- The identification and acceptance of eating disorders as a psychiatric illness is increasingly common. They remain difficult to treat as effectiveness trials are limited, and patients are inherently resistant to accepting treatment.
- Eating disorder not otherwise specified is currently the most commonly diagnosed form of eating disorder; however, proposed changes to the diagnostic criteria in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders would separate binge eating disorder as a stand-alone diagnosis.
- 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 link mutation has not been identified.
- Shifting between eating disorder diagnostic categories is possible, especially when symptom remission is not achieved with treatment.
- Psychiatric comorbidities are common with all forms of eating disorders, and the differential diagnosis should generally include evaluation for depression, schizophrenia, generalized anxiety, and obsessive–compulsive and personality disorders.
- During the process of caloric restoration, calories must be gradually introduced to prevent the potentially fatal complication known as refeeding syndrome.
- Mortality resulting from suicide in 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 with antidepressant therapy.
- The current preferred treatment approach for anorexia nervosa includes a minimum of 6 months of psychotherapy, preferably cognitive behavioral therapy.
- Data supporting the use of medication in anorexia nervosa are largely inconclusive. Primary limitations are small sample sizes and a bias in clinical trials because more highly motivated patients participate in studies.
On completion of the chapter, the reader will be able to:
Compare and contrast epidemiologic differences between anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, night eating syndrome, and binge eating disorder.
Discuss the potential etiologic factors associated with eating disorders.
Evaluate patients with eating disorders for potential exacerbating factors.
Compare and contrast the diagnostic criteria for anorexia nervosa and bulimia nervosa.
Discuss the potential future changes in DSM-V diagnostic criteria for to anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specified.
Describe the clinical presentation of anorexia nervosa and bulimia nervosa, both physical and psychiatric.
Discuss the medical consequences and potential long-term effects of bingeing and purging behaviors.
Identify and assess for common psychiatric disorders that commonly co-occur or mimic the symptoms of eating disorders.
Describe the long-term prognosis of patients with anorexia nervosa and bulimia nervosa.
Develop a basic set of short- and long-term treatment goals for patients with anorexia nervosa and bulimia nervosa.
Formulate a basic nonpharmacologic treatment plan for anorexia nervosa and bulimia nervosa.
Recommend appropriate weight restoration goals for patients with anorexia nervosa and bulimia nervosa, and whether oral refeeding or implementation of total parenteral nutrition is the most appropriate form of caloric supplementation.
Identify when antidepressant therapy is appropriate for the management of symptoms associated with anorexia nervosa.
Identify when antipsychotic therapy is appropriate for the treatment of anorexia nervosa.
Identify when antidepressant ...