CHAPTER 8: Eating and Weight-Related Disorders

Introduction One in 10 women will be diagnosed with an eating disorder in their lifetime. Many more women experience subthreshold disordered eating symptoms. Eating disorders have the highest mortality rate of any psychiatric disorder.

Diagnostic Features Anorexia Nervosa (AN) – Body size that is at least 15% less than minimally normal weight for one’s age and height – Extreme level of dissatisfaction with their appearance – Intensely fearful of gaining weight – Absence of at least three consecutive menstrual cycles Restricting subtype or binge/purge subtype

Diagnostic Features Bulimia Nervosa (BN) – Recurrent (at least once per week for three months) episodes of binge eating and inappropriate compensatory behaviors to prevent weight gain – Feeling that one cannot stop eating – Binges followed by feelings of guilt, shame, and increased weight concern Purge subtype or nonpurge subtype

Diagnostic Features Binge-Eating Disorder (BED) – Binge eating and distress about the occurrence and frequency of binge episodes – Not associated with purgative methods to compensate for overeating – No body image disturbance criterion

Diagnostic Features Eating Disorder Not Otherwise Specified (EDNOS) – Meets some, but not all, criteria for AN or BN

Diagnostic Features Body Dysmorphic Disorder (BDD) – Preoccupation with an imagined or slight defect in one’s appearance – Causes clinically significant levels of distress and/or interferes with daily functioning

Diagnostic Features Dual diagnoses – Depression, anxiety, obsessive compulsive personality disorder(OCPD) Prevalence rates in Western cultures – AN: 0.5% – BN and BED: 1–3% – EDNOS: 2–5% – BDD: 1.7–2.5% Course and prognosis – AN: greatest mortality and most chronic

Risk Factors for Eating Disorders Genetic Factors Developmental Stages Psychological/Sociocultural Factors Mass Media Objectification Theory

Treatment Options Common Treatment Approaches – Cognitive-behavioral therapy (CBT) – Interpersonal therapy – Behavioral therapies – Pharmacotherapy

Treatment Options Anorexia Nervosa – Treatment resistant – Family therapy, CBT, pharmacological treatment used – Inpatient vs. outpatient treatment Bulimia Nervosa – CBT most effective – Often treated outpatient

Treatment Options Binge-Eating Disorder – CBT most effective – Interpersonal therapy also used Eating Disorder Not Otherwise Specified – Evaluations of treatment efficacy are hampered by heterogeneity of those who meet criteria for EDNOS Body Dysmorphic Disorder – CBT and pharmacotherapy

Treatment Options Challenges to Treatment – Economic burden – Healthcare service utilization – Shame or embarrassment in seeking help – Retention rates

Future Research Need for systematic investigation of genetic markers for eating disorders Need to correct classification systems for eating disorders Future work on treatment strategies More research on non-Western cultures