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Survey Puts New Focus on Binge Eating as a Diagnosis

By NICHOLAS BAKALAR Binge eating is not yet officially classified as a psychiatric disorder. But it may be more common than the two eating disorders now recognized, anorexia nervosa and bulimia. The first nationally representative study of eating disorders in the United States, a nationwide survey of more than 2,900 men and women, was published by Harvard researchers in the Feb. 1 issue of the journal Biological Psychiatry. It found a prevalence in the general population of 0.6 percent for anorexia, 1 percent for bulimia and 2.8 percent for binge-eating disorder. Lifetime rates of the disorders, the researchers found, are higher in younger age groups, suggesting that the problem is increasingly common. Eating disorders are about twice as common among women as men, the study reports. Experts not involved in the study called it significant. “This is probably the best study yet conducted of the frequencies of eating disorders in American households,” said Dr. B. Timothy Walsh, director of the eating disorders research unit of the New York State Psychiatric Institute at Columbia University Medical Center. “It confirms that anorexia nervosa and bulimia are uncommon but serious illnesses, especially among women,” Dr. Walsh said. “It also finds that many more individuals, especially those with significant obesity, are troubled by binge eating, and underscores the need to better understand this problem.” Copyright 2007 The New York Times Company

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment
Link ID: 9959 - Posted: 06.24.2010

Confusion over body size could help explain eating disorders

You may think you know the back of your hand like, well, the back of your hand. But scientists have found that our brains contain distorted representations of the size and shape of our hands, with a tendency to think of them as shorter and fatter than they really are. The work could have implications for how the brain unconsciously perceives other parts of the body and may help explain the underpinnings of certain eating disorders in which body image becomes distorted. Neuroscientists at University College London asked more than 100 volunteers to place their left hand palm-down on a table. The researchers covered the volunteers' hands with a board and then asked them to indicate where they thought landmarks such as fingertips lay underneath. This data was used to reconstruct the "brain's image" of the hand. The results, published yesterday in the Proceedings of the National Academy of Sciences, showed a consistent overestimation of the width of the hand. Many of the volunteers estimated their hand was about 80% broader than it really was. "It's a dramatic and highly consistent bias," said Matthew Longo of UCL's Institute of Cognitive Neuroscience, who led the work. "It was the same with estimation of finger lengths. When you get to the ring finger, with the largest bias, it's 30%-40% underestimation." The brain uses several ways to work out the location of different parts of the body. This includes feedback from muscles and joints and also some sort of internal model of the size and shape of each part. Behavioral Health Central © Copyright 2010,

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 8: General Principles of Sensory Processing, Touch, and Pain
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 5: The Sensorimotor System
Link ID: 14187 - Posted: 06.24.2010

Sex hormone implicated in eating disorder onset

A biological factor may play an essential part in the development of eating disorders in girls during puberty, a new study finds. The research, led by Michigan State University (MSU) scientists, finds that the genes of girls who have higher levels of estradiol at puberty can act as a catalyst for the development of eating disorders. Estradiol is the primary form of estrogen in women's bodies. It plays a key role in the development of secondary sex characteristics and bone development. "The reason we see an increase in genetic influences during puberty is that the genes for disordered eating are essentially getting switched on during that time," said Kelly Klump, MSU associate professor of psychology, in a release. "What we found is that increases in estradiol apparently are activating genetic risk for eating disorders." The genes responsible for activating eating disorders have yet to be identified. The researchers also believe that environmental factors and a genetic link (having a family history of eating disorders) play a part in the development of the condition. The researchers measured the amount of estradiol in the bloodstreams of 200 sets of twin girls between the ages of 10 and 15. The study is published in the journal Psychological Medicine. © CBC 2010

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 5: Hormones and the Brain
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 8: Hormones and Sex
Link ID: 14149 - Posted: 06.24.2010

Unnamed eating disorders may go untreated

By Rachael Rettner Anorexia and bulimia are probably the most familiar types of eating disorders, but they are not the most common. Some 50 to 60 percent of patients don't quite make the cut to be diagnosed with full-blown anorexia or bulimia, and are instead classified as having an eating disorder "not otherwise specified" (EDNOS). But this group is so vast, and the cases within it so diverse, that many in the field believe it creates more problems than it does solutions in terms of treating patients and understanding the syndromes. Patients lumped into this unspecified group can also have misperceptions about their condition, thinking it is not as serious as anorexia or bulimia. But in fact, recent studies have found that there really isn't a medical difference between the three recognized types of eating disorders. Now, physicians and psychiatrists are taking action to remedy the situation. They are proposing revisions to the psychiatric "bible," the Diagnostic and Statistical Manual of Mental Disorders, or DSM, for the newest version (DSM-5) to be published in 2013. The suggested changes include relaxing the strict criteria for anorexia and bulimia somewhat, and giving other conditions, such as binge eating, their own official labels. These more specific labels could be a boon to treatment and the mental health of the patient, who will finally know what he or she "has." In addition, experience has shown that when a disorder gets a name, more research and attention is paid to it. Even so, some experts aren't sold, saying these DSM changes won't make any real difference as far as treatment goes. © 2010 msnbc.com

