In the current western culture, the development of eating disorders is an ever growing occurrence that is generally marked by disturbances in eating behavior.1 It is estimated that about 4 out of 5 females in the United States are utterly dissatisfied with their appearance and about 40% usually succumb to an eating disorder in order to achieve what is considered to be the perfect body. For the most part, the development of an eating disorder as generally been associated with the female gender, and has become a major public health concern within the last few years. Greater focus has been placed on this growing issue as it is becoming more and more of a widespread epidemic among even younger females. The focus of women's health has been actively taking steps towards educating the public about the detrimental and often times irreversible effects of the disorder. Women can experience both systemic and external effects related to the practice of self-deprivation or the development of unhealthy eating habits but systemic effects are typically more prevalent. Systemic effects can range from infertility to complete organ dysfunction.
According to the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, there are categories for an eating disorder diagnosis which include anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified, and binge-eating disorder. All four categories for an eating disorder are generally considered to be a disturbance in an individual's eating pattern and behavior that eventually leads to significant impairments in a person's life and perform normal activities of daily living as a result of the preoccupation with their weight.
First of all, in terms of the more predominant eating disorder, bulimia is recognized as being more common than anorexia nervosa. The characteristics of bulimia consists of four key symptoms that clinicians attempt identify when performing an assessment: (i) over-concern with weight and body shape, (ii) recurrent episodes of binge eating, (iii) recurring subsequent purging, restriction, or excessive exercise, and (iv) binge eating and subsequent inappropriate compensatory behaviors, occurring a minimum average of twice a week for at least three months. In contrast to women with anorexia, women with bulimia can typically be within the normal weight range, although recurrent weight changes can frequently observed in this population.
The majority of female patients with eating disorders can be treated in the outpatient settings. Hospitalization is usually reserved for severely symptomatic patients such as women who present with extremely low body weight (75% or less of expected body weight) whose condition must be hemodynamically stabilized, or those with medical problems requiring intensive monitoring such as patients with electrolyte imbalances, cardiac arrhythmias, profound hypoglycemia, self-mutilation, impaired capacity for self-care, or active suicidal ideation. Also, the failure of outpatient treatment may serve as a valid reason for an individual to receive inpatient treatment. It should be noted that women with a diagnosis of bulimia rarely need hospitalization unless binge-purge cycle has led to anorexia resulting in severe metabolic deficiencies such as severe electrolyte imbalances, or suicidal depression is present.
Some of the treatment of eating disorder consists of the choice of pharmacotherapy (i.e. antidepressants or low dose antipsychotics) and/or psychotherapy (i.e. cognitive behavioral therapy, interpersonal therapy, psychodynamic therapy, family therapy) where psychotherapy has been shown to have the best improvement on symptoms, and the combination of both pharmacotherapy and psychotherapy has been shown to produce the greatest benefits if the dose and duration of therapy is optimal. While pharmacotherapy has been shown to play a significant role in improving the symptoms of anorexia nervosa it only provides modest benefit for bulimia nervosa but cognitive behavioral therapy is recognized as the most effective treatment intervention for bulimia nervosa.
The use of pharmacotherapy has been shown to be modestly effective in the treatment of treating bulimia. For example, fluoxetine (Prozac) and other selective serotonin re-uptake inhibitors (SSRIs) such as trazodone (Desyrel) have been shown to assist with the management of bulimia symptoms. Another class of antidepressants called tricyclic antidepressants such as imipramine (Tofranil) and desipramine (Norpramin®) can be used to reduce binge eating and vomiting in bulimic patients. On the other hand, bupropion (Zyban®, Wellbutrin®,Budeprion®) is one antidepressant that is known to be contraindicated in the treatment of bulimia due to the fact that is can lead to increased risk of seizures and weight loss. According to a randomized controlled trial that was conducted by Golden et al. (2005) which focused on adolescents with anorexia nervosa, weight restoration was determined to be the most important factor of bone mineral density, but treatment with alendronate did increase the bone mineral densities of the lumbar spine and femoral neck within the group receiving alendronate, but not compared with placebo in the primary analysis. Until additional studies have demonstrated efficacy and long-term safety, the use of alendronate in this population should be confined to controlled clinical trials. Dietary supplements are usually not recommended for anorexia. In a randomized controlled study, Barbarich, et al. (2004) concluded that supplement strategies are not a substitute for proper nutrition and are ineffective in increasing the efficacy of fluoxetine in underweight anorexia nervosa subjects. The implementation of tube or intravenous feeding is rarely needed or recommended unless the patient's condition is life threatening.
Eating disorders will continue to be viewed as a major public health issue but the different forms of treatment that are currently available can help suffers of the disorder and for many this can be a lifelong issue. The advent of pharmacotherapy that can be combined with psychotherapy has the ability to manage symptoms and improve the condition of many women who currently suffer with the disorder.
Abimbola Farinde PhD - Columbia Southern University Orange Beach, AL
Hersen M, Turner S. & Beidel D. (Eds.). Adult psychopathology and diagnosis. (5th ed.) Hoboken, NJ: John Wiley & Sons, 2007.
Schaffner A. & Buchanan L. Evidence-Based Practices in Outpatient Treatment for Eating Disorders. International Journal of Behavioral Consultation & Therapy, 2010; 6(1): 35-44.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. Text citation: (American Psychiatric Association, 2013).
Hahn RK, Albers LJ, & Reist C.Psychiatry. Blue Jay, California: Current Clinical Strategies Publishing, 2008.
Golden NH, Iglesias EA, Jacobson MS, et al. Alendronate for the treatment of osteopenia in anorexia nervosa: A randomized, double-blind, placebo-controlled trial. J Clin Endocrinol Metab. 2005;90(6):3179-3185.
Barbarich NC, McConaha CW, Halmi KA, et al. Use of nutritional supplements to increase the efficacy of fluoxetine in the treatment of anorexia nervosa. Int J Eat Disord. 2004;35(1):10-15.