EATING DISORDERS IN ADOLESCENTS AND YOUNG ADULTS

Three principles for the medical care of adolescents with eating disorders were proposed by Comerci:⁴ (1) early restoration of a normal nutritional and physiologic state; (2) establishment of trust; and (3) a team approach (therapeutic partnership). This article reviews and clarifies the definitions, epidemiology, pathogenesis, and clinical aspects of eating disorders in internal medicine practice. The early restoration of health requires early recognition of the disorder from the basis of a broad differential diagnosis. An understanding of eating disorders by the clinician is needed to establish trust with patients, who are often wary of any recommendations to gain weight or change their eating habits. Because patients with eating disorders often present with physical symptoms caused by starvation, induced emesis, or diet pill and laxative abuse, the primary care provider may be the first person to diagnose an eating disorder and to establish the therapeutic team. Many of the psychiatric aspects of eating disorders have been discussed in numerous earlier articles and chapters1, 5, 7, 31 and are not discussed in detail here. For the sake of clarity, female pronouns are used in reference to patients because at least 90% of patients with eating disorders are adolescent and young adult women. The approach to males is similar, however.