Rare medical manifestations of severe restricting and purging: “Zebras,” missed diagnoses, and best practices

Gaudiani, Jennifer L.; Mehler, Philip S.

doi:10.1002/eat.22475

Cited by 23 publications

(7 citation statements)

References 95 publications

(154 reference statements)

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“…Many serious somatic complications of eating disorders are not readily visible to lay observers or recognizable to the affected individual (Table S3). Even experienced healthcare professionals have difficulty accurately identifying complications or may misattribute their causes (Currin, Schmidt, & Waller, ; Currin, Waller, & Schmidt, ; Currin, Waller, et al, ; Gaudiani & Mehler, ). From a broad perspective, eating disorders have also been neglected in research and funding in proportion to the public health burden that they incur (Geil, Schmidt, Fernandez‐Aranda, & Zipfel, ; Schmidt et al, ).…”

Section: Truth 1: Many People With Eating Disorders Look Healthy Yetmentioning

confidence: 99%

The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders

Schaumberg

Welch

Breithaupt

et al. 2017

Euro Eating Disorders Rev

205

127

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Objective In 2015, the Academy for Eating Disorders (AED) collaborated with international patient, advocacy, and parent organizations to craft the “Nine Truths About Eating Disorders.” This document has been translated into over 30 languages and has been distributed globally to replace outdated and erroneous stereotypes about eating disorders with factual information. In this paper, we review the state of the science supporting the Nine Truths. Methods The literature supporting each of the Nine Truths was reviewed, summarized, and richly annotated. Results Most of the Nine Truths arise from well-established foundations in the scientific literature. Additional evidence is required to further substantiate some of the assertions in the document. Future investigations are needed in all areas to deepen our understanding of eating disorders, their causes, and their treatments. Conclusions The “Nine Truths About Eating Disorders” is a guiding document to accelerate global dissemination of accurate and evidence-informed information about eating disorders.

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Section: Truth 1: Many People With Eating Disorders Look Healthy Yetmentioning

confidence: 99%

The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders

Schaumberg

Welch

Breithaupt

et al. 2017

Euro Eating Disorders Rev

205

127

View full text Add to dashboard Cite

show abstract

“…The symptoms that patients experience lead to further decreases in oral intake, which in turn brings about further weight and fat pad loss and thus worsening of the duodenal obstruction. In the eating disorder population, the symptoms of SMA syndrome can be inappropriately overlooked or dismissed and instead attributed to the inherent psychiatric component of this disease and the aversion to food and weight gain . Also, patients with AN often have co‐morbid conditions such as gastroparesis that can aggravate abdominal symptoms and make ongoing attempted oral intake very challenging.…”

Section: Discussionmentioning

confidence: 99%

“…In the eating disorder population, the symptoms of SMA syndrome can be inappropriately overlooked or dismissed and instead attributed to the inherent psychiatric component of this disease and the aversion to food and weight gain. 12 Also, patients with AN often have co-morbid conditions such as gastroparesis that can aggravate abdominal symptoms and make ongoing attempted oral intake very challenging. Gastroparesis, or slowed gastric emptying, manifests in patients with more severe forms of AN with symptoms of bloating, nausea, and early satiety, but not actual pain.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric artery syndrome in severe anorexia nervosa: A case series

Watters

Gibson

Dee

et al. 2019

Clinical Case Reports

Self Cite

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Superior mesenteric artery syndrome presents with nonspecific GI complaints, hindering weight restoration in those with anorexia nervosa. Diagnosis is made with radiologic testing, and treatment requires only weight restoration, negating the need for surgical intervention. K E Y W O R D Sanorexia nervosa, CT scan, gastroparesis, GI series, superior mesenteric artery syndrome How to cite this article: Watters A, Gibson D, Dee E, Mascolo M, Mehler PS. Superior mesenteric artery syndrome in severe anorexia nervosa: A case series.

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“…Once in hospital, patients with severe anorexia nervosa present major challenges. In a review of complications seen during preparation for surgery in patients with anorexia nervosa (Hirose 2014), hypoglycaemia, leukopaenia and other potentially fatal complications were seen frequently, and Gaudiani & Mehler (2016) point to the difficulty medical units face in diagnosing and treating rare medical complications of anorexia nervosa. One potentially fatal complication in the treatment of severe anorexia nervosa is re-feeding syndrome.…”

Section: Acute Presentation Of Anorexia Nervosa In Medical Settingsmentioning

confidence: 99%

MARSIPAN: management of really sick patients with anorexia nervosa

Robinson¹,

Jones²

2018

BJPsych advances

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SUMMARYAnorexia nervosa is a potentially fatal illness that affects women and a smaller proportion of men. When a patient becomes so severely ill that admission to a medical unit is required, the risk of a poor outcome is high. Most medical services do not have sufficient expertise, without psychiatric help, to manage the nutritional, medical, behavioural and family problems that often appear. These problems interact and this can adversely affect outcome. This article discusses, with reference to the MARSIPAN report, the procedure that should be followed when such a patient presents to an acute medical service. It considers diagnosis, risk assessment, consent, re-feeding syndrome, underfeeding syndrome and treatment-sabotaging behaviours. It stresses the importance of collaboration between expert medical and psychiatric staff, and involvement of the family. When these issues are adequately addressed, the outcome for the patient is more likely to be positive.LEARNING OBJECTIVES•Be confident in diagnosing individuals with anorexia nervosa and identify when urgent in-patient medical treatment is required•Be confident in assessing and managing physical risk in individuals with anorexia nervosa•Be aware of the Royal College of Psychiatrists’ MARSIPAN report and its implications for the management of individuals with eating disorders in medical settingsDECLARATION OF INTERESTNone.

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Rare medical manifestations of severe restricting and purging: “Zebras,” missed diagnoses, and best practices

Cited by 23 publications

References 95 publications

The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders

The Science Behind the Academy for Eating Disorders' Nine Truths About Eating Disorders

Superior mesenteric artery syndrome in severe anorexia nervosa: A case series

MARSIPAN: management of really sick patients with anorexia nervosa

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