Eating Disorders in Adolescents - Physical and Psychiatric Perspectives

ABSTRACT

@#Eating disorder (ED) referrals of school age children and adolescents, by their parents and school teachers, have become more common. Also, they are now presenting at an earlier age to the primary health care and school systems, with physical, medical and psychological symptoms. Nevertheless, there is an average of six months to two years between the onset of symptoms to formal assessment and treatment by specialist team. There are also more cases presenting to ED specialist clinic services, especially pre-pubertal children, with early onset and presentation before 14 years old. Mid and late adolescent presentations (after 14 years old) continue to make up more than two third of the cases. More than 60 percent of cases seen in specialist clinics are of the restrictive type anorexia nervosa, and often associated with persistent and excessive exercise. Thirty percent of cases presented are Bulimia nervosa, which tend to be episodic. Majority of single episode bulimia cases do not present themselves early to medical services but take on open source self-directed management. For patients with bulimia who comply to treatment program and recover after 6-12 months of therapy, they can also experience high relapse rate as they often discontinue their follow up. Avoidant-restrictive food intake disorder is more closely related to pre-pubertal onset eating disorder with arrested sexual maturity and growth failure, if left untreated. Psychiatric co-morbidities arising from body image disturbance, overdrive high achievement needs, prior exposure to adverse childhood experiences (ACE), dysfunctional family or peer relationships, include anxiety, avoidance behavior, obsessive rumination, depression, suicidal ideation and attempt. Death can arise from acute presentation and chronic state of ED, when associated with medical complications from refeeding syndrome, severe malnourishment, accidents and suicide. Early identification and assessment by family physicians would significantly improve the prognosis and mitigate against long term chronicity when share care with ED specialist services.