Eating disorders in adults with intellectual disability.
Adults with ID often have hidden eating disorders—ask about pica, rumination, and food refusal at intake.
01Research in Context
What this study did
Leigland (2000) looked at eating disorders in adults with intellectual disability.
The paper is a narrative review. It pulls together what was known about prevalence, comorbidity, and treatment gaps.
The author found that pica, rumination, and food refusal are often missed during routine care.
What they found
Eating disorders are under-recognized in this group.
Standard mental-health screens rarely ask about chewing non-food items or bringing food back up.
Without targeted questions, these problems stay hidden and untreated.
How this fits with other research
Meier et al. (2012) extends this call by giving step-by-step behavioral guidelines for pica. They show that multi-component plans can drive pica to near-zero levels.
Burack et al. (2004) is a direct successor. Published four years later, it supplies validated eating-disorder tools the 2000 paper asked for.
DiStefano et al. (2020) updates the assessment challenge. It warns that floor effects in standard tests can hide true ability in severe ID, so we need adapted tasks.
Why it matters
Add three quick questions to your intake: "Do you eat things that are not food?" "Do you bring food back up on purpose?" "Do you often refuse meals?" If the answer is yes, probe further and track data. These simple steps catch problems earlier and open the door to evidence-based plans like those in Meier et al. (2012).
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Add three eating-disorder screening questions to your adult-ID intake form today.
02At a glance
03Original abstract
There is an increasing focus on the nutrition of people with intellectual disability (ID), but less interest in the range of eating disorders (EDs) that they may exhibit and the bio-psycho-social impact of these conditions. Despite diagnostic and methodological difficulties, psychopathology and ED research studies suggest that 3-42% of institutionalized adults with ID and 1-19% of adults with ID in the community have diagnosable EDs. Weight surveys indicate that 2-35% of adults with ID are obese and 5-43% are significantly underweight, but the contribution of diagnosable EDs is unknown. Such data and case reports suggest that EDs are associated with considerable physical, behavioural, psychiatric and social comorbidity. Review papers have focused on the aetiology and treatment of pica, rumination, regurgitation, psychogenic vomiting and food faddiness/refusal. Emerging clinical issues are the development of appropriate diagnostic criteria, multimodal assessment and clinically effective treatment approaches. Key service issues include staff training to improve awareness, addressing comorbidity and access issues, and maintaining support for adults with ID and EDs, and their carers. Research should confirm the multifaceted aetiology and comorbidity of EDs. Then multicomponent assessment and treatment models for EDs can be developed and evaluated.
Journal of intellectual disability research : JIDR, 2000 · doi:10.1046/j.1365-2788.2000.00308.x