Eating Disorders: Identification and Management in General Medical and Psychiatric Settings

Abstract

OBJECTIVE Eating disorders (EDs) are serious, complex illnesses with both behavioral and physical health features. EDs have high rates of medical and psychiatric morbidity, and a 6% mortality rate, the highest of any mental illness. Early detection of EDs offers the best opportunity for recovery; yet, estimates are that as few as one in 10 individuals with an ED receive treatment. The purpose of this article is to provide an ED identification and management overview for inpatient nurse clinicians in general psychiatric and medical settings, helping to facilitate timely recognition and care. METHOD An overview of ED diagnostic criteria and two evidence-based ED tools are introduced for consideration. RESULTS Opportunities to identify and help manage an ED are numerous. Most individuals with an ED make several health care visits in either medical or psychiatric settings without ever being screened for an ED. General ED screening and assessment tool familiarization can facilitate a treatment trajectory for these patients, improve overall quality of life, and may potentially result in a life-saving intervention for this often-deadly cluster of medical and psychiatric disorders. CONCLUSION Screening and assessment in general clinical settings, identifying patients with undiagnosed EDs, beginning basic treatment plans, and referrals for appropriate follow-up care, have the potential to reduce ED recidivism and related health care costs. Simultaneously, and most important, long-term outcomes for patients with EDs may improve.

Understanding Eating Disorders and the Nurse's Role in Diagnosis, Treatment, and Support

“…When the ED is discovered, many patients are physically and psychologically ill (Mehler & Andersen, 2022;Owens et al, 2023). Initial inpatient treatment often fails, and patients are admitted multiple times for relapses at rates as high as 63%, especially during the first year after initial treatment.…”

“…to recovery and restoration (Corral-Liria et al, 2022;Owens et al, 2023;Salzmann-Erikson & Dahlén, 2017;Stavarski et al, 2019).…”

“…Patients find ways to conceal eating disorder behavior well: wearing loose clothing, eating normally in front of others, and then purging food privately or exercising excessively when alone. Additionally, healthcare providers in outpatient settings where patients with EDs may present for other problems may not have the knowledge to recognize subtle cues that could identify an ED (Johns et al, 2019; Owens et al, 2023; Salzman-Erikson & Dahlén, 2017).…”

“…Identifying EDs can be problematic in the early stages of illness when treatment may be most effective. Routine screenings for disordered eating, body image, mental health, height, weight, and body mass index (BMI) may discover early-stage EDs and improve treatment outcomes (Dooley-Hash et al, 2019; Hornberger et al, 2021; Owens et al, 2023). Patients with EDs present across healthcare settings where nurses can identify concerns by understanding physiological cues and conducting a thorough assessment and history.…”

“…Initial treatment of many patients with EDs involves medical stabilization in an inpatient setting before they can successfully engage in psychotherapy. The dual treatment of medical and psychological concerns during medical stabilization requires practitioners who demonstrate understanding, sensitivity, and knowledge regarding EDs and recognition of the multidisciplinary needs of patients (Johns et al, 2019; Owens et al, 2023; Salzman-Erikson & Dahlén, 2017). Medical stabilization often centers on nutritional restoration, avoidance of refeeding syndrome —a dangerous metabolic syndrome that can occur when nutrition is reintroduced after a prolonged period of malnutrition (Cioffi et al, 2021), management of electrolyte imbalance and other laboratory values, dietary planning, care of psychiatric concerns, and behavioral interventions such as staff supervision and support (Hornberger et al, 2021; Hovde et al, 2021; Owens et al, 2023).…”