Eating Disorders: Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder

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Eating Disorders:

Anorexia Nervosa, Bulimia Nervosa, Binge Eating Disorder

SECTION 1 Basic Prescribing Practices

Essential Concepts

  • The reader should appreciate the commonalities of the genetic heritability and brain functional abnormalities that appear to be common across the DSM-5 eating disorders and should also understand there may be significant symptom overlap.

  • The key is in the detail of the symptom (phenotypic) presentation and, frankly, in the symptom list diagnostic approach provided by the DSM-5 system. Particular attention to this detail may lead to better diagnosis, treatment selection, and outcome.

  • For example, bulimia nervosa (BN) and binge eating disorder (BED) share many symptoms, and even anorexia nervosa (AN) patients may suffer from compensatory activities to avoid weight gain (induced vomiting, excessive exercise, etc.) as well.

  • Eating disorder in adults is often confounded by other psychiatric disorders, such as the existence of an anxiety, depressive, or personality disorder.

  • Anorexia patients often have more rigid, obsessive-compulsive personality types while bulimics tend to be more impulsive and addictive.

  • Women tend to be diagnosed and identified more than men, but men are being increasingly diagnosed and should be screened for eating disorders routinely as well.

  • AN patients may present as medical emergencies and have a higher mortality risk whereas BN and BED do not.

  • There are no approved medications for AN and treatment is largely behavioral and residential.

  • The SSRI antidepressants are approved for BN.

  • Lisdexafetamine is approved for BED.

Phenomenology, Diagnosis, Clinical Interviewing

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