Eating disorders: When to refer to a specialist
There are limited community and institutional resources for people with eating disorders, either individual clinicians or specialized programs. Nevertheless, you can look for such resources through the National Eating Disorder Information Centre.
If there is diagnostic uncertainty, especially concerning possible comorbid psychiatric diagnoses, a psychiatric consultation should be obtained.
Think broadly about the term "specialist" when seeking treatment for this clinical population. People with specialized expertise may be found within primary care, pediatrics, internal medicine, women's health, nursing, psychology, nutrition, social work and occupational therapy. Community-based support groups for patients and their families may provide specialized experiential expertise.
Take a team-based approach using the available resources within your community. Such an approach helps your patient in meeting broad needs and helps you in shouldering the responsibility.
Hospitalization for eating disorders
- In anorexia nervosa, when weight loss becomes precipitous and out of control or reaches frank emaciation, hospitalization is usually required both to minimize the multiple physical complications and to provide intensive and supervised re-feeding.
- In bulimia nervosa, hospitalization is rarely required unless there is severe metabolic instability, electrolyte disturbance with cardiac risk from hypokalemia, or suicidality.
- In binge eating disorder, there is no current role for hospitalization.