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17 - Assessment and treatment of chronic medical complications

from Part IV - Evidence-based care

Published online by Cambridge University Press:  02 December 2009

Brett McDermott
By
Richard E. Kreipe
Edited by
Tony Jaffa
Brett McDermott
Affiliation:
University of Queensland
Richard E. Kreipe
Affiliation:
Golisano Children's Hospital at Strong,Rochester, NY, USA
Tony Jaffa
Affiliation:
Phoenix Centre, Cambridge
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Summary

Approach to young patients with chronic medical complications

Patients with chronic medical complications associated with an eating disorder (ED) often elicit negative countertransference from medical care providers (Franko & Rolfe, 1996). Common reactions by professionals include frustration with treating conditions that patients ‘bring on themselves’ or anger at a patient's resistance to treatment or intentional falsification of body weight during weigh-ins. What makes these conditions especially vexing is that they often occur in extremely bright, talented young people who seem to be unaware of the harm that they are doing to themselves. As noted by Strober (2004), the chronically ill patient requires a unique approach to care, one that minimizes the risk of iatrogenic effects of too-rapid weight restoration or failure to be aware of potentially negative effects of countertransference ‘by integrating clinical experience, empirical psychological findings and a conceptual understanding of developmental and phenomenologic aspects of the illness’.

Given the tendency for younger patients with chronic medical complications to resist efforts to change, it is worthwhile for practitioners to apply the biopsychosocial approach in a manner that optimizes the likelihood that patients will cooperate with treatment recommendations. Promising in this regard is the use of motivational interviewing, closely linked with readiness-to-change.

Keywords

adolescentsamenorrhoeabrainchronic medical complicationseating disorderpatient
Type
Chapter
Information
Eating Disorders in Children and Adolescents , pp. 212 - 224
Publisher: Cambridge University Press
Print publication year: 2006

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References

Bachrach, L. K., Guido, D., Katzman, D. & Litt, I. F. (1990). Decreased bone density in adolescent girls with anorexia nervosa. Pediatrics, 86, 440–7.Google Scholar
Birch, K. (2005). Female athlete triad. British Medical Journal, 330, 244–6.Google Scholar
Crow, S. J., Thuras, P., Keel, P. K. & Mitchell, J. E. (2002). Long-term menstrual and reproductive function in patients with bulimia nervosa. American Journal of Psychiatry, 159, 1048–50.Google Scholar
Franko, D. L. & Rolfe, S. (1996). Counter-transference in the treatment of patients with eating disorders. Psychiatry, 59, 108–16.Google Scholar
Franko, D. L., Blais, M. A., Becker, A. E.et al. (2001). Pregnancy complications and neonatal outcomes in women with eating disorders. American Journal of Psychiatry, 158, 1461–6.Google Scholar
Golden, N. H., Jacobson, M. S., Schebendach, J.et al. (1997). Resumption of menses in anorexia nervosa. Archives of Pediatrics and Adolescent Medicine, 151, 16–21.Google Scholar
Golden, N. H. (2003). Osteopenia and osteoporosis in anorexia nervosa. Adolescent Medicine State of the Art Reviews, 14, 97–108.Google Scholar
Gordon, C. M., Dougherty, D. D., Fischman, A. J.et al. (2001). Neural substrates of anorexia nervosa: a behavioral challenge study with positron emission tomography. Journal of Pediatrics, 139, 51–7.Google Scholar
Gordon, C. M. & Nelson, L. M. (2003). Amenorrhea and bone health in adolescents and young women. Current Opinion in Obstetrics and Gynecology, 15, 377–84.Google Scholar
Gordon, I., Lask, B., Bryant-Waugh, R., Christie, D. & Timimi, S. (1997). Childhood-onset anorexia nervosa: towards identifying a biological substrate. International Journal of Eating Disorders 22, 159–65.Google Scholar
Grinspoon, S., Thomas, L., Miller, K., Herzog, D. & Klibanski, A. (2002). Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 87, 2883–91.Google Scholar
Grottoli, S., Gasco, V., Ragazzoni, F. & Ghigo, E. (2003). Hormonal diagnosis of GH hypersecretory states. Journal of Endocrinological Investigation, 26 (10 Suppl), 27–35.Google Scholar
Gull, W. W. (1874). Anorexia nervosa. Transactions of the Clinical Society of London, 7, 22–8.Google Scholar
Hasler, G., Delsignore, A., Milos, G., Buddeberg, C. & Schnyder, U. (2004). Application of Prochaska's transtheoretical model of change to patients with eating disorders. Journal of Psychosomatic Research, 57, 67–72.Google Scholar
Isner, J. M., Roberts, W. C., Heymsfield, S. B. & Yager, J. (1985). Anorexia nervosa and sudden death. Annals of Internal Medicine, 102, 49–52.Google Scholar
Katzman, D. K., Zipursky, R. B., Lambe, E. K. & Mikulis, D. J. (1997). A longitudinal magnetic resonance imaging study of brain changes in adolescents with anorexia nervosa. Archives of Pediatrics and Adolescent Medicine, 151, 793–7.Google Scholar
Kazis, K. & Iglesias, E. (2003). The female athlete triad. Adolescent Medicine State of the Art Reviews, 14, 87–95.Google Scholar
Kerem, N. C. & Katzman, D. K. (2003). Brain structure and function in adolescents with anorexia nervosa. Adolescent Medicine State of the Art Reviews, 14, 109–18.Google Scholar
Key, A., Mason, H., Allan, R. & Lask, B. (2002). Restoration of ovarian and uterine maturity in adolescents with anorexia nervosa. International Journal of Eating Disorders, 32, 319–25.Google Scholar
Keys, A. (1948). Cardiovascular effects of malnutrition and starvation. Modern Concepts in Cardiovascular Disease, 27, 21.Google Scholar
Klibanski, A., Biller, B. M., Schoenfeld, D. A., Herzog, D. B. & Saxe, V. C. (1995). The effects of estrogen administration on trabecular bone loss in young women with anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 80, 898–904.Google Scholar
Kohn, M. R., Ashtari, M., Golden, N. H.et al. (1997). Structural brain changes and malnutrition in anorexia nervosa. Annals of the New York Academy of Sciences, 817, 398–9.Google Scholar
Kouba, S., Hallstrom, T., Lindholm, C. & Hirschberg, A. L. (2005). Pregnancy and neonatal outcomes in women with eating disorders. Obstetrics and Gynecology, 105, 255–60.Google Scholar
Kreipe, R. E., Churchill, B. H. & Strauss, J. (1989). Long-term outcome of adolescents with anorexia nervosa. American Journal of Diseases of Children, 143, 1322–7.Google Scholar
Kreipe, R. E. & Harris, J. P. (1992). Myocardial impairment resulting from eating disorders. Pediatric Annals, 21, 760–8.Google Scholar
Kreipe, R. E., Hicks, D. G., Rosier, R. N. & Puzas, J. E. (1993). Preliminary findings on the effects of sex hormones on bone metabolism in anorexia nervosa. Journal of Adolescent Health, 14, 319–24.Google Scholar
Kreipe, R. E., Goldstein, B., DeKing, D. E., Tipton, R. & Kempski, M. H. (1994). Heart rate power spectrum analysis of autonomic dysfunction in adolescents with anorexia nervosa. International Journal of Eating Disorders, 16, 159–65.Google Scholar
Lantzouni, E., Frank, G. R., Golden, N. H. & Shenker, R. I. (2002). Reversibility of growth stunting in early onset anorexia nervosa: a prospective study. Journal of Adolescent Health, 31, 162–5.Google Scholar
Mehler, P. S. (2003). Osteoporosis in anorexia nervosa: prevention and treatment. International Journal of Eating Disorders, 33, 113–26.Google Scholar
Miller, K. K., Grieco, K. A., Mulder, J.et al. (2004). Effects of risedronate on bone density in anorexia nervosa. Journal of Clinical Endocrinology and Metabolism, 89, 3903–6.Google Scholar
Misra, M., Miller, K. K., Almazan, C.et al. (2004). Alterations in cortisol secretory dynamics in adolescent girls with anorexia nervosa and effects on bone metabolism. Journal of Clinical Endocrinology and Metabolism, 89, 4972–80.Google Scholar
Modan-Moses, D., Yaroslavsky, A., Novikov, I.et al. (2003). Stunting of growth as a major feature of anorexia nervosa in male adolescents. Pediatrics, 111, 270–6.Google Scholar
Newman, M. M. & Halmi, K. A. (1989). Relationship of bone density to estradiol and cortisol in anorexia nervosa and bulimia. Psychiatry Research, 29, 105–12.Google Scholar
Palmer, E. P. & Guay, A. T. (1985). Reversible myopathy secondary to abuse of ipecac in patients with major eating disorders. New England Journal of Medicine, 313, 1457–9.Google Scholar
Ramacciotti, C. E., Guidi, L., Bondi, E.et al. (1997). Differential dynamic responses of luteinizing hormone to gonadotropin releasing hormone in patients affected by bulimia nervosa-purging versus non-purging type. Eating and Weight Disorders: EWD, 2, 150–5.Google Scholar
Roche, F., Barthelemy, J. C., Mayaud, N.et al. (2005). Refeeding normalizes the QT rate dependence of female anorexic patients. American Journal of Cardiology, 95, 277–80.Google Scholar
Rowland, T., Koenigs, L. & Miller, N. (2003). Myocardial performance during maximal exercise in adolescents with anorexia nervosa. Journal of Sports Medicine and Physical Fitness, 43, 202–8.Google Scholar
Russell, G. F. M. (1979). Bulimia nervosa: an ominous variant of anorexia nervosa. Psychological Medicine, 9, 429–48.Google Scholar
Shamim, T., Golden, N. H., Arden, M., Filiberto, L. & Shenker, I. R. (2003). Resolution of vital sign instability: an objective measure of medical stability in anorexia nervosa. Journal of Adolescent Health, 32, 73–7.Google Scholar
Shomento, S. H. & Kreipe, R. E. (1994). Menstruation and fertility following anorexia nervosa. Adolescent and Pediatric Gynecology, 7, 142–6.Google Scholar
Sutton, John M. G.St, Plappert, T., Crosby, L.et al. (1985). Effects of reduced left ventricular mass on chamber architecture, load and function: a study of anorexia nervosa. Circulation, 72, 991–1000.Google Scholar
Strober, M. (2004). Managing the chronic, treatment-resistant patient with anorexia nervosa. International Journal of Eating Disorders, 36, 245–55.Google Scholar
Swenne, I. (2004). Weight requirements for return of menstruations in teenage girls with eating disorders, weight loss and secondary amenorrhoea. Acta Paediatrica, 93, 1449–55.Google Scholar
Turner, J. T.Bulsara, M. K., McDermott, B. M.et al. (2001). Predictors of low bone density in adolescents with anorexia nervosa and other dieting disorders. International Journal of Eating Disorders, 30, 245–51.Google Scholar
Vanderdonckt, O., Lambert, M., Montero, M. C., Boland, B. & Brohet, C. (2001). The 12-lead electrocardiogram in anorexia nervosa: a report of 2 cases followed by a retrospective study. Journal of Electrocardiology, 34, 233–42.Google Scholar
Vitousek, K., Watson, S. & Wilson, G. T. (1998). Enhancing motivation for change in treatment-resistant eating disorders. Clinical Psychology Review, 18, 391–420.Google Scholar
Wilson, G. T. & Schlam, T. R. (2004). The transtheoretical model and motivational interviewing in the treatment of eating and weight disorders. Clinical Psychology Review, 24, 361–78.Google Scholar

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