Admitted for an Eating Disorder: Challenges Clinical Psychologists Face in Working with Patients and Their Families on a
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Admitted for an Eating Disorder: Challenges Clinical Psychologists Face in Working with Patients and Their Families on a Consultation–Liaison Service in a Tertiary Pediatric Hospital Lauren M. Potthoff1,2 · Imari‑Ashley F. Palma1 · Ryan D. Davidson1 · I. Simona Bujoreanu1 · Katharine Thomson1
© Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Eating disorders are one of the most common causes of pediatric hospitalizations due to primary mental health diagnoses. The purpose of this article is to discuss the challenges clinical psychologists face in working with patients with eating disorders and their families during medical admissions. Using the Psychiatry Consultation Service at a tertiary pediatric academic medical center in the Northeast as a framework, authors present the responsibilities of clinical psychologists on this service and their role within the larger, interdisciplinary team. Topics addressed also include systemic challenges, medical and psychiatric comorbidities, and differential psychiatric diagnoses. Case examples are provided to highlight various challenges as well as potential solutions and approaches. Clinical implications, limitations, and directions for future research are also discussed. Keywords Consultation–liaison · Eating disorders · Child · Adolescent · Disposition
Introduction
Background
Eating disorders (EDs) are one of the most common causes of pediatric hospitalizations due to a primary mental health diagnosis (Bardach et al., 2014). Patients with anorexia nervosa (AN) have the highest mortality rate of all psychiatric disorders (Fichter & Quadflieg, 2016). Their hospitalizations are typically due to cardiac dysrhythmias, malnutrition, hypotension, and hypokalemia (Calderon, Vander Stoep, Collett, Garrison, & Toth, 2007). Similarly, patients with Avoidant-Restrictive Food Intake Disorder (ARFID) are admitted due to nutritional insufficiency (Strandjord, Sieve, Richmond, & Rome, 2015), while those with bulimia nervosa (BN) may require hospitalizations due to electrolyte or acid base imbalance (Westmoreland, Krantz, & Mehler, 2016).
Setting
* Lauren M. Potthoff [email protected] 1
Department of Psychiatry, Boston Children’s Hospital/ Harvard Medical School, Boston, IL, USA
Department of Gastroenterology, Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
2
The Psychiatry Consultation Service (PCS) is an interdisciplinary service that includes both psychology and psychiatry attending staff and trainees as well as social workers. It is located within a tertiary pediatric academic medical center in the Northeast. PCS receives consultation requests from over 30 medical services and sees patients across inpatient medical, surgical, and intensive care units. On average, 11% of all PCS consultations each year are related to ED evaluation and management. Hospital protocols stipulate that admitting medical services consult with PCS within 24 h of identifying a
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