Prevalence and Correlates of Eating Disorder Symptoms in Adolescents in Acute Psychiatric Treatment

Publications Category : Psychiatry

Author(s): Vanessa Sevilla, Robert Suddath, Roxanne Abella, Jamie Lee

Project Description : Background: While major eating disorder (ED) diagnoses are uncommon, symptoms involving appetite changes, and concerns about weight and appearance may be present in other psychiatric disorders. The prevalence and severity of ED symptoms may be overlooked. It is important to further investigate these comorbidities to expand our understanding of eating-related pathology as a part of broader psychiatric illness. Methods: Child and adolescent patients participating in acute psychiatric inpatient and partial hospital treatment programs routinely complete a series of behavioral measures as part of their clinical evaluation. A group of questions designed to assess symptoms in patients with anorexia were administered to a broad population of all patients admitted for acute treatment. Ten (10) questions assessed the frequency with which the patients had experienced various eating-related symptoms, including concerns about body image, weight and eating, specifically within the week prior. The Eating Disorder Examination Questionnaire (EDE-Q) was utilized to measure the subjective severity of the symptoms, ranked from none to marked severity. The responses to these questions were analyzed and compared to other measures to evaluate the prevalence, frequency and severity of ED symptoms in a group of general psychiatric patients. The sample consisted of 162 patients ages 9-17. 56% identified as female, 30% as male and 14% as gender diverse. Results: 108 patients (66.7%) reported some frequency of ED symptoms of at least slight severity. EDFS (Eating Disorder Frequency and Severity) scores were calculated by multiplying each patient's average frequency score with their average reported severity of symptoms, and ranged from 0-3 with 3 being maximum frequency and severity and 0 being no frequency and severity. The resulting scores were positively correlated with depression (PHQ-9, MFQ) and had a slightly stronger correlation with anxiety (GAD-7). Male patients had an average EDFS score of 0.55; both Female patients and gender diverse patients had an average EDFS score of 1.90, which is significantly higher than that of males (p<0.05). Conclusions: The overall prevalence of some ED symptoms with some impairment were very common, reported in two thirds of our sample of acute child and adolescent psychiatric patients. The symptoms correlated with both depression and anxiety measures but were not specifically associated with a particular diagnosis, indicating ED symptoms being a more pervasive entity in this population. While the symptoms were present across all ages, they occurred at much higher frequencies and severities in both females and gender diverse patients with average frequencies of 1-2 days a week and moderate severity. This research suggests the potential importance of eliciting ED symptoms including restricting calories, body dysmorphic symptoms and obsessive worry about appearance and weight across a broad range of psychiatric presentations.

Additional Informational : Presented at the American Psychiatric Association annual meeting, Los Angeles CA, May 17-21, 2025