Eating Disorders: Disorders of Under- and Overnutrition

Key Points

• Eating disorder diagnoses consist of anorexia nervosa (restricting type and binge-eating/purging type); bulimia nervosa (purging and nonpurging types); and eating disorder, not otherwise specified (including binge-eating disorder, night eating syndrome, and purging disorder).

• Physical complications of anorexia nervosa affect most major systems in the body and are caused by starvation and the effects of purging. Most physical complications of bulimia nervosa are due to purging.

• Overweight and obesity are linked with binge-eating disorder and night eating syndrome. Patients typically request that weight loss be addressed with treatment.

• Anorexia nervosa is difficult to treat and may need initial inpatient treatment for refeeding. Subsequently, family therapy is recommended for patients still living with their families.

• Cognitive behavioral therapy is the first line of therapy recommended for bulimia nervosa, binge-eating disorder, and night eating syndrome. Interpersonal therapy has also been shown effective for bulimia nervosa and binge-eating disorder with similar efficacy as cognitive behavioral therapy at 12 months post-treatment.

• Selective serotonin reuptake inhibitors have been shown effective for treating bulimia nervosa, binge-eating disorder, and night eating syndrome, as has topiramate. Sibutramine is also effective for binge-eating disorder. Medication trials have not identified a drug that effectively addresses the refusal to maintain a healthy body weight, the core symptom of anorexia nervosa.

• Prevention studies are in their infancy, but dissonance-based programs have shown promise.