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  • image Historically, the categorization of eating disorders as a psychiatric illness has faced significant scrutiny, while no longer the case the treatments of these disorders continue to be challenging with limited evidence-based medicine–supported treatments.

  • image Despite strong genetic associations for the development of eating disorders as established in monozygotic and dizygotic twin studies, a clear association with a specific genetic linkage or mutation has not been identified.

  • image Shifting between eating disorder diagnostic categories is possible, especially when symptom remission is not achieved with treatment.

  • image Psychiatric comorbidities are common with all forms of eating disorders, and the differential diagnosis should generally include evaluation for depression, schizophrenia, generalized anxiety, obsessive–compulsive disorder (OCD), and personality disorders.

  • image During the process of caloric restoration, calories must be gradually introduced to prevent the potentially fatal complication known as refeeding syndrome. Failure to restore calories quickly enough may result in an unfeeding syndrome.

  • image Mortality resulting from suicide in individuals with eating disorders is not uncommon, and clinicians must monitor closely for suicidality and educate appropriately as they would during the treatment of patients with major depressive disorder taking antidepressants.

  • image The current preferred treatment approach for anorexia nervosa (AN) includes a minimum of 6 months of psychotherapy, preferably cognitive behavioral therapy (CBT), in adults and family-based therapy in children.

  • image Despite limited data, antidepressants are the preferred pharmacologic intervention for the acute and maintenance phases of bulimia nervosa (BN) in combination with nonpharmacologic treatments.

  • image A growing body of evidence supports the use of selective serotonin reuptake inhibitors (SSRIs) for the treatment of binge-eating disorder (BED) along with CBT and interpersonal psychotherapy (IPT). Lisdexamfetamine is the sole FDA-approved agent for BED treatment.

  • image There is growing sentiment that severe and enduring AN exists and that the focus should be on the impact of the disorder and improving quality of life instead of on treating medical symptoms.


Preclass Engaged Learning Activity

Review the guidelines from the American Psychiatric Association (APA), the National Institute for Health and Care Excellence, and the World Federation of Societies of Biological Psychiatry.31,104,114 Develop a comparative table by filling in appropriate first- and second-line treatment strategies including both nonpharmacologic and pharmacologic strategies for each of the guidelines.


Eating disorders are widely accepted as serious mental illnesses. The spectrum of eating disorders encompasses several complex diseases, with most sharing the pathologic feature of overevaluation of body shape and weight. Eating disorders arise from the complex interaction between environmental, societal, developmental, psychosocial, genetic, and biologic factors. It is estimated that 5 to 10 million women and 1 million men in the United States alone have an eating disorder. The urbanization of society, social pressure, and obsession with perfection and being thin have led to an increasing prevalence of eating disorders, with a median age of onset between 18 and 21 years, though estimates in adolescent studies suggest median ages of ...

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