Better clinical management of anorexia nervosa in teens

To the Editor

In their recent wjm paper on eating disorders in adolescents, Brown and colleagues discussed key issues in diagnosis and clinical management.¹ There were two important issues, however, that they failed to address.

Firstly, although the authors state that their data are relevant to adolescents with anorexia nervosa, it is important to remember that some patients present with partial syndromes. These are classified by the American Psychiatric Association as “eating disorders not otherwise specified.”² Patients with partial syndromes do not have all of the clinical manifestations that characterize the classical subtypes of eating disorders, but their medical complications are the same as those of anorexia nervosa. Patients with partial syndromes may not show the usual overvalued ideas that are common in the classic anorexia nervosa syndrome,³ and they are therefore able to correct their pathologic thoughts about “becoming too fat.” Indeed, in some cases, gentle discussion with patients may assist them in changing their maladaptive eating behavior, with consequent clinical improvement.

Secondly, the authors suggest that most adolescents with eating disorders can be treated as outpatients. They recommend that hospitalization be reserved only for those teens whose weight loss has been rapid or intense, or for those adolescents with cardiovascular arrhythmias.

Although this is good clinical advice, clinicians should remember that a change in the patient's environment may be therapeutic, particularly if patients are experiencing difficulties in the home setting.⁴ Perhaps hospital-based day programs for eating disorders would offer the best compromise.