An Atypical Eating Disorder with Crohn's Disease in a Fifteen Year Old Male: A Case Study

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Most of the time, school or counseling psychologists are not specifically trained to work with children who have physical disorders that cause or exacerbate psychological problems. This article describes a 15-year-old male with delayed physical development who was referred for psychological evaluation and treatment of a suspected eating disorder. Six months after psychological intervention, appropriate eating behaviors were established, yet he had not gained weight as expected. After further medical evaluation, he was diagnosed as having Crohn's disease. Criteria for a DSM-III-R diagnosis of Anorexia Nervosa or Eating Disorder, Not Otherwise Specified, are discussed and symptoms of Crohn's disease described. Also discussed are differential diagnoses and practical recommendations for professionals in the field.

Typically, counseling or school psychology training programs include required courses in psychological theories, research design, statistical methods, therapeutic interventions, developmental issues, assessment procedures, and abnormal psychology. Electives are usually designed to expand on a specific topic related to required courses. What is missing from most of these programs is a course designed to alert future school and counseling psychologists and therapists to medical problems that might cause, or complicate, psychological difficulties. This article demonstrates that a medical disorder, Crohn's disease, might lead to or exacerbate an eating disorder.

In the following case study, the patient was initially evaluated by a pediatrician who noted vague gastrointestinal symptoms with inconclusive test results. Because of the patient's phobic-like behavior toward eating, he was referred to Pediatric Psychology to determine whether some or all of his physical problems were due to emotional sources. After interviews with the patient and his mother, an atypical eating disorder was diagnosed and an intervention implemented that was successful in encouraging him to eat. Yet his rate of weight gain was discouragingly slow. After six months of psychological therapy with nutritional monitoring and an increase in food intake, further medical testing revealed Crohn's disease. A collaborative process was possible because the patient was seen in a teaching hospital where all services were available and members of several disciplines worked as a team. If communication between team members had not been coordinated, the patient's psychological problems might have been further compromised and there might have been a longer delay in the diagnosis of Crohn's disease. The authors believe that counselors or psychologists who do not work in medical settings would benefit from developing a network of resources for consultations.

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