Ep 202 Eating Disorders: Common, Commonly Missed, Mismanaged and Misunderstood

Eating disorders have the highest mortality rate of any psychiatric illness, yet they are frequently missed in the Emergency Department as they can be elusive. Only one in 246 patients who screen positive for an eating disorder at triage have a chief complaint suggesting it. These patients don’t always fit the stereotype—many appear “healthy", have normal BMIs, and/or present with vague GI, cardiac, or neurological symptoms. Missing the diagnosis has important consequences. The earlier an eating disorder is identified and the earlier that appropriate treatment is initiated the better the long term outcomes. In this episode, with the expertise of Dr. Samantha Martin and Dr. Jennifer Tomlin, we’ll break down the essential clinical clues, screening questions, red flags, and subtle exam findings that can help Emergency Physicians diagnose eating disorders early and initiate treatment to decrease mortality and long term morbidity in these young patients. Eating disorders need to be thought of as both a psychiatric condition and medical condition to optimize the pick up rate and appropriate management. Missing or mismanaging eating disorders in the ED means missing an opportunity to save a life and prevent long term morbidity... Podcast production, sound design & editing by Anton Helman; Voice editing by Braedon Paul Written Summary and blog post by Anton Helman February, 2025 Cite this podcast as: Helman, A. Tomlin, J. Martin, S. Episode 202 Eating Disorders: Common, Commonly Missed, Mismanaged and Misunderstood. Emergency Medicine Cases. February, 2025. https://emergencymedicinecases.com/eating-disorders. Accessed February 28, 2025 Résumés EM CasesA 16-year-old male presents to the ED with his mother with the chief complaint of intermittent abdominal pain and constipation for several weeks. There are no red flag symptoms for an underlying surgical cause and review of systems is otherwise unremarkable. Vital signs include a HR 50, BP 85/40 T 35.9. Blood work is ordered, and it shows a mildly low potassium at 3.2 mEq/L, a mildly low hemoglobin at 11g/dl and normal liver enzymes. The patient is discharged from the ED with the diagnosis of low-risk nonspecific abdominal pain with a recommendation to follow up with their primary care physician, and instructions to return for list of red flag symptoms. This case represents a miss of a potentially life-threatening diagnosis that Emergency Physicians have little knowledge of. Eating disorders are common, often elusive, and can be deadly * Eating disorders, which include anorexia nervosa, bulimia nervosa, binge eating disorder and Avoidant/restrictive food intake disorder (ARFID), are common with increasing prevalence, increasing visits to emergency departments, and have the highest mortality of any psychiatric illness. * The lifetime prevalence rates of anorexia nervosa are as high as 4% among females and is increasing among males. * In young females the mortality rate of eating disorders is estimated to be as high as 10%. * In a recent study, after a 5-year follow-up the mortality rate of anore...