Commentary on Clinical Case Rounds in Child and Adolescent Psychiatry

The issue of etiology in eating disorders is a complex one with the need to consider both biological and psychosocial contributors which can - particularly at a young age- have a devastating impact on a child’s growth and development. The case reported by Calkin and Carandang demonstrates the complicated, and sometimes symbiotic, relationship that exists between eating disorders and obsessive compulsive disorder (OCD). The case reported is particularly challenging as the patient was prepubertal and male, two subgroups of eating disorder patients who have higher rates of OCD (Peebles et al, 2006). Individuals with eating disorders may present with preoccupations and ritualized behaviours with regards to food or weight loss that resemble obsessions and compulsions. It is possible, as Sokol and colleagues (2002) suggest, that some individuals develop a type of anorexia nervosa (AN) related to PANDAS-associated OCD. However, there is currently insufficient evidence, such as strength of association, to demonstrate a causal relationship between PANDAS and AN. In addition, the clinical implications of this subtype of AN are not yet understood: for example, what would be the clinical indicators for the use of antibiotics and/or IV plasmaphoresis in such patients? We agree with the authors that this fascinating area requires more research before best practice guidelines can be presented to clinicians.