Almost anyone who works in a specialized field (such as pediatric eating disorders) spends a great deal of time thinking about diagnostic criteria for diseases and conditions. This is true throughout medicine and psychiatry, of course: is it type 1 or type 2 diabetes? Is it autism or pervasive developmental disorder? Is it bulimia nervosa or binge purge anorexia nervosa? Is it eating disorder not otherwise specified (EDNOS, a term no longer included in DSM-5) or anorexia nervosa?… Read More
Viewing blog posts tagged with "Diagnosis"
Sometimes I get discouraged by what appears to me to be the excruciating slowness with which new ideas enter the mainstream of medical and psychological teaching and practice. In the same way that many of us dress in the style that was favored in our youth, many of us do not move far from what we were taught in college or professional school, even when the science has whipped past those teachings with the speed of light. Some professionals even spend their entire lives and careers…Read More
Talking to a mother whose son has just entered our Food Phobia treatment program I realized that I may not have done a very good job stating clearly what our “recipe” for success with this illness has been. What can a parent expect? What can a child look forward to? What if a provider is forced to treat a child with food phobia in an outlying hospital; how might they proceed?
First, a bit about the diagnosis.
Food phobia is the term Kartini Clinic uses for the sudden onset of…Read More
Thinking about obesity: calmly, rationally and outside the box
When I was a rotating intern at Sacred Heart Medical Center, long ago, I attended rounds with the then head of medicine Dr. Patrick Tennison. Dr. Tennison was a thin, dark haired, intense guy who years later would save my life, but at that time was obsessed with imbuing young doctors with a sense of urgency about diagnostic dilemmas. He was more like a highly competitive detective than your typical doctor.
“The main…Read More
This blog will be short as I am preparing to attend and speak at the F.E.A.S.T. conference in Texas this week. Very exciting!
Recently I was asked to consult on a child who “won’t eat” and who hasn’t eaten for several weeks. Her situation is complicated by English not being the family’s first language and by her entrance into the medical “system” being through the emergency room, but it did remind me how complicated making the correct diagnosis can be in a child who won’t eat. This…Read More
Many people are shocked when they learn that we have patients with anorexia nervosa as young as six or seven, and, although it is rare, it certainly does occur.
Why are they shocked? Because most of these folks, despite hearing me (and Dr. Tom Insel, among others) say “it’s a brain disorder”, still deeply believe that “the media” and our obsession with thinness causes anorexia. They are horrified that someone so young could be “ruined by society”. And blaming the parents for this…Read More
This week’s blog covers a topic - menstruation in female patients - which I have written about before, but, given its critical importance to our female patients and their parents, I’d like to bring it up again.
First let me distinguish between menarche (first period) and the resumption of menses (monthly periods). Menses is an important marker of recovery in girls who menstruated prior to the onset of their eating disorder, and something I’ve written about before. Today I would like…Read More
I’m sure all specialties have their frustrations, but here is a major one of mine: patients who come to Kartini Clinic needing -- indeed deserving -- help but at the “eleventh hour.”
What do I mean by this? I mean families who come in seeking help for a condition which is characterized by anosognosia, having waited for a variety of reasons, until shortly before their child’s 18th birthday, at which age their child will be able to refuse treatment, and often will do. Even in…Read More
Inspired to think outside my usual box by Dr. Eric Topol, author of Creative Destruction of Medicine this morning, I began to ask myself: how can I help parents who may not have access to experienced care, who fear that their child may have an eating disorder, make that diagnosis and get help? Where do I start?
Well, start first with self-examination.
We doctors are made very uncomfortable by any talk of patient autonomy or patient empowerment. The words “self diagnosis” are said…Read More
I am occasionally asked whether or not anorexia nervosa is a chronic illness. As far as I am concerned, anorexia nervosa is a chronic illness of remission and exacerbation, which is a medical way of saying an illness that often returns after a period of stability. Anorexia can be gotten into good remission, which may last many years, but it can flare up with a recurrence of symptoms during times of stress, life change or for no apparent reason. We call this relapse.
As with the…