Screening for child and adolescent eating disorders in primary care settings

Eating disorders are among the most pernicious psychiatric disorders presenting in young women and girls today, with significantly elevated mortality rates (Arcelus, Mitchell, Wales, & Nielson, 2011; Birmingham, Su, Hlynsky, Goldner, & Gao, 2005; Papadopoulos, Ekbom, Brandt, & Ekselius, 2009). Early identification of pathological eating behaviors is essential, but youth with eating disorders often do not initially present to mental health clinics and may not even gain the attention of their parents due to the secrecy that frequently surrounds their symptoms. Primary care physicians are in the unique position to identify eating disorders at some of their earliest presentations given the regularity with which patients present in these settings and doctors' longstanding relationships with a patient's family (Rome, 2003; Rosen, 2010). The current study evaluated the utility of systematic eating disorder screens in a pediatric primary care setting. Participants were 78 female children aged 10-17 years and their parents who presented to a primary care practice. Parents, children, and pediatricians completed a brief screening questionnaire assessing eating disorder symptoms. Eighty-four percent of families presenting for primary care appointments agreed to complete the screen. Pediatricians completed screens for 73 participants (94%). Forty-one percent of participants screened positively on the questionnaire. Confirmatory diagnostic interviews were conducted on a subset to determine accuracy of screens. Results suggest that while screening for eating disorders in primary care settings is feasible for pediatricians to complete as part of a regular office visit, accuracy of screens is limited. Findings have significant implications for integrating eating disorder screening practices into pediatric primary care settings.