Eating disorders: 1. Anorexia nervosa

Few organ systems are spared the progressive deterioration seen in this disease. Most medical complications are the result of starvation and can be reversed with a well-planned refeeding program. A potentially catastrophic treatment complication is the refeeding syndrome, in which the demands that a repleted circulatory system places on a nutritionally depleted cardiac mass result in cardiovascular collapse.     

Eating disorders. Anorexia nervosa in adolescents

EPIDEMIOLOGICAL DATA: Anorexia nevrosa is mainly observed in young women in the 15-24 year age range. The incidence is 1 to 2% in the general population of female adolescents. The sex ratio is 9 girls for 1 boy. SYMPTOM TRIAD: Three symptoms predominate in anorexia nevrosa: weight loss, anorexia, amenorrhea. Weight loss results from restrictive eating behavior and not from a loss of appetite. CLINICAL DIAGNOSIS: Diagnosis is clinical and confirmed by an analysis of the underlying psychological conflicts which involve difficulty in accepting the female identity and in assuming self-sufficiency outside the family. The clinician should evaluate the quality of the familial environment, particularly the mother-daughter and father-daughter relationship as well as the social environment (school, friends) which is also needed to apprehend the global situation. Physical examination and laboratory tests are aimed at rapidly eliminating any differential diagnosis and to quantify the weight loss and its rate, and identify any nutritional disorders. ETIOLOGY: Anorexia nevrosa is not a truly structured psychopathological disorder but rather a loss of a stable organization of Self, with a highly vulnerable narcissistic element and precarious neurotic defences. CLINICAL COURSE: The risk of poor outcome is very real, sometimes life threatening. The treatment of choice is to implement analytical management as soon as possible, but outside acute episodes.     

Bulimia nervosa: dental perspectives

Bulimia nervosa and bulimic behavior are among the most common eating disorders, affecting up to 13% of female college students. Most health professionals are aware of the compulsive overeating, self-induced vomiting, and laxative abuse associated with this disease; yet, only a small proportion of affected patients are ever diagnosed, generally only after years of abuse. Since the dental changes observed in most bulimics are recognizable and usually undeniable, the clinician should be aware of the oral and maxillofacial changes of this disease in order to arrive at an early diagnosis. Without successful treatment, an estimated 1 in 300 bulimic cases will have a fatal outcome. Even with treatment, one-third of affected individuals suffer early relapse and half of them do not consider themselves cured after 5 years of psychologic therapy. The learning objective of this article is to discuss the dental and psychologic features of this disorder, with focus on the differential diagnosis and treatment of the oral manifestations.     

Bulimia?=?bulimarexia?=?bulimia nervosa.

S. Cullari and W. K. Redmon (see record 1984-04326-001) suggested that bulimarexia and bulimia nervosa are similar to one another but different from bulimia. The present author argues that given the current state of knowledge, it is conceptually incorrect to consider bulimia and bulimiarexia as separate eating disorders and that such a distinction may lead to serious problems in both clinical research and practice. (10 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating in anorexia nervosa and bulimia nervosa: An application of the tripartite model of anxiety.

Investigated anxiety in 40 women before, during, and after eating, as well as during an earlier neutral activity. Ss were 10 restricting-anorexics, 10 bulimic-anorexics, 10 bulimic, and 10 normal-weight females. Anxiety was assessed by self-report (ratings of pleasure, arousal, and anxiety), psychophysiological indicators (heart rate and skin conductance), and food consumption measures. Controls reported little or no anxiety and ate almost all of the test meal. The eating-disordered Ss reported a high level of anxiety throughout the study. Bulimics and controls ate similar amounts, whereas the anorexics ate much less. Psychophysiological arousal during eating was high in all groups. (French abstract) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders: A call to arms.

Presents an overview of this issue of the American Psychologist. In this issue, four state-of-the-art articles on eating disorders by internationally recognized psychological scientists are presented. These articles were developed with the recognition that research in the psychological sciences constitutes an important key to realizing a pronounced decrease in the death and devastation that eating disorders leave in their wake and with the hope that there will be an increased investment in science that will lead to enlightened and effective treatments for eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Validity of the Eating Attitudes Test and the Eating Disorders Inventory in bulimia nervosa.

Assessed criterion and concurrent validity of the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI) in 82 women (mean age 24.3 yrs) with bulimia nervosa. Both tests demonstrated criterion validity by discriminating bulimia nervosa Ss from normal Ss. However, only weak support was found for the concurrent validity within bulimia Ss. Generally there was little association between the EAT or the EDI and behavioral measures, including vomiting frequency, duration of disorder, eating during test meals, thoughts while eating, and body-size distortion. It is suggested that self-report questionnaires in conjunction with direct behavioral-measures of eating and vomiting would provide the most complete assessment for bulimia nervosa. (6 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders: progress and problems

Recent research on Anorexia Nervosa and Bulimia Nervosa has yielded an increasingly detailed understanding of the range of biological and psychological abnormalities associated with these eating disorders. Inherited vulnerabilities, cultural pressures, and adverse individual and family experiences all appear to contribute to the onset of extreme dieting, binge eating, and purging. Once initiated, these behaviors give rise to multiple physiological disturbances, some of which may serve to perpetuate the illness. Although there have been substantial advances in the management of Bulimia Nervosa, the goal of offering effective treatment to all individuals with eating disorders remains elusive. This article reviews current thinking on the etiology and treatment of the two major eating disorders and a related syndrome, Binge Eating Disorder.     

Anorexia nervosa and bulimia nervosa. II. Somatic complications of undernourishment

In anorexia nervosa and bulimia nervosa, cachexia and deficient nourishment cause various physical abnormalities, especially of the endocrine and digestive systems and the heart. Disorders in the serotoninergic and dopaminergic systems contribute to development of an eating disorder, whereas an acquired deficiency of tryptophan impairs the serotoninergic system. Any problems of nutritional deficiencies, low blood sugar levels and gastrointestinal disorders disappear after normal nourishment is resumed. Hypotension and sinus bradycardia are manifestations of a physiological adjustment to a lower basal metabolism and need no treatment. Osteoporosis occurs from two years after the onset of weight loss; oestrogen supplementation may protect against this. In patients with infections, symptoms such as fever, leukocytosis and high BSE may be lacking. Hypoglycaemia incidentally leads to coma and death, and a lengthened QT interval to acute cardiac death. During restoration of the nutritional status, the intake of fluid and calories should initially be limited. During the first two weeks, the risk of cardiovascular complications is increased.     

Disintegrated experience: The dissociative disorders revisited.

Presents proposed changes to the dissociative disorders section of the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) and reviews the concept of pathological and nonpathological dissociation, including empirical findings on the relations between trauma and dissociative phenomenology and between dissociation and hypnosis. The most important proposals include the creation of 2 new diagnostic entities, brief reactive dissociative disorder and transient dissociative disturbance, and the readoption of the criterion of amnesia for a multiple personality disorder diagnosis. Further work on dissociative processes will provide an important link between clinical and experimental approaches to human cognition, emotion, and personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Bulimia Test—Revised: Validation with DSM-IV criteria for bulimia nervosa.

The Bulimia Test —Revised [(BULIT-R) M. H. Thelen, J. Farmer, S. Wonderlich, & M. Smith; see record 78:17280] was given to participants who met the criteria in the fourth edition of the Diagnostic and Siatistical Manual of Mental Disorders (DSM-IV) for bulimia nervosa and control participants to determine if the test continues to be a valid measure of bulimia nervosa. Although the BULIT-R was developed and validated with bulimic individuals as determined by the DSM-III-R criteria, it appears to be a valid instrument with which to identify individuals who meet DSM-IVcriteria for bulimia nervosa. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders among athletes. Research and recommendations

Research indicates that certain athletes, particularly those in sports that emphasize leanness to enhance performance or appearance (e.g., gymnastics, wrestling, figure skating, diving, and ballet), are at risk for eating disorders. Little is known about the risk for eating disorder symptoms in weight and strength training. It is concluded that, even when mild variants of eating disorders are observed in athletes, they should be given immediate attention because they may severely compromise health and performance. Practical recommendations are made for coaches and trainers to identify the physical, psychological, and behavioral symptoms of eating disorders. Finally, suggestions are made for addressing eating disorders in athletes.     

Eating disorders: National Institute of Mental Health's perspective.

The mission of the National Institute of Mental Health (NIMH) is to reduce the burden of mental and behavioral disorders through research, and eating disorders embody an important fraction of this burden. Although past and current research has provided important knowledge regarding the etiology, classification, pathophysiology, and treatment of the eating disorders, there are still significant challenges that need to be addressed. This article briefly describes some of these challenges, recent NIMH-supported research and research-related activities directed at addressing these challenges, and approaches and areas of research that hold promise for furthering the understanding and treatment of eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Eating disorders and health insurance

Eating disorders are being diagnosed and managed by an increasing number of pediatricians and practitioners of adolescent medicine. These physicians are increasingly discovering the power and importance of their patients' health insurance status in the management of these conditions because the lack of appropriate insurance may often pose obstacles and barriers to care. This article provides an analysis of this situation through brief case presentations followed by a discussion and recommendations.     

Eating disorders. Guide to medical evaluation and complications

Eating disorders lead to numerous physical complaints with signs and symptoms affecting nearly every organ system of the body. We review the presentation of a patient with eating disorder to the primary care giver or general psychiatrist, focusing on the physical manifestations of the underlying illness. Specific complications related to laboratory findings, the gastrointestinal tract, and the endocrine system are reviewed. Algorithms for medical evaluation of these patients are also presented.     

Eating disorders: A bibliography of recent clinical and research reports.

Lists 47 references on eating disorders, including binge eating, bulimia, bulimarexia (binge eating and purging), and compulsive eating. This bibliography was compiled from a systematic review of selected journals and books about the assessment and treatment of obesity, anorexia nervosa, and eating disorders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Bulimia and taste: Possible interactions.

Potential abnormalities of taste were examined in bulimic subjects who purged by vomiting and in controls. When spatial testing of the tongue and palate was performed by direct local application of sweet, salty, sour, and bitter solutions, bulimics showed a selective spatial loss on the palate. The palate may be affected by purging because vomit is directed toward the roof of the mouth where the palate receptors are located. The data suggest that the acid in vomit damages these receptors. Bulimics and controls did not differ in their basal ratings of intensity or pleasantness of sweet, salty, sour, and bitter stimuli when these were sipped rather than directly applied to the tongue. However, after ingesting a glucose load, controls found sweet taste significantly less pleasant, whereas bulimics did not. The results suggest that bulimics may also have an abnormal experience of satiety. (PsycINFO Database Record (c) 2010 APA, all rights reserved)