ). However, no study to date has compared SSRDs to ARFID specifically, differentiated from other eating disorder subtypes.…”