Remuda Ranch

When To Refer

Admission to inpatient eating disorder treatment is justified when the patient is diagnosed with an eating disorder that meets DSMIV Criteria and when the patient manifests disabling medical or psychiatric symptoms which impede the treatment of the eating disorder in a less restrictive setting.

Common Symptoms

• Rapid or persistent decline in oral intake or decline in weight despite intensive outpatient or partial hospitalization intervention
• Inability to control purge behaviors leading to medical compromise
• Failure or anticipated failure at lower level of care
• Motivation for recovery: Fair or Poor
• Ego-Syntonic ED thoughts = 4 hours/day
• Co-occurring psychiatric disorder requiring hospitalization
  • Substance abuse
  • Suicide plan or intent, severe depression
  • Severe anxiety, PTSD, OCD
• Needs meal supervision or will restrict/binge/purge
• Inability to function in daily responsibilities
• Uncontrolled compulsive exercise
• Severe dysfunctional family system/Lack of support system
• Resistant or uncooperative with treatment
• Geographical isolation from treatment services
• Medical Complications...

Medical Complications in Adults

• HR < 40 bpm
• Dehydration
• BP < 90/60
• Hepatic, renal, cardiovascular organ compromise
• Glucose < 60 mg/dl
• Potassium < 3 meq/liter
• Weight < 85% IBW
• Other electrolyte imbalance
• Type I Diabetes
• Temperature < 97° F

Medical Complications in Children

• HR in the 40s
• > 20 bpm increase in HR with position changes
• > 10-20 mm Hg drop in BP with position changes
• BP < 80/50
• Acute weight decline with food refusal even if not < 85% IBW
• Others listed for adults

DSM-IV Diagnostic Criteria for Eating Disorders

Anorexia Nervosa

• Low Weight: Refusal to maintain body weight at or above a minimally normal weight for age and height (e.g., weight loss leading to maintenance of body weight less than 85% of that expected; or failure to make expected weight gain during period of growth, leading to body weight less than 85% of that expected).
• Weight Phobia: Intense fear of gaining weight or becoming fat, even though underweight.
• Body Image Issues: Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.
• Amenorrhea: In postmenarcheal females, amenorrhea, i.e., the absence of at least three consecutive menstrual cycles. (A woman is considered to have amenorrhea if her periods occur only following hormone, e.g., estrogen, administration).

Bulimia Nervosa

• Binge-Eating: Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
  • Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
• Compensatory Behaviors: Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise.
• Frequency: The binge eating and inappropriate compensatory behaviors both occur, on average, at least twice a week for 3 months.
• Body Image Issues: Self-evaluation is unduly influenced by body shape and weight.
• Exclusion: The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

Eating Disorders Not Otherwise Specified (EDNOS)

The EDNOS category is for disorders of eating that do not meet the criteria for any specified Eating Disorder.

• For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses.
• All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual's current weight is in the normal range.
• All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months.
• The regular use of inappropriate compensatory behavior by an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies).
• Repeatedly chewing and spitting out, but not swallowing, large amounts of food.
• Binge eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviors characteristic of Bulimia Nervosa.