With an eating disorder often comes a high incidence of comorbid psychiatric conditions. Below, Madhurani Khare, MD, Medical Director of Child and Adolescent Psychiatry at Penn Medicine Princeton House Behavioral Health, shares her insights on how this correlation pertains to children and teens.
What psychiatric comorbidities are most common among these patients?
A: About 60-70% of children and teens with eating disorders also have a co-occurring psychiatric disorder, most frequently depression or anxiety. Obsessive-compulsive disorder is one of the more common forms of anxiety seen in this population. Other co-existing conditions of note include bipolar disorder and oppositional defiant disorder, particularly in preteens.
Which comes first—the eating disorder or the psychiatric condition?
A: Every patient is different. For some, depression or anxiety may precede the eating disorder, and for others, the reverse may be true. As far as treatment, the best approach is to tackle both simultaneously. If a young patient is suffering from anxiety, it will be nearly impossible to focus on an eating disorder treatment plan without addressing the psychiatric condition.
How does medication play a role in treatment?
A: When warranted and with parental consent, medications can play a key role in enabling patients to participate in a treatment plan. Many also work relatively quickly and can help avoid lost time. For example, the antihistamine hydroxyzine can provide a temporary jump start in reducing panic attacks that may be preventing treatment progress. Medications like fluoxetine in combination with olanzapine or quetiapine can help stabilize the serotonin imbalances characteristic of depression, anxiety, and obsessive-compulsive disorder. For many patients, I generally recommend using these medications for six months before weaning, as this helps with sustained elevation of serotonin levels.
How has the COVID-19 pandemic affected this patient population?
A: We’ve seen an increase in patients with eating disorders and depression or anxiety since the pandemic began. A prolonged period of isolation paired with a complete disruption of school, sports, and social routines has led to a high incidence of psychiatric issues. As we face continued challenges related to the pandemic, the creation of structure is critical for mental health in children and teens. This includes healthy sleep, eating, and exercise routines.
When should a child or teen be referred for inpatient care?
A: Young people may benefit from an evaluation for a higher level of care if they exhibit certain manifestations in addition to concerning weight trends; these may include delayed puberty, loss of menstrual cycle, concerning growth curves, cardiac irregularities, a lack of progress in outpatient treatment, or noncompliance with existing care. Research demonstrates that early detection and treatment can yield the best outcomes.