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[page 71]                                                             [Emergency Care Journal 2024; 20:12726]

                             Emergency Care Journal 2024 volume 20:12726

Dear Editor,

We consider it appropriate to highlight the importance of early
psychological intervention in emergencies for patients with eating
disorders. In the contemporary age, characterized by incessant
socio-cultural pressures and aesthetic ideals, eating disorders
emerge as a complex and critical challenge to mental and physical
health in individuals during developmental age. This psychiatric
condition can have fatal outcomes. Approximately one-fifth to
one-third of adolescent patients with Anorexia Nervosa (AN)
require intensive care during the course of the illness. Access to
critical care areas in healthcare facilities due to significant emaci-
ation-related organic decompensation is increasing significantly,
particularly after the COVID-19 pandemic. Typically, emergency
room access for these patients is ensured by family members or
caregivers who can recognize the critical developments of the eat-
ing disorder. However, many patients, despite being in clinically
severe conditions, are unable to identify the seriousness of their

clinical condition. The treatment proposed by healthcare personnel
often encounters opposition from the patient, who may refuse ini-
tial care, thereby risking their own life. Clinical emergency condi-
tions related to anorexia nervosa include electrolyte imbalances
with cardiac arrhythmias, dysproteinemia with the potential for
pericardial effusion, and multi-organ functional compromise.
Recent systematic reviews highlight a lack of criteria, objectives,
and treatment modalities, sometimes providing an ambiguous
account of hospitalization practices. We believe that a consensus
conference should be initiated to outline a systematic, shared
approach to the emergency treatment of critically ill patients with
eating disorders. In this context, the role of an expert clinical psy-
chologist can be fundamental, even in critical care settings. The
presence of such professionals could:  i) better facilitate the pro-
posed therapeutic approach, which is often life-saving; ii) interact
with the family and caregiver; iii) liaise with emergency personnel
treating the patient. This collaboration aims at a more rapid clinical
treatment, reducing possible oppositional attitudes that hinder care.
The presence of an expert psychologist could optimize the assis-
tance and treatment times for patients with AN in critical care.

References
1. Herpertz-Dahlmann B. Intensive treatments in adolescent

Anorexia Nervosa. Nutrients 2021;13:1265. 
2. Vaccaro CM, Guarino G, Conte D, et al. Social networks and

eating disorders during the Covid-19 pandemic. Open Med
(Wars) 2021;16:1170-4.

3. Toppino F, Martini M, Longo P, et al. Inpatient treatments for
adults with anorexia nervosa: a systematic review of literature.
Eat Weight Disord 2024;29:38. 

Correspondence: Giacomo Fiacco, Department of Educational,
Psychological and Communication Sciences, University Suor
Orsola Benincasa, Naples, Italy 
E-mail: giacomofcc@outlook.com

Key words: anorexia, eating disorders, emergency.

Contributions: all the authors made a substantive intellectual contri-
bution. All the authors have read and approved the final version of
the manuscript and agreed to be held accountable for all aspects of
the work.

Conflict of interest: the authors declare no potential conflict of interest.

Funding: none.

Availability of data and materials: all data generated or analyzed
during this study are included in this published article.

Received: 16 June 2024.
Accepted: 20 August 2024.
Early view: 17 September 2024.

This work is licensed under a Creative Commons Attribution 4.0
License (by-nc 4.0).

©Copyright: the Author(s), 2024
Licensee PAGEPress, Italy
Emergency Care Journal 2024; 20:12726
doi:10.4081/ecj.2024.12726

Publisher's note: all claims expressed in this article are solely those of
the authors and do not necessarily represent those of their affiliated
organizations, or those of the publisher, the editors and the reviewers.
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made by its manufacturer is not guaranteed or endorsed by the publisher.

The importance of psychological intervention in emergencies for patients
with anorexia nervosa
Giacomo Fiacco, Gennaro Catone

Department of Educational, Psychological and Communication Sciences, University Suor Orsola Benincasa, Naples, Italy

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