Books about eating disorders are seen on a shelf in an office of the Department of Behavioral Health Services at the University of Iowa Hospitals and Clinics in Iowa City on Wednesday, Sept. 14, 2016. (Adam Wesley/The Gazette)
I have worked exclusively in the area of eating disorders for over 15 years as a registered dietitian. There are issues with UICH dropping the eating disorders program to “broaden mental health needs” according to Dr Peggy Nopoulos.
With most mental illnesses, there are times when a person can do well on an outpatient basis and times when they need to be hospitalized or attend PHP to stabilize. Eating disorders as a mental illness also utilize levels of care ranging from inpatient to outpatient care. All these levels are distinct and offer different services.
UIHC is literally the only hospital in the state of Iowa to treat inpatient eating disorders. With the loss of this program, Iowans who suffer from eating disorders will not receive any type of service in their most desperate and sickest times. There are many other hospitals and clinics that deal with other mental health disorders such as depression and anxiety that a patient can visit, but not eating disorders.
Eating disorders are very complex diseases: Eating disorders have the second highest death rate of any mental health disorder, surpassed only by opioid addiction.(1) Among those struggling against anorexia; 1 in 5 deaths is by suicide.(2) There is a significantly higher risk of obsessive-compulsive disorder in people with eating disorders.(3) People with bulimia nervosa, binge eating, or any binge eaters have significantly higher rates of PTSD. than people without an eating disorder.(4) 32-39% of people with anorexia nervosa, 36-50% of people with bulimia nervosa, and 33% of people with binge eating disorder are also diagnosed with the disorder major depressive illness.(5) 48-51% of people with anorexia nervosa, 54-81% of people with bulimia nervosa, and 55-65% of people with binge eating are also diagnosed with an anxiety disorder.(6 ) Traumatized people with eating disorders show high levels of dissociative symptoms, such as the inability to remember the traumatic event.(7)
Eating disorders are associated with some of the highest levels of medical and social disability of all psychiatric disorders. (8) Closing the program when the people of Iowa need it to stay open seems very irresponsible and short-sighted of the university. I agree that the eating disorder patient has a longer length of stay than other mental health patients due to their complexity, but does he not deserve care or is he too expensive to treat and therefore consumable?
As a teaching hospital, cutting out some of the most complex mental health patients is a disservice to medical residents and students, as it diminishes the knowledge and experience they will bring to their communities once their residency ended.
It is a complete failure for the state of Iowa to eliminate the inpatient program when no other program like it exists in the state. Nowhere in the mission, vision, or core values set forth by the UIHC does it say that it will meet the needs of the people of Iowa. That needs to change because Iowa taxpayer dollars help support the UIHC.
Sue Clarahan, RD, LD is a Registered Dietitian with over 40 years of experience in the dietetics field, the last 15 years working exclusively with eating disorders. Her experience includes advising clients in home, hospital and clinical settings. She was recognized as Iowa’s Registered Dietitian of the Year in 2007 and was named EDCIowa Volunteer of the Year in 2018.
1. Chesney, E., Goodwin, GM and Fazel, S. (2014). Risks of all-cause and suicide mortality in mental disorders: a meta-review. Global Psychiatry, 13(2), 153-160.
2. Papadopoulos, FC, A. Ekbom, L. Brandt and L. Ekselius. “Excess mortality, causes of death and prognostic factors in anorexia nervosa.” The British Journal of Psychiatry 194.1 (2008): 10-17.
3. Altman, SE and Shankman, SA (2009). What is the association between obsessive-compulsive disorder and eating disorders? Journal of Clinical Psychology, 29, 638-646.
4. Dansky, BS, Brewerton, TD, O’Neil, PM, & Kilpatrick, DG (1997). The National Women’s Study: Relationship Between Victimization and Post-Traumatic Stress Disorder and Bulimia Nervosa. International Journal of Eating Disorders, 21, 213-228.
Hudson, JI, Hiripi, E., Pope, HG, Jr., & Kessler, RC (2007). The prevalence and correlates of eating disorders in the replication of the National Comorbidity Survey. Biol Psychiatry, 61(3), 348-358. doi:10.1016/j.biopsych.2006.03.040
5. Hudson JI, Hiripi E, Pope HG Jr and Kessler RC. (2007). The prevalence and correlates of eating disorders in the replication of the National Comorbidity Survey. Biological Psychiatry, 61(3):348-58.
“NIH Expenditure by Category – NIH Research Portfolio Online Reporting Tools (Report).” United States National Library of Medicine. United States National Library of Medicine, July 3, 2017. Web. Jan 11, 2018.
Milos, G., Spindler, A., Buddeberg, C. and Crameri, A. (2003). Axis I and II comorbidity and treatment experiences in subjects with eating disorders. Psychother and Psychosom, 72(5), 276-285.
6. Hudson JI, Hiripi E, Pope HG Jr and Kessler RC. (2007). The prevalence and correlates of eating disorders in the replication of the National Comorbidity Survey. Biological Psychiatry, 61(3):348-58.
NIH Categorical Spending -NIH Research Portfolio Online Reporting Tools (RePORT).” US National Library of Medicine. US National Library of Medicine, July 3, 2017. Web. January 11, 2018.
Ulfvebrand, S., Birgegard, A., Norring, C., Hogdahl, L. and von Hausswolff-Juhlin, Y. (2015). Psychiatric comorbidity in women and men with eating disorders results from an extensive clinical database. Psychiatry Res, 230(2), 294-299.
7. Brewerton, TD (2004). Eating disorders, victimization and comorbidity: principles of treatment. In TD Brewerton (Ed.), Clinical Handbook of Eating Disorders: An Integrated Approach (pp. 509-545). New York: Marcel Decker.
Brewerton, TD, Dansky, BS, Kilpatrick, DG and O’Neil, PM (1999). Bulimia nervosa, PTSD and forgetfulness results from the National Women’s Study. In LM Williams & VL Banyard (Eds.), Trauma and Memory (pp. 127-138). Durham: Sage.
8.Klump KL, Bulik CK, Kaye W, Treasure J, Tyson E. Eating Disorders Academy Position paper: Eating disorders are serious mental illnesses. Int J Eat Disord. 2009 Mar;42(2):97-103. doi: 10.1002/eat.20589.