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Clinical Handbook of Psychological Consultation in Pediatric Medical Settings pp 211–226Cite as

Eating Disorders and Avoidant/Restrictive Food Intake Disorder

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Part of the book series: Issues in Clinical Child Psychology ((ICCP))

Abstract

Pediatric eating and feeding disorders, including anorexia nervosa, bulimia nervosa, binge eating disorder, and avoidant/restrictive food intake disorder, affect many children and teens throughout the United States. In the treatment of eating and feeding disorders, pediatric consultation-liaison psychologists are often involved in diagnostic evaluation, treatment planning, and coordination of care with the patient, family, and other multidisciplinary providers. This chapter summarizes evidence-based approaches to engaging patients with eating and feeding disorders and their families in evaluation, formulation, treatment, and disposition planning. The chapter providers review of levels of care and models for empirically supported treatment as well as considerations for adaptation based on factors commonly experienced in consultation-liaison practice. Case examples and other resources for the consultation-liaison psychologist are also provided.

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Author information

Authors and Affiliations

  1. Department of Psychiatry, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA

    Kevin K. Tsang & Lillian C. Hayes

  2. Department of Pediatrics, Nemours Alfred I. duPont Hospital for Children, Sidney Kimmel Medical College, Thomas Jefferson University, Wilmington, DE, USA

    Chrissy Cammarata

Authors
  1. Kevin K. Tsang
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  2. Lillian C. Hayes
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  3. Chrissy Cammarata
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Corresponding author

Correspondence to Kevin K. Tsang .

Editor information

Editors and Affiliations

  1. Pediatric Consultation-Liaison Service, Norton Children’s Hospital, Louisville, KY, USA

    Bryan D. Carter

  2. Department of Pediatrics, University of Louisville, School of Medicine, Louisville, KY, USA

    Bryan D. Carter

  3. Department of Pediatrics, C.S. Mott Children’s Hospital Michigan Medicine, Ann Arbor, MI, USA

    Kristin A. Kullgren

Appendices

Appendix 1: Review of Levels of Care

Overview

PCP with outpatient mental health involvement

Multidisciplinary outpatient

Intensive outpatient/partial hospitalization

Residential treatment center

Medical admission/inpatient

PCP management, integrated primary care psychologist or community mental health support, nutrition consult

Eating disorder specialty team with adolescent medicine physician, eating disorder mental health specialist, and nutrition support

May involve 2–5 days/week, several hours/day treatment. May be step-down from residential care

Highly structured environment for healthy eating, promoting weight gain/management, reducing destructive behaviors, and working toward effective coping skills

Medical or psychiatric admission to medically and/or psychiatrically stabilize

Medical status

Medically stable for treatment outside hospital setting

Unstable: HR near 40, orthostatic BP changes, BP <80/50 mmHg; hypokalemia, hypomagnesemia

Psychiatric status

No psych comorbidities or suicidal risk

One or more comorbid psychiatric diagnoses

Risk of danger to self or others; specific plan with lethality or intent; depression with poor impulse control or previous suicide attempt

Weight, BMI

BMI within acceptable limits for age

Persistent weight loss; BMI <18

85–90% of goal weight

75–85% of goal weight

Weight <75% of goal weight; rapid weight loss over 30 days prior to admission

Unable to achieve prescribed weight or stop binge/purge cycle; uncontrolled symptoms

Support

Good social support

Good social support

May have poor social support

May have poor social support

Severe family conflict or problems or absence of family or support

  1. APA (2013) and Intermountain Healthcare (2013)

Appendix 2: Resources for Consultation-Liaison Psychologists

Organizations

Books

  • Lock, J., & Le Grange, D. (2013). Treatment manual for Anorexia Nervosa: A family-based approach (2nd ed.). New York: Guilford.

  • Le Grange, D., & Lock, J. (2007). Treating Bulimia in adolescents: A family-based approach (2nd ed.). New York: Guilford.

  • Thomas, J. J., & Eddy, K. T. (2018). Cognitive-Behavioral Therapy for Avoidant/Restrictive Food Intake Disorder: Children, adolescents, and adults. Cambridge, United Kingdom: Cambridge University Press.

Articles

Anorexia Nervosa

  • Katzman, D. K., Peebles, R., Sawyer, S. M., Lock, J., & Le Grange, D. (2013). The role of the pediatrician in family-based treatment for adolescent eating disorders: Opportunities and challenges. Journal of Adolescent Health, 53, 433–440.

  • Stiles-Shields, C., Rienecke Hoste, R., Doyle, P. M., & Le Grange, D. (2012). A review of family-based treatment for adolescents with eating disorders. Reviews on Recent Clinical Trials, 7, 133–140.

  • Lock, J., Le Grange, D., Agras, S., Moye, A., Bryson, S. W., & Jo, B. (2010). Treatment of adolescent eating disorders: Progress and challenges. Minerva Psichiatrica, 51, 207–216.

  • Grave, R. D, Calugi, S., Doll, H. A., & Fairburn, C. G. (2013). Enhanced cognitive behaviour therapy for adolescents with anorexia nervosa: An alternative to family therapy? Behaviour Research and Therapy, 51, R9–R12.

Bulimia Nervosa

  • Le Grange, D. Crosby, R. D., Rathouz, P. J., & Leventhal, B. L. (2007). A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Archives of General Psychiatry, 64, 1049–1056.

  • Le Grange, D., Doyle, P., Crosby, R. D., & Chen, E. (2008). Early response to treatment in adolescent bulimia nervosa. International Journal of Eating Disorders, 41, 755–757.

  • Linardon, J., Wade, T. D., de la Piedad Garcia, X., & Brennan, L. (2017). The efficacy of cognitive-behavioral therapy for eating disorders: A systematic review and meta-analysis. Journal of Consulting and Clinical Psychology, 85, 1080–1094.

Binge Eating Disorder

  • Hay, P. P., Bacaltchuk, J., Stefano, S., & Kashyap, P. (2009). Psychological treatments for bulimia nervosa and binging. Cochrane Database of Systematic Reviews, 4.

  • Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: A “transdiagnostic” theory and treatment. Behaviour Research and Therapy, 41, 509–528.

Avoidant/Restrictive Food Intake Disorder

  • Thomas, J. J., Wons, O. B., & Eddy, K. T. (2018). Cognitive–behavioral treatment of avoidant/restrictive food intake disorder. Current Opinion in Psychiatry, 31, 425–430.

  • Manikam, R., & Perman, J. A. (2000). Pediatric feeding disorders. Journal of Clinical Gastroenterology, 30, 34–45.

  • Zucker, N. L., LaVia, M. C., Craske, M. G., Foukal, M., Harris, A. A., Datta, N., … Maslow, G. R. (2019). Feeling and body investigators (FBI): ARFID division—An acceptance-based interoceptive exposure treatment for children with ARFID. International Journal of Eating Disorders, 52, 466–472.

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Tsang, K.K., Hayes, L.C., Cammarata, C. (2020). Eating Disorders and Avoidant/Restrictive Food Intake Disorder. In: Carter, B.D., Kullgren, K.A. (eds) Clinical Handbook of Psychological Consultation in Pediatric Medical Settings. Issues in Clinical Child Psychology. Springer, Cham. https://doi.org/10.1007/978-3-030-35598-2_17

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