Part I of this book is an overview of literature on eating disorders. In chapters 1, 2, and 3, we succinctly review the literature on anorexia nervosa, bulimia nervosa, and binge eating disorder, and in chapter 4, the literature on eating disorders not otherwise specified. This material will be of most utility to those practitioners who have come to the field of eating disorders recently. Clinicians who are experienced in working with this patient population will probably already know much of this work, although some of the more recent findings summarized may be of interest.

In considering this literature it...

Although descriptions of anorexia nervosa have been well documented since the sixteenth century (see Silverman, 1995), the termanorexiawas first used by Sir William Gull (1874) in a manuscript presenting case descriptions of four women exhibiting significantly low body weight. The derivation of the termanorexiais Greek for “loss of appetite.” It is important to note, however, that individuals with anorexia nervosa do not experience a loss of desire to eat, but rather a fear of eating that promotes excessive dieting and subsequent weight loss. Within the past few decades, attitudinal disturbance regarding weight and shape has emerged...

Although variously noted as a clinical syndrome for much of the twentieth century, bulimia nervosa was first recognized as a common, distinct diagnostic entity in a classical paper by Russell published inPsychological Medicinein 1979, at which time the termbulimia nervosawas first applied. This paper followed a period of several years during which eating disorder researchers and clinicians had focused on the treatment of anorexia nervosa, and the termeating disorders—suggesting several distinct types—was not yet in widespread use. However, “variants” of anorexia nervosa started to be seen commonly, and in many clinics came to...

A large number of individuals in the general population report serious overeating or binge eating but do not engage in compensatory behaviors, such as vomiting. This binge eating is frequently associated with marked distress. This group of individuals is identified in the DSM-IV as having binge eating disorder, a diagnosis included in the appendix as a disorder for further study, and as an example of eating disorders not otherwise specified (EDNOS). Although there was a considerable debate as to whether to include this diagnosis in the DSM-IV text as a full diagnostic grouping, it was finally decided to include it...

Popular portrayals of eating disorders typically present cases of anorexia nervosa and bulimia nervosa. When eating disorders are mentioned, many people think of Karen Carpenter, or perhaps Lady Diana. However, many individuals who have an eating disorder do not fit the standard profiles. Such cases were previously considered atypical eating disorders (in the DSM-III) and now may receive a diagnosis of Eating Disorders Not Otherwise Specified (EDNOS; APA, 1994 [DSM-IV]). The prevalence of atypical eating disorder diagnoses depends on the population surveyed and on the criteria used, ranging widely from 2.9% among a sample of Scottish psychiatric inpatients (Kutcher, Whitehouse,...

The treatment of patients with eating disorders usually requires a team approach. This caveat is offered so frequently in the literature that it may be taken for granted, but this observation is of great importance. In particular, the requirement that the management of these patients usually requires several individuals with different areas of expertise markedly limits the availability of adequate treatment resources. The average practitioner, whether a psychiatrist or clinical psychologist working in the community, will not have access to such a team unless she or he is associated with a clinical program through which the other team members can...

Health professionals within different specialties often find themselves interacting with patients in a way that requires or that would benefit from familiarity with techniques basic to counseling. However, basic counseling skills are not typically provided as an aspect of training within each health profession. This chapter will present an overview of basic counseling techniques that are conducive to engendering therapeutic change, and then will provide examples of how these basic techniques can be applied when working with patients who have eating disorders. Emphasis will be placed on difficult treatment issues that commonly emerge.

The following topics are covered: distinguishing the...

Treatment outcome investigations indicate that among the psychotherapies, cognitive-behavioral therapy (CBT) has the most empirical support in the treatment of anorexia nervosa, bulimia nervosa, and binge eating disorder, although the data for anorexia nervosa and binge eating disorder are more modest than for bulimia nervosa (Peterson & Mitchell, 1999; Wilson, Fairburn, & Agras, 1997). The rationale for this therapeutic approach is to target the behavioral and cognitive patterns that cause and maintain the eating disorder symptoms.

In contrast to other approaches, CBT is symptom focused and does not typically address underlying psychological issues. It is usually time limited, follows a...

This chapter offers concrete specific recommendations regarding the pharmacotherapy of patients with eating disorders. Although the controlled treatment database in this area has grown considerably in the past decade, many important questions remain unanswered, and thus good clinical judgment and a careful assessment of the individual patient and his or her needs are indicated. Some general guidelines can be offered, although they will require modifications in certain situations.

Anorexia nervosa is unlike many other psychiatric disorders, in that pharmacotherapy is seen as adjunctive and should only be instituted in certain cases. Many patients with anorexia nervosa will respond to outpatient...

Clinicians who work with patients with eating disorders have often been puzzled by the fact that although patients at times seem to have similar levels of eating disorder pathology, in terms of frequency of binge eating and vomiting in bulimia nervosa or amount of weight loss in anorexia nervosa, they may experience widely divergent clinical courses and patterns of outcome. One possible explanation for these divergent courses is the presence of certain underlying personality traits and, in some patients, underlying personality disorders. When such an underlying problem is present, it is reasonable to assume that the personality disorder may complicate...

An individual’s eating disorder affects many other people. Therapists and dietitians working with patients with anorexia nervosa, bulimia nervosa, and binