Background: Perhaps no illness is more indicative of the need for dual medical and mental health treatment than eating disorders. The potential for true physiological problems with emotional overlay makes diagnosis and treatment particularly challenging. Physical symptoms may be true manifestations of physical illness, psychosomatic symptoms or other associated mental illness.
A Fine Line: The Intersection of mental health and medical treatment of eating disorders
- I. Introduction
- II. Common Medical Complications of Eating Disorders
- III. Common Mental Health Issues in Eating Disorders
- IV. Case Presentations of Eating Disorders demonstrating the complicated interplay of Medical and Psychiatric Aspects
- a. Case of chest pain vs anxiety
- b. Case of Dizziness vs Medication SE
- V. Techniques used to Differentiate Primary Medical vs Psychiatric Symptom Etiology
- VI. Conclusion
Perhaps no illness is more indicative of the treatment needs of patients with highly complex co-morbid mental health and medical illness than eating disorders. Anorexia nervosa has the highest mortality rate of any mental health diagnosis with some dying of suicide but many more succumbing to medical problems. Complications generally result from organ failure from malnutrition but also from alcohol and drug use compounding the physiological deterioration with eating disorders as well as those related to alcohol or recreational drug use mixed with medications targeting anxiety and depression. Particularly challenging are the situations where physical symptoms may mask the underlying emotional illness such as that seen with somatization and anxiety-related illness. Physical symptoms may be true manifestions of physical illness, psychosomatic symptoms or other co-morbid mental health illnesses. This can make diagnosis and treatment of eating disorders or other co-morbid mental health issues very challenging with distraught, often resistant patients. These challenges with eating disorder treatment have broader implications for a number of other acute and chronic illnesses in adolescents and young adults, and accurate diagnosis and treatment necessitate the interaction of a multidisciplinary team including mental health, medical and nutrition.
This presentation will include a didactic session with presentations from Lauren Ozbolt, MD, a child and adolescent psychiatrist with extensive eating disorder experience and Joel Jahraus, MD, FAED, CEDS, a family physician caring for medical issues of eating disorder patients for many years. There will be a handout for all attendees and a Q&A session following the presentations.
Goals:
- To understand the acute and evolving needs of patients with eating disorders from a physiologic and emotional perspective
- To understand the interplay and potential masking of some aspects of treatment given the complexities of physical and emotional interaction
- To understand the risks including potentially life-threatening aspects of care when physical and emotional symptoms present simultaneously
- To discuss appropriate evaluation and treatment in a multidisciplinary team setting with emphasis on effective evaluation and treatment of both physical and medical components of the illness utilizing the synergism of effective interaction of team members on both medical and mental health sides of the treatment team
Dr. Joel Jahraus is well-known and respected for his two decades of specialization in the medical management of patients with eating disorders. A board-certified physician for over 30 years, he is a recognized expert on diabetes and the medical complications of eating disorders. He co-authored a chapter on eating disorders in the Textbook of Psychosomatic Medicine, published by the American Psychiatric Association and has been featured in various national media documentaries on eating disorders. For his outstanding contributions to the field, he received the prestigious Ellis Island Medal of Honor in 2011.
Lauren Ozbolt, MD is a board certified child and adolescent psychiatrist with a sub-specialty in eating disorders. In the past, she has served as the Medical Director of the University of Miami Eating Disorder Program and Attending Psychiatrist of the Oliver-Pyatt Residential Eating Disorder Treatment Program. She has been interviewed on local and national television and radio programs for her expertise in eating disorders and body image. She currently provides eating disorder consultation services and operates a small private practice in Los Angeles.