Body Image Concerns Hardwired Into Women's Brains

By Emily Sohn To be an American woman and feel good about your body requires a powerful inner strength and the will to resist an unrealistically skinny social ideal. But even women who truly accept themselves as they are have internalized the desire to be thin, suggests a new study that looked deep into women's brains. The study found that the brains of healthy women resemble those of bulimic women when confronted with the idea that they might be overweight. The findings might eventually help doctors better evaluate and treat body image issues, no matter how subtle. "This is kind of validating the suspicion that most women are teetering on the edge of an eating disorder," said Mark Allen, a neuroscientist at Brigham Young University in Provo, Utah. "If the brain response is so strong in these apparently healthy women, maybe most of us could use a little dose of what it is that you go through in an eating disorder therapy." Who are you? What makes you unique? What fulfills you? Are you friendly, cheerful, grumpy or important? When people consider questions like these that force them to engage in serious self-reflection, activity picks up in a part of the brain called the medial prefrontal cortex. Scientists have suspected that this self-reflective part of the brain could betray subconscious thoughts that people might not even know they have. For example, other studies have shown that, in tasks like word-associations, people who don't think they're racist still show racist tendencies when they don't have time to consciously override what's under the surface. © 2010 Discovery Communications, LLC.

Is binge eating a psychiatric disorder?

By Melissa Healy >>> Rina Silverman's refrigerator is almost always empty. She keeps it that way to avert episodes of frantic food consumption, often at night after a full meal, in which she tastes nothing and feels nothing but can polish off a party-sized bag of chips or a container of ice cream, maybe a whole box of cereal. The food she's eating at these moments hardly matters. In short order, the nothing that Silverman feels and tastes will give way to nauseating fullness, and a bitter backwash of guilt, shame and self-reproach. The fullness, in time, passes. But the corrosive shame and self-reproach are always there. Silverman, a 43-year-old executive assistant from Sherman Oaks, is one of the 145 million Americans who are overweight or obese. But the frenzies of consumption put her in a far smaller category of Americans, not all of whom are even overweight. Silverman is a binge eater, one who is slowly inching her way toward recovery. She and as many as 1 in 30 Americans -- roughly 7.3 million adults -- are at the center of a psychiatric debate over whether and how to recognize binge eating as a mental disorder. A decision on the matter is expected early next year, as the American Psychiatric Assn. updates the diagnostic manual that guides the mental health profession. In light of new research and a seemingly growing population of patients who fit the broad description of binge eaters, psychiatrists must decide whether "binge eating disorder" should stand alongside anorexia nervosa and bulimia nervosa as a separate psychiatric condition -- identifiable by a distinct set of symptoms, a recognizable pattern of progression and a track record of response to certain treatments. © 2009, The Los Angeles Times

Struggling to Understand the Power of an Eating Disorder.

By Caitlin Gibson Leah's voice was calm on the phone. I'm on my way home, she said. Sarah died this morning. In the steady tone my best friend would use to say she had a flat tire or was late for class, Leah explained that she was about to board a flight to join her family as they prepared for her little sister's funeral. Leah had known on some level that this might happen. She'd read the books, done the research and understood that girls with eating disorders got better, or they didn't. She saw Sarah as what she was: the everygirl of her illness, not immune because she was smart and beautiful, popular and athletic. But the knowledge that it might happen did nothing to prepare Leah. Her false serenity lasted until the funeral, where she sat beside her parents in the synagogue and greeted a seemingly endless line of mourners. I took my place behind her, next to her aunt. Person after person shuffled forward to offer tearful embraces, and Leah's cocoon suddenly collapsed. The piercing cry that tore from her throat silenced the room. Leah's aunt and I lunged forward in the instinctive way that one body answers another: our palms pressed against her back, fingers wrapped around her shoulders. Leah's scream subsided into a whimper, then quiet. The day shuddered on. A growing consensus suggests that for young people with eating disorders, the sooner the problem is identified and aggressively treated, the better the chance of recovery. © 2009 The Washington Post Company

Is Vegetarianism a Teen Eating Disorder?

By John Cloud Tuesday, Being a teenager means experimenting with foolish things like dyeing your hair purple or candy flipping or going door-to-door for a political party. Parents tend to overlook seemingly mild, earnest teen pursuits like joining the Sierra Club, but a new study in the Journal of the American Dietetic Association suggests that another common teen fad, vegetarianism, isn't always healthy. Instead, it seems that a significant number of kids experiment with a vegetarian diet as a way to mask an eating disorder, since it's a socially acceptable way to avoid eating many foods and one that parents tend not to oppose. The study, led by nutritionist Ramona Robinson-O'Brien, an assistant professor at the College of Saint Benedict and Saint John's University in Minnesota, found that while adolescent and young adult vegetarians were less likely than meat eaters to be overweight and more likely to eat a relatively healthful diet, they were also more likely to binge eat. Although most teens in Robinson-O'Brien's study claimed to embark on vegetarianism to be healthier or to save the environment and the world's animals, the research suggests they may be more interested in losing weight than protecting cattle or swine. (See pictures of a diverse group of American teens.) For one thing, many young "vegetarians" continue to eat the white meat of defenseless chickens (25% in the current study) as well as the flesh of those adorable animals known as fish (46%), even when they are butchered and served up raw as sushi. And in a 2001 study in the Journal of Adolescent Health, researchers found that the most common reason teens gave for vegetarianism was to lose weight or keep from gaining it. Adolescent vegetarians are far more likely than other teens to diet or to use extreme and unhealthy measures to control their weight, studies suggest. The reverse is also true: teens with eating disorders are more likely to practice vegetarianism than any other age group. © 2009 Time Inc.

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 1: Introduction: Scope and Outlook
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 20:
Link ID: 12774 - Posted: 06.24.2010

Extreme Measures

By Carrie Arnold The Griecos had learned of Christina's illness just months earlier, although she had been struggling with the eating disorder for three years. They found outpatient therapy for her right away, but it didn't stop her from slashing her calories to starvation levels. Feeling helpless and guilty, as if they were somehow to blame, the Griecos, who live in Chantilly, arranged for Christina to spend two months in an eating disorders clinic in Arizona, at a cost of more than $100,000. ad_icon In their haste, they forgot about a note that one therapist had scribbled on a scrap of paper: "Maudsley approach," it read. "Very effective for adolescents." Looking back, the Griecos wish they had focused on it sooner. Unlike traditional eating disorder treatment programs, which tend to equate parental involvement with parental interference, the Maudsley approach treats the family as an integral part of the healing process. Named for the London hospital where it was developed in the 1980s, the Maudsley approach views food as medicine and parents as the optimal people to help their child return to health. Unlike traditional psychotherapy, this family-based treatment views the ill teenager as unable to start eating, rather than as choosing not to eat. © 2009 The Washington Post Company

Anorexia and Reward

Anorexic from a young age, 31-year old Erin Kennedy still struggles to convince herself that her own body image is often distorted. "When I hear I'm healthy, to me that means I'm fat," she says. "But, you know, healthy is good. I have to remember healthy is good." Such self-monitoring is an essential part of Kennedy's challenging recovery process, but she says, "It's not always easy, and it's not something I always do." Kennedy has not been hospitalized for more than four years, the longest stretch of time she's been on her own since her first hospitalization in high school. In the hospital, Kennedy had to report to the nurse's station six times daily to drink Ensure. "People passing by wanted one, and I used to try to sneak it to them," she remembers. Even now, despite years of treatment, Kennedy says that anxiety about weight remains "a constant" in her life. Recovery from anorexia often takes years, and new brain scan research shows that even fully recovered anorexics are distinct from the general population in the way their brains process reward. According to a study published in the American Journal of Psychiatry, women who never had anorexia showed highs and lows in brain activity that corresponded with winning or losing. But former anorexics showed no difference in their brains' reward centers. "People with anorexia had a hard time distinguishing win or loss," says Walter Kaye, a psychiatrist and coauthor of the new study. © ScienCentral, 2000-2008.

Ears Too Big? It's All in Your Head

By Constance Holden People with body dysmorphic disorder (BDD) hate the way they look. Even though they are as normal in appearance as anyone else, they are obsessed with features such as their skin, their noses, and their hair, which--to them--never look right. Now, the first brain-imaging study of BDD patients shows that the condition is not an emotional problem. Rather, their brains are presenting them with skewed images of themselves. Psychiatrist James Feusner and colleagues at the University of California, Los Angeles, asked BDD subjects and controls to scrutinize images of faces while their brains were being scanned by functional magnetic resonance imaging. Each face was presented in three versions: One was an unaltered photograph; one included only low-spatial-frequency information, resulting in a blurred image that yielded just a general impression of the face; and the third contained only high-frequency information, which exaggerated the lines of the face (see picture). Previous research has shown that different neural pathways process high- and low-frequency information. When the image is blurry, the normal brain analyzes the face as a whole, whereas with high-frequency data, it zeroes in on details. The scientists found that the control subjects used a more holistic, right-brain strategy for the unaltered face and the low-frequency one. They only moved to the high-detail strategy for the high-detail face. In the BDD group, however, subjects failed to look at the figure as a whole, instead using left-brain channels that dwell on details for all three faces. © 2007 American Association for the Advancement of Science.

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 19: Language and Lateralization
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 15: Language and Lateralization
Link ID: 11036 - Posted: 06.24.2010

Researchers Examine 'Purging Disorder'

By AMY LORENTZEN DES MOINES, Iowa -- An Iowa researcher is studying a little-known eating disorder that some doctors may miss: purging disorder. Though similar to women with bulimia, patients who fit this description don't binge-eat. Yet they feel compelled to purge, usually by vomiting, even after eating only a small or normal amount of food, said Pamela Keel, the University of Iowa researcher who led a study on the subject. Keel, a psychology professor, and colleagues from Iowa and the Harvard Medical School describe their research in this month's issue of Archives of General Psychiatry. "Purging disorder is new in the sense that it has not been officially recognized as a unique condition in the classification of eating disorders. But it's not a new problem," Keel said. "Women were struggling with purging disorder long before we began studying it." If further study supports that it is a distinct disorder, Keel said the American Psychiatric Association could revise its criteria for diagnosing eating disorders. That's important because doctors could then better screen these patients and identify treatments for them. Otherwise, they might be missed because they are normal weight and don't report binge-eating, she said. © 2007 The Associated Press

Mom's Unforgiving Mirror

By Deborah Tannen I once showed my mother a photograph taken of me by a professional photographer. Instead of commenting on the glamorous pose and makeup-artist adornment, she said, "One of your eyes is smaller than the other." Then she turned to me and gripped my chin as she examined my face. "It is," she pronounced. "Your left eye is smaller." For a while after, whenever she saw me, she inspected my eye and reiterated her concern. During that time, I too became preoccupied with my left eye. My mother's perspective had become my own. When else does a slight imperfection -- a pimple, a small asymmetry -- become the most prominent feature on your face? When you're looking in a mirror. A mother who zeroes in on her daughter's appearance -- often on the Big Three: hair, clothes and weight -- is regarding her daughter in the same way that she looks at herself in a mirror. The more I thought about it, the more this seemed to account for some of the best and worst aspects of the mother-daughter relationship: Each tends to see the other as a reflection of herself. It's wonderful when this means caring deeply, being interested in details and truly understanding the other. But it can cause frustration when it means scrutinizing the other for flaws in the same way that you scrutinize yourself. The mirror image is particularly apt during the teenage years. At this age, a girl may spend hours in front of a full-length mirror, scouring her reflection for tiny imperfections that fill her with dread. And it is typically also at this age that she is most critical of her mother. (One woman recalls how her teenage daughter summed it up: "Everything about you is wrong.") The teenage girl is critiquing her mother -- and finding her wanting -- just as she scans her own mirror image for imperfections. © 2007 The Washington Post Company

"Dissonance" therapy aids eating disorder symptoms

By Amy Norton NEW YORK (Reuters Health) - Group therapy using a technique based on the theory of "cognitive dissonance" may help young women at risk of eating disorders, new research suggests. The study included 93 college women who responded to a call for women who were not satisfied with their bodies. Both interventions lasted about 6 weeks. The researchers found that group therapy, once-weekly for 6 weeks, relieved some of the students' body dissatisfaction, unhealthy eating habits and symptoms of anxiety. The other approach that was used -- yoga -- failed to spur any improvements, according to findings published in the International Journal of Eating Disorders. However, the researchers note that 6 weeks was a relatively short period to learn yoga, and previous studies that found a relationship between yoga and a reduction in eating disorder symptoms included women who practiced yoga for about six years. The problem of "disordered eating" is common among college women. Though they fall short of an official eating disorder diagnosis, these women suffer from body dissatisfaction and fear of gaining weight, and often use unhealthy weight control measures like fasting, vomiting and laxative and diuretic abuse. Many go through cycles of binge-eating. © 1996-2007 Scientific American, Inc

Dads may unwittingly push daughters toward bulimia

By Megan Rauscher NEW YORK (Reuters Health) - Fathers are important influences on their daughters' perceptions of their weight and shape during childhood, and can increase their risk of developing an eating disorder in adolescence, research shows. "Fathers have been mostly ignored in previous research on eating disorders," Dr. W. Stewart Agras, who led the research, told Reuters Health. Based on his findings, Agras said fathers "should avoid criticizing their daughter's weight or shape. Rather they should build up their daughter's confidence by emphasizing other positive attributes." Weight concerns and preoccupation with being thin, together with social pressure to be thin, are strong risk factors for eating disorders in later adolescence. In an effort to throw light on what factors during childhood contribute to weight concerns and thin body preoccupation, Agras and colleagues from Stanford University in California followed 134 children (68 girls and 66 boys) from birth to age 11 and their parents. Annual questionnaires beginning at age 2 assessed parents' concerns about their children's weight and eating habits as well as their own weight. The results show, Agras said, that "fathers are important in influencing their daughters toward bulimia, particularly fathers who were overweight and wanted to be thinner." These influences may be direct -- such as criticizing the daughter's weight or shape -- or indirect, by expressing their own concerns about weight and shape. © 1996-2007 Scientific American, Inc.

Boys recover more quickly from anorexia

NEW YORK (Reuters Health) - Anorexia nervosa runs a longer course in girls than in boys, research shows. One year after undergoing treatment for anorexia, Dr. Michael Strober of the David Geffen School of Medicine at UCLA and colleagues found that girls showed a higher level of continued preoccupation with weight and eating than did boys. And while none of the boys in the current study had relapsed into full-blown anorexia at one year after treatment, 8.2 percent of girls had. The study is the first to look at gender differences in anorexia patients, the study team points out in the International Journal of Eating Disorders. Given that the disease is much more common among females, they note, some researchers have suggested that there may be gender differences in why it develops. To investigate, Strober and colleagues looked at 99 anorexia patients aged 13 to 17, 14 of whom were boys. Both boys and girls had similarly severe symptoms when they entered treatment, the researchers found, and were also equally likely to suffer from anxiety disorders and traits known to be associated with anorexia such as rigidity and perfectionism. However, girls showed greater concern with weight. One year later, the researchers found, the girls reported more concern with weight, shape and eating than the boys, and were more likely to have fallen below their recommended maintenance weight. © 1996-2006 Scientific American, Inc.

Related chapters from BN: Chapter 13: Homeostasis: Active Regulation of the Internal Environment; Chapter 12: Sex: Evolutionary, Hormonal, and Neural Bases
Related chapters from MM:Chapter 9: Homeostasis: Active Regulation of the Internal Environment; Chapter 8: Hormones and Sex
Link ID: 9569 - Posted: 06.24.2010

Bodies of Evidence

By Sandra G. Boodman The programs have catchy names like "Food, Mood and Attitude" and "Full of Ourselves" as well as an ambitious goal: to prevent adolescent eating disorders, which tend to be chronic, difficult to treat and sometimes fatal. But do they work? In the case of one such program -- "Student Bodies," developed by researchers at Stanford University -- a recently published study suggests that the answer is yes. Stanford researchers, who followed 480 female California college students for up to two years, report that the eight-week Internet-based program reduced the development of eating disorders in women at high risk. "This study shows that innovative intervention can work," said Thomas Insel, director of the National Insitute of Mental Health, which funded the study; its findings appeared in the August issue of the Archives of General Psychiatry. Prevention programs for eating disorders have proliferated in the past decade, in part because of the high cost and low success rate of treatment programs. The disorders include a constellation of problems, including anorexia, a pathological fear of gaining weight marked by self-starvation. Anorexia has the highest mortality rate of any psychiatric illness: About 10 percent of patients hospitalized for treatment ultimately die of the disorder. © 2006 The Washington Post Company

A Complicated Process: Diagnosing and Treating Anorexia Nervosa and Bulimia

By Katherine A. Halmi, M.D. Anorexia nervosa (AN) and bulimia nervosa (BN) are the two major eating disorders. Anorexia nervosa is characterized by weight loss, an intense fear of gaining weight, a distorted body image and amenorrhea. Bulimia nervosa is a disorder in which binge eating is the predominant behavior. People with BN engage in some sort of compensatory behavior to counteract the potential weight gain from calories ingested during bingeing. They are frequently overconcerned about their physical appearance. Why are these disorders difficult to diagnose? Patients with AN do not wish to be diagnosed because they do not wish to be treated. They deny the core symptomatology of their disorder and will often try to mislead their primary care provider into believing there are other medical issues causing their weight loss. Thus, it is very helpful to obtain further information from family members about the patient's behavior, if possible. Furthermore, there are problems with the DSM-IV diagnostic criteria for AN and BN (see Table 1 for an abbreviated version). The DSM-IV criteria are undergoing scrutiny because many patients suffering from eating disorders do not quite fit. For AN, the criterion of weight loss would seem to be noncontroversial. However, there is no consensus as to how weight loss should be calculated. Some investigators emphasize a total weight loss from an original high weight, and others emphasize weight loss below a normal weight for age and height. © 2005 Psychiatric Times. All rights reserved.

Exploring the Gene-Environment Nexus in Anorexia, Bulimia

by Arline Kaplan, Psychiatric Times August 2004 Vol. XXI Issue 9 Although eating disorders have been considered to be largely sociocultural in origin, findings from family, twin and molecular genetic studies conducted during the last decade are refuting that perspective, an expert in genetic epidemiology told attendees at the recent 2nd World Congress on Women's Mental Health in Washington, D.C. (Bulik et al., 2004). "Twenty years ago when I started in this field, and gave my favorite lecture on eating disorders, it was all about the role of the family and social factors in the etiology of eating disorders," said Cynthia M. Bulik, Ph.D., William R. and Jeanne H. Jordan Distinguished Professor of Eating Disorders in the department of psychiatry and director of the eating disorders program at the University of North Carolina, Chapel Hill. "Both anorexia and bulimia were very much viewed as disorders of choice. These young girls were viewed as trying to emulate some cultural ideal and diet themselves down to a certain weight. Now, any patient would have told you had you listened that wasn't what they were doing. They went far beyond any societal ideal in Cosmopolitan or any other magazine." Bulik explained that when she and colleagues started talking about genes as being involved in these disorders, "people pretty much thought we were out of our minds." However, the investigators are discovering a complex interplay between genes and the environment leading to the development of anorexia nervosa (AN) and bulimia nervosa (BN). © 2004 Psychiatric Times

Pharmacotherapy for Patients With Eating Disorders

by Timothy D. Brewerton, M.D. , Psychiatric Times Eating disorders, including anorexia nervosa (AN), bulimia nervosa (BN) and binge-eating disorder (BED), remain one of the most complex and clinically challenging groups of mental disorders in our nomenclature. There are no easy solutions, and the bottom line of this article is that pharmacological agents are not the primary treatment of choice. Although a number of agents have been found in randomized controlled trials to be beneficial, they are by and large insufficient as stand-alone treatments. Space does not allow a comprehensive overview of this topic, but the reader is referred to a recent review by Steinglass and Walsh (2004). In addition, the revised American Psychiatric Association practice guidelines for the treatment of eating disorders (APA, 2000) and the recently released National Institute of Clinical Excellence (NICE) Guidelines (2004) are useful resources regarding the use of drug therapy within the context of a comprehensive treatment approach. No pharmacological agents have ever been shown in double-blind, placebo-controlled trials to significantly improve AN when given outside a structured, inpatient program. Food remains the "drug of choice" for this population, for reasons that will be elaborated below. Of course, administering food in the interest of weight restoration is much easier said than done, given the profound denial and resistance typical of this disorder. There are a handful of drugs found to be statistically better than placebo in randomized controlled trials, but there is little clinical significance of these findings. Lithium (Eskalith, Lithobid) was shown in one controlled trial to be statistically better than placebo in a small group of patients being treated at the National Institute of Mental Health on an intensive, highly structured, specialized treatment unit (Gross et al., 1981). However, the effect was small, and eating disorder specialists generally deem the potential risks of lithium treatment in this population to be far greater than the possible benefits, largely due to the danger of lithium toxicity secondary to dehydration and electrolyte imbalances from starvation, compulsive exercising and/or purging. Another study found amitriptyline (Elavil) statistically better than placebo for patients who are both bulimic and anorexic, while cyproheptadine (Periactin) was better for restricting anorexia (Halmi et al., 1986). However, other studies have had mixed results. © 2004 Psychiatric Times. All rights reserved.

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