Eating Disorders in Adolescence
Gordon Harper MD1
1 Director, Inpatient Psychiatry, Children's Hospital, Assistant Professor of Psychiatry, Harvard Medical School, Boston, MA.
Eating disorders challenge the pediatrician in several ways. The treatment course can be long, and the patient's response may be frustrating. Patients find it hard to trust professionals (as they find it hard to trust themselves) and present their situation in provocative terms (eg, "I know what I need to eat; the only problem is that my parents are giving me a hard time.") that ignore the cultural, familial, developmental, and physiological roots of the disorders and minimize the patient's own confusion. The impression projected by the patient that she is "in control" can make it hard to view her sympathetically. Being "in control" of an emaciated body or of chaotic eating is part of the problem.
Unpleasant feelings, such as shame, blame, frustration, inadequacy, rage, and guilt, are felt routinely by patients, parents, and professionals. The risk of serious injury or death is great. The differential diagnosis includes many other serious disorders first presenting in adolescence. For all these reasons, the eating disorders are an important part of pediatric practice, and the pediatrician monitoring the patient's physical well-being and overall development is an indispensable part of the team.
The eating disorders are "model" disorders, whose management requires understanding the physical, physiological, psychological, familial, and cultural dimensions of a teenager's life.
