Postural orthostatic tachycardia syndrome (POTS) and disordered eating in adolescents

Abstract

Background: Adolescents with POTS often experience disruptions in eating patterns associated with abdominal pain/nausea. These adolescents share several symptoms with adolescents with disordered eating/eating disorders (e.g., orthostatic intolerance, generalized weakness, dizziness/lightheadedness, headaches, fatigue). While the etiologies differ, these similarities may lead clinicians to misattribute starvation-induced orthostatic symptoms to POTS in patients who actually struggle with disordered eating. The purpose of this exploratory study was to examine whether differences exist between disordered eating symptomatology in adolescents with POTS/chronic pain compared to adolescents with chronic pain only. Methods: Participants included 199 adolescents (M age=15.49 years, SD=1.69) consecutively admitted into an intensive pain rehabilitation program. Seventy-three adolescents were diagnosed with POTS/chronic pain, and 126 adolescents were diagnosed with chronic pain only. Results: 17.8% of patients with POTS scored above the cut-off (≥20) for disordered eating compared to 17.5% of patients with chronic pain. There was no difference between the two groups, t(197)=-.062, p=.902. However, patients with POTS (M=0.85, SD=1.57) had significantly lower EAT-26 scores compared to the subset of patients with chronic abdominal pain (M=2.09, SD=2.83, p<.05). Discussion: Approximately 1/5 of patients with POTS evidence disordered eating and would benefit from eating disorder referral as disordered eating may interfere with recovery from POTS. Additionally, as patients with POTS reported less severe symptoms of disordered eating compared to patients with chronic abdominal pain, this study suggests that the overlapping symptoms between POTS and eating disorders may not obscure the identification of either disorder. Further research is needed to determine causality and best treatment options.