Eating disorders are serious psychiatric conditions with the highest mortality rate of any mental illness. This article covers clinical presentation, medical complications, and treatment.
ANOREXIA NERVOSA
Diagnostic Criteria
A. Restriction of energy intake leading to significantly low body weight
B. Intense fear of gaining weight or becoming fat
C. Disturbance in body image, undue influence of weight on self-evaluation
Subtypes
- Restricting type: No binge-eating or purging
- Binge-eating/purging type: Recurrent episodes
Medical Complications
- Bradycardia, hypotension
- Electrolyte abnormalities (hypokalemia)
- Osteoporosis
- Amenorrhea
- Lanugo hair
- Cardiac arrhythmias (leading cause of death)
BULIMIA NERVOSA
Diagnostic Criteria
A. Recurrent episodes of binge eating (large amounts, loss of control)
B. Recurrent inappropriate compensatory behaviors (purging, fasting, excessive exercise)
C. Episodes occur at least once weekly for 3 months
D. Self-evaluation unduly influenced by body shape/weight
Medical Complications
- Dental erosion (perimylolysis)
- Parotid gland enlargement
- Electrolyte abnormalities
- Esophageal tears/Mallory-Weiss
- Russell's sign (calluses on knuckles)
BINGE EATING DISORDER
Diagnostic Criteria
A. Recurrent episodes of binge eating with sense of lack of control
B. Associated with eating rapidly, eating until uncomfortably full, eating alone due to embarrassment, feeling disgusted/guilty afterward
C. Episodes occur at least once weekly for 3 months
D. NOT associated with compensatory behaviors
TREATMENT
Anorexia Nervosa
- Nutritional rehabilitation (primary)
- Family-Based Treatment (FBT) for adolescents
- Individual therapy (CBT-E, SSCM)
- No FDA-approved medications
- Medical stabilization may require hospitalization
Bulimia Nervosa
- CBT-BN (most evidence)
- Fluoxetine 60 mg (FDA approved)
- Nutritional counseling
Binge Eating Disorder
- CBT-BN adapted
- Lisdexamfetamine (FDA approved)
- SSRIs may help
TREATMENT SETTING
Inpatient criteria
- <75% ideal body weight
- Vital sign instability
- Electrolyte abnormalities
- Suicidal ideation
- Failed outpatient treatment
PROGNOSIS
- AN: ~50% recover, 30% improve, 20% chronic, ~5% mortality
- BN: Better prognosis than AN
- BED: Good response to treatment
Early intervention significantly improves outcomes.