"We Don’t Treat Eating Disorders"

Eating disorders have the highest mortality rate of any psychiatric disorder. However only 10-30% of affected people will receive treatment. Reasons for this limited treatment rate are varied and complex, including the nature of the illnesses, but also the unclear and overwhelming nature of navigating treatment options for both families and community providers. Additionally, some evidence-based approaches are available, but treatment outcomes remain modest with a persistently discordant level of research funding when compared to the illness burden. And this was prior to COVID.



The psychosocial stressors and isolation associated with the pandemic provided the ideal conditions for eating disorders to worsen across all ages and geography. The National Eating Disorders Association reported a 70% increase in the number of inquiries compared to last year. Given the likelihood of enduring downstream effects of the pandemic on mental health, there is little expectation for this volume to meaningfully change in the near future. However, the system of care for these illnesses, already vulnerable, has been unable to adequately support the need. Specialized treatment programs have been at prolonged capacity, or even closed, thereby necessitating fast adaptation for consultation-liaison (C/L) services both at the acute inpatient level of care and in the community.



Eating disorders are among the most challenging conditions that a C/L psychiatrist is asked to help manage, and require an integrated, multi-disciplinary approach for success. They are universally complex throughout the lifespan to treat. Not only are the patients’ symptoms particularly disarming in their own right (they are ego-syntonic and occasionally border on the psychotic), but also their behaviors often cause considerable distress in the teams caring for them. Thus, the C/L psychiatrist is often in the position of attending to the emotions and reactions of the hospital staff while addressing the psychiatric needs of the individual patient. Treatment approaches can be met with both enthusiasm and strong resistance.



The workshop will begin and end by polling audience members to determine their pre and post-workshop sense of self-efficacy/competency in treating eating disorders.



Dr. Robert Mendenhall, will present updated epidemiological trends across the lifespan. He will address the pandemic’s impact, including isolation, changes in structure, and early trends of food availability, as well as the current landscape of eating disorder research.



Dr. Roslyn Gerwin will present the successes and challenges of rapidly creating a framework for Anorexia Nervosa on an inpatient pediatrics unit, utilizing a case-based approach. Discussion will include developing community-based treatment options at a rural tertiary care center.



Dr. Laura Markley will highlight strategies for supporting the ancillary staff who care for these hospitalized patients.



Dr. Eva Ihle will describe additional clinical scenarios in which the consulting psychiatrist addresses the frustration and counter-transference reactions of the primary team.