Purging and pregnant: adaptation of an institutional eating disorder protocol

Matthew Johnson, MD

Beth Israel Deaconess Medical Center
Purging and pregnant: adaptation of an institutional eating disorder protocol

Scientific Abstract

Background: The treatment of patients diagnosed with eating disorders is multifaceted from a clinical, ethical, and interdisciplinary standpoint. While institutions may have concrete protocols, the malleability and adaptability of eating disorder protocols is often challenged in practice and amended amidst multiple medical and psychiatric comorbidities. As an at-risk patient population, pregnant women with eating disorders engender unique ethical, psychosocial, and medical vulnerabilities.

Methods: The focal point of this case study is a 29 year old G2P0101 woman (18 weeks) with bulimia nervosa, OCD, and borderline personality disorder, presenting with starvation ketoacidosis in the setting of binging and subsequent purging during dissociative episodes. The patient was admitted to the medical floor and started on an institutional eating disorder protocol adapted to meet the needs of the patient and her fetus with interdisciplinary input (psychiatry, nutrition, internal medicine, case management, nursing).

Results: Current literature provides evidence for the risks associated with disordered eating including concomitant depressive symptoms, anxiety, poor self-esteem, changes in body-image, relationship satisfaction, higher rates of miscarriage, intrauterine growth restriction, and low fetal birth weight. An approach to treatment focuses on medical stabilization for the safety of the patient and fetus as well as concurrent treatment of decompensated mood and anxiety symptoms. A clinical algorithm and approach to evaluation and treatment is proposed.

Conclusions: This case emphasizes the importance of adapting eating disorder protocols through a constructive lens, by identifying medical, ethical, and interdisciplinary issues that arise during treatment.

research Areas


Matthew C. Johnson, MD, Varsha Radhakrishnan, MD

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