Eating Disorders

Ellen S. Rome; Sarah E. Strandjord

doi:10.1542/pir.2015-0180

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Ellen S. Rome, MD, MPH*
Sarah E. Strandjord, MD^†

^*Department of General Pediatrics, Cleveland Clinic Children’s Hospital, Cleveland, OH.
^†Cleveland Clinic Lerner College of Medicine, Cleveland, OH.

AUTHOR DISCLOSURE
Drs Rome and Strandjord have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Educational Gap

For patients with moderate malnutrition, higher-calorie diets during refeeding may provide benefits, such as less initial weight loss, faster weight gain, and shorter hospitalization, without increasing the risk of refeeding syndrome. (1)(2)(3)

Objectives

After completing the article, the reader should be able to:

Understand the differences between Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) and prior diagnostic criteria for eating disorders.
Recognize clinical presentations characteristic of anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Plan appropriate management for anorexia nervosa, bulimia nervosa, and binge-eating disorder.
Distinguish avoidant/restrictive food intake disorder from other eating disorders.

Introduction

Eating disorders are complex illnesses with profound psychosocial and physical consequences, including high rates of mortality. Despite growing recognition of their prevalence and severity, eating disorders remain underdiagnosed and undertreated. This review provides up-to-date information on eating disorder diagnosis, including tips for early recognition and evaluation, along with an overview of potential complications and evidence-based treatments. Pediatricians, in particular, play an important role in providing patients and their families with the care, resources, and guidance they need to reach and maintain recovery.

Eating Disorders in the Context of DSM-5

Eating disorder presentation and severity varies widely among individuals. In developing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), (4) one of the primary goals of the Eating Disorder Work Group was to better describe the spectrum of patient behaviors. Previous editions of DSM only specified 2 eating disorders, anorexia nervosa and bulimia nervosa, with more than 50% of patients grouped into the category of Eating Disorders Not Otherwise Specified (EDNOS). The DSM-5 Feeding and Eating Disorders chapter includes 6 entities: anorexia nervosa, …