Eating Disorders
Dr. Turnbull is a Certified Eating Disorders Specialist treating the full spectrum of eating disorders, including anorexia, bulimia, obesity, binge-eating disorder. Eating disorders are the most lethal mental health diagnosis, with 4x the death risk of Major Depression, 3x the death risk of Bipolar Disorder, & 2x the death risk of Schizophrenia. Rapid & aggressive treatment of eating disorders in children & adolescents is associated with the best prognosis. As a result, Dr. Turnbull often requires verification of patient medical stability by an endocrinologist & cardiologist prior to initiating outpatient psychotherapy. Moreover, Dr. Turnbull often requires patients with eating disorders to receive concurrent management of the disorder with a dietician & psychiatrist.
The following are the first goals of treatment:
- Nutritional rehabilitation
- Weight restoration
- Medical stabilization and prevention of serious medical complications and death
- Resumption of menses (where appropriate)
- Cessation of binge eating and/or purging behaviors
- Cessation of eating disordered ideation including body image disturbance and dissatisfaction
- Restore meal patterns that promote health and social connections
- Re-establish social engagement
Full resolution of symptoms may take an extended period of time, & tend to average around 2 years from medical stability. Full symptom resolution may include family therapy as eating disorders are often representative of larger family issues/concerns.
Should you meet any of the following criteria (established by the American Academy of Pediatrics, 01/01/2003), Dr. Turnbull will likely refer you for stabilization in a hospital prior to treating you in an outpatient setting:
Anorexia Nervosa
- <75% ideal body weight, or ongoing weight loss despite intensive management
- Refusal to eat
- Body fat <10%
- Heart rate <50 beats per minute daytime; <45 beats per min nighttime
- Systolic pressure <90
- Orthostatic changes in pulse (>20 beats per min) or blood pressure (>10 mm Hg)
- Temperature <96ºF
- Arrhthymia
Bulimia Nervosa
- Syncope
- Serum potassium concentration <3.2 mmol/L
- Serum chloride concentration <88 mmol/L
- Esophageal tears
- Cardiac arrhythmias including prolonged QTc
- Hypothermia
- Suicide risk
- Intractable vomiting
- Hematemesis
- Failure to respond to outpatient treatment
