Treating Eating Disorders

by Victor Fornari, MD

With the preoccupation that our society has about weight and dieting, it is often confusing to determine who has an eating disorder. Figures are that 50% of 4th grade girls have dieted and the figure rises to 90% by age seventeen. This cultural pressure to be thin starting at such an early age sets the stage for the development of eating disorders in up to 15% of young women. Eating disorders occur in young men but may be up to ten times more common in women. Eating disorders represent serious illnesses and can be categorized into three major types:

1. Anorexia Nervosa
2. Bulimia Nervosa
3. Binge-Eating Disorder

Anorexia Nervosa is characterized by extreme weight loss, body image disturbance and an intense fear of becoming fat. This is generally accompanied by an absence of three consecutive menstrual cycles in young women.

Bulimia Nervosa is characterized by secretive binge eating episodes followed by either self-induced vomiting, fasting, excessive exercise or the use of laxatives, diuretics, or the manipulation of other medications.

Binge-Eating Disorder is characterized by recurrent episodes of binge eating without the purging behavior seen in bulimia nervosa.

Eating disorders often have tragic medical and emotional consequences. The death rate for young women with eating disorders is twelve times higher than for other women of similar ages and the extent of loss of normal functioning and death rates in anorexia nervosa alone are amongst the highest recorded for any psychiatric disorders. An estimated one thousand women die each year of anorexia nervosa in this country. Many of these deaths are related to malnutrition, heart attacks and suicide. Although it is estimated that more than five million Americans suffer from an eating disorder, bulimia nervosa and binge eating disorder are much more prevalent than anorexia nervosa. Although the exact cause of eating disorders is not clear, vulnerable individuals often may begin with a simple diet. This initial voluntary dieting often results in malnutrition and changes in brain chemistry. Individuals often become increasingly obsessed as a result of this change in body chemistry and may set the stage for the development of the full syndrome.

It is often difficult to determine what may be the predisposing cause of an eating disorder and what may be the effect of the eating disorder. For example: the depressed mood seen in individuals with anorexia or bulimia nervosa may be the byproduct of starvation and the disturbed family functioning may be the families adaptation to dealing with the seriously ill family member. There is hope and help for individuals with anorexia, bulimia nervosa, and binge eating disorder. Early intervention is critical. A team of professionals trained specifically in the treatment of eating disorders can be available to evaluate and set up individual treatment planning. This should include a comprehensive, multidimensional assessment with psychiatric assessment, nutritional assessment, medical evaluation and a coordinated care plan. Treatment interventions are first aimed at nutritional rehabilitation and the restoration of normal eating. Long term goals are to assess and help to resolve the associated psychological family, social and behavioral problems in order to prevent relapse.

Psychotherapy for anorexia and bulimia nervosa is often the mainstay of treatment. Cognitive behavioral therapy and interpersonal therapy are proving to be two effective treatments of eating disorders. Cognitive behavioral therapy is designed to help the patient gain control of unhealthy eating behaviors and to alter the distorted and rigid thinking that perpetuates the syndrome. In interpersonal psychotherapy, the focus is on the patient's current circumstances and relationships. In addition to psychotherapy, medication may be helpful in the treatment of eating disorders. Although the use of medication is more common for patients with bulimia nervosa than with anorexia nervosa, there is some evidence that medications do assist with recovery in both disorders. Antidepressant medications such as the specific serotonin reuptake inhibitors are helpful for individuals with significant symptoms of depression, anxiety or obsessions. They may also have a specific role in reducing the frequency of bingeing. In anorexia nervosa these medications may also be helpful in relapse prevention. Because of the severity of medical and psychiatric symptoms often associated with anorexia and bulimia nervosa, intervention is critical. If you or someone you know is suffering from an eating disorder, it is critical that you try to obtain or refer for treatment. Often a discussion with your primary care physician may help you find the referral to both a mental health professional, a medical doctor, or a nutritionist specializing in these disorders. Centers that treat individuals with anorexia and bulimia nervosa often have multidisciplinary teams of professionals available for consultation and treatment. Treatment may be provided on an Outpatient Daytime or Inpatient setting, depending on the severity of symptoms. Contacting your local psychiatric society is a good way to obtain referrals for specialists who treat individuals with eating disorders. For further information you may contact the Greater Long Island Psychiatric Society at (516) 249-1117.

REFERENCE:

Practice for the Treatment of Patients Guideline With Eating Disorders, Official Journal of the American Psychiatric Association, Vol. 157, No. 1., 1/2000

ABOUT THE AUTHOR:
Victor Fornari, MD, is the Associate Chairman for Education and Training in the Department of Psychiatry at North Shore University Hospital. He is also Associate Professor of Clinical Psychiatry at New York University School of Medicine. Dr. Fornari is actively involved in research in eating disorders, and has collaborated on numerous published articles and textbook chapters on the subject. In 1994 he was awarded a National Institute of Mental Health grant to study the use of phototherapy for the treatment of Bulimia Nervosa.