Inpatient Treatment of Children and Adolescents With Anorexia nervosa and Bulimia Nervosa

Eating disorders (EDs), in particular anorexia nervosa (AN) and bulimia nervosa (BN), mainly affect adolescents and young adults. Studies report a decreasing age of onset of the disorder and even 8-year-old children may be diagnosed with AN. Often, the course of EDs is chronic and associated with both severe comorbid somatic and psychological problems. In the worst case, EDs can be lethal with the mortality rate for AN reaching up to 15%, depending on the severity of the illness. The etiology of eating disorders is multifactorial. In the pathogenesis, a vulnerability comprising genetic, social, individual, and personality factors interacts with stressful life events and family characteristics. Somatic consequences may be severe, depending on the rate and severity of weight loss in AN and may include, for example, dental damage, gastrointestinal and cardiac problems, as well as decreased bone mineral density followed by pathological fractures. A variety of treatment options exist for young patients with ED, including outpatient, day-clinic, and inpatient treatment. As an early start of therapy is associated with a better prognosis, an early diagnosis of the disorder is of great importance. Knowledge of diagnostic criteria and typical physical and psychological consequences of EDs is essential in this endeavor. The treatment of children and adolescents with EDs should follow the German S3 guideline for the diagnosis and treatment of EDs. The treatment of choice for both AN and BN is psychotherapy. Treatment involving relatives is evidence-based in children and adolescents with EDs and should be an essential part of outpatient or inpatient care. As part of a guideline-oriented therapy, the following therapeutic elements are included: development and normalization of eating behavior and weight, accompanying medical treatment of patients, treatment of possibly existing excessive exercising behavior, description of triggering and sustaining factors of the disorder, improvement of perception and expression of feelings, development of self-esteem, treatment of accompanying psychiatric disorders, preparation of reintegration into family and everyday life, as well as accompanying school care. This article provides an overview of symptomatology, diagnostics, differential diagnostics, epidemiology, pathogenesis, functionality, and treatment options with a focus on inpatient therapy of children and adolescents with AN and BN. Our article ends with a description of previous inpatient studies evaluating the effectiveness of inpatient treatment for adolescents with EDs and a discussion of relapse rates. We also present our own outcome data of inpatient treatment of the adolescent unit of the Schoen Clinic Roseneck.