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When Death Begins at the Dinner Table: Interview with Noted Psychiatrist on Eating Disorders

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Written by Howard G. Rosenthal, EdD, CCMH, MAC

Monday, 06 August 2007

Editor’s Note: Kimberli McCallum, MD is a board-certified child and adolescent psychiatrist, as well as adult psychiatrist. She received her medical degree from Yale School of Medicine and completed her training in general psychiatry at the UCLA Neuropsychiatry Institute. She has developed several eating disorder treatment programs, including inpatient, partial hospitalization and intensive outpatient programs. Dr. McCallum has lectured across the country on a variety of topics, achieving national recognition for her skills and knowledge in treating eating disorders and in the medical management of complicated cases.

Howard Rosenthal: Initially, you had a typical psychiatric practice in which you treated patients with a wide range of problems. What led you to specialize in the field of eating disorders?

Kimberli MCallum: I began working with patients with eating disorders during my residency in Psychiatry at UCLA. At the time, some of the leaders in the field were on the faculty and able to provide wonderful training and supervision while I worked on a specialized unit and in one of the first day treatment programs. When I returned to St. Louis, I discovered that few residency programs offered any training in the evaluation and treatment of eating disorders. My year of training in internal medicine and extra training in psychotherapy and fellowship in child and adolescent psychiatry allowed me to integrate developmental, psychological and medical perspectives in designing treatments. I believe that when you work with a population of patients who are underserved you can’t help but become an advocate. When hospitals closed specialty programs due to high costs and poor reimbursement, I had no place in town to treat my patients with severe symptoms and medical complications. Services and supports for patients with eating disorders are limited. This led me to open our own treatment center, McCallum Place in Kirkwood, Mo. We now treat patients from all over the country.

HR: In one of my first psychology classes, my professor told us that anorexia was very rare, and that we might see a single individual with this affliction during the course of our careers. Now, in my graduate classes, middle and high school teachers assert that a third of their class claims to have a problem. Are we merely talking about eating disorders more these days, or is the problem really escalating?

KM: The average prevalence of anorexia is 0.3 to one percent of young females while bulimia is one to three percent. Many cases that come to treatment are significant but may not meet criteria for a specific eating disorder (i.e. purging disorder, “exercise bulimia,” and binge eating disorder). Eating disorders occur in men less commonly — perhaps 20 percent bulimia cases and 10 percent anorexia cases occur in men. Only a minority of patients receive treatment. Population studies show that although the incidence of eating disorders has been increasing throughout the last century, the number of new cases has leveled out over the past 20 years. The popularity of dieting correlates with increased incidence of eating disorders. There is greater awareness of these disorders and more males are seeking treatment.

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