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The Evaluation of Eating and Weight Symptoms

A Comparison of Medically Ill and Eating Disorder Patients

Received May 30, 1997; revised September 11, 1997; accepted September 23, 1997. From the Departments of Psychiatry and Internal Medicine, The University of Iowa College of Medicine, Iowa City. Address reprint requests to Dr. Carney, Department of Psychiatry, The University of Iowa College of Medicine, Iowa City, IA 52242.

The purpose of this study was to determine the utility of hospitalization in a medical-psychiatry unit for eating disorder patients. A retrospective chart review of 48 patients given an International Classification of Disease-9 diagnosis of an eating disorder was conducted. Presenting symptoms, functional status using the Karnofsky Index, medical and psychiatric evaluation, diagnosis, treatment, and outcome were evaluated. Patients fell into 1 of 3 groups: those with an active eating disorder and comorbid medical complications (Eating Disorder [ED] positive [POS], n=25), those with a history of an eating disorder admitted for some other reason (ED history [HX], n=8), and those with eating or weight symptoms ultimately found to be related to a noneating disorder or primary medical process (ED negative [NEG], n=15). The ED POS patients were younger (28.1 vs. 49.1 years, P=0.0001) but had a lower functional status on admission compared with the ED NEG patients (Karnofsky score 51 vs. 72, P=0.0002). They were more likely to binge eat, restrain intake, and abuse laxatives (P=0.0001, P=0.024, P=0.037, respectively) but did not differ with respect to history of vomiting (P=0.113). The ED POS patients were more likely to be transferred to a general psychiatry or eating disorder unit. Overall length of stay was greater in this group (44.6 vs. 20.4 days, P=0.031). Initial evaluation of patients presenting with eating or weight symptoms may be difficult given similarities between the patients with primary eating disorders and those with other underlying medical causes. The medical-psychiatry unit provides comprehensive initial evaluation and treatment of patients with eating and weight symptoms.

Key Words: Eating Disorder • Eating • Weight • Anorexia Nervosa • Bulimia Nervosa • Medical-Psychiatry Unit

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