Eating disorders by Mario Maj + professional psychology test ” Are you a Stress Eater?” pdf
The emergence in the 20th century of the eating disorders anorexia nervosa, bulimia nervosa and variants thereof is documented in a vast literature describing diagnostic refinement, increased incidence and prevalence and a variety of treatment modalities. Anorexia nervosa is now considered a specific syndrome with core clinical features that distinguish it from other psychiatric disorders.
Recognition that binge eating and purging behaviors can occur both in patients with anorexia nervosa and in normal weight persons has led to ongoing research attempting to more accurately define and classify the eating disorders. This research includes the study of comorbid psychiatric disorders and specific personality traits or characteristics associated with core eating disorder symptomatology.
At the current time investigations are showing a robust association between a perfectio-nistic personality trait and the restricting type of anorexia nervosa, and between impulsive behaviors, including alcoholism and drug abuse, and binge eating and purging behaviors. A further refinement of the role of anxiety disorders in the development and presentation of eating disorders needs to be clarified.
In the beginning of the 20th century anorexia nervosa was rarely recognized and diagnosed as such. At the end of the century this disorder reached an incidence of 0.1% in the population of industrialized countries. Bulimia nervosa, which was not described as a specific entity until the late 1970s, has a current incidence of about 1% in industrialized countries. Anorexia nervosa has the highest mortality rate of psychiatric disorders. Approximately 0.5% of people with anorexia nervosa die per year.
Since this death rate is cumulative, over 20 to 30 years, 10% to 15% of the people with anorexia nervosa will die from this illness. Long-term outcome studies have shown that only one-fourth to one-third of anorexia nervosa patients completely recover. Thus, most of these patients continue to have varying degrees of impairment due to their illness. Bulimia nervosa tends to be a chronic relapsing disorder in which relapses are often associated with stress events. The peak age onset of these eating disorders is during adolescence.
Thus, the impairment of function occurs during the most formative years of the patients’ life and usually continues through young adulthood, at the time of expected greatest productivity.
Treatment has been more effective for bulimia nervosa than anorexia nervosa. State of the art cognitive-behavioral therapy (CBT) for bulimia nervosa can be expected to eliminate bingeing and purging behavior in about 50% of patients and to significantly reduce this behavior in 80 to 90% of patients. Unfortunately, therapists trained in the specific CBT for bulimia nervosa are rare and thus this form of treatment is not widely available.
Treatment of bulimia nervosa is further complicated by the necessity of having to treat other comorbid problems such as alcoholism, drug abuse, impulsive personality disorder problems and depression in the same individual.
There are very few adequate sample size randomly assigned controlled treatment studies for the treatment of anorexia nervosa. There is some indication that early diagnosis and early intensive treatment involving the family with patients under the age of 18 portends a better outcome. Anorexia nervosa patients ill for longer than 6 years tend to defy all treatment intervention. The active resistance to treatment and the reinforcements of the disorder for the anorectic patient are so compelling that treatment remains a significant challenge especially for patients over the legal age of 18.
Motivational enhancement techniques have not had considerable impact; however, none of the new enhancement techniques have been studied in a properly controlled design.
Most of the physiological and medical changes in the eating disorders can be attributed to starvation and purging behaviors. Recent investigations of neurotransmitter function and genetics in eating disorder patients may provide some pertinent clues for the development of pharmacological treatment of these disorders.
An understanding of the basic physiological aberrations associated with the eating disorders can also provide a foundation for early diagnosis and markers for the progress and effectiveness of a variety of treatment techniques.
This volume of the WPA Series “Evidence and Experience in Psychiatry” aims to review the research developments and controversies concerning the diagnosis and management of eating disorders, and to provide a balanced state of the art update of emerging scientific evidence and accumulated clinical wisdom for psychiatrists from countries all over the world.
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