Anorexia and bulimia nervosa in adolescents: medical, nutritional, psychological and psychiatric evaluation and management

Abstract: In this paper, we review the diagnostic criteria and clinical management for anorexia nervosa and bulimia nervosa in adolescents treated in primary care settings. A clinical review and discussion of the evaluation and treatment of the medical, nutritional, psychological, and psychiatric aspects, including psychopharmacological management, of these serious disorders in adolescents will be presented. Although a variety of pharmacologic treatments are reviewed, the mainstay of treatment is nutritional rehabilitation with careful medical monitoring. The care of these youth requires a multidisciplinary team approach. Given the high potential mortality rate, evidence-based treatment approaches are described to address the psychological and family aspects of the disorders. These include dialectic behavioral therapy to address the suicidal and non-suicidal self-injury, as well as cognitive behavioral therapy to treat the maladaptive cognitions often associated with these disorders. The need for comprehensive evaluation and treatment of youth with an eating disorder (ED) is described; this includes safety planning, given the high rate of both suicidal behavior and non-suicidal self-injury. The care of adolescents with an ED requires a comprehensive approach with a multidisciplinary team with ongoing communication, discussion as the treatment proceeds and team meetings to review the progress of the treatment. Appreciating the necessary level of care is critical to limit morbidity and to prevent mortality from these serious conditions. Caring for adolescents with an ED in the primary care setting requires an understanding of the clinical condition, the various aspects of the treatment and an appreciation for the careful monitoring for safety.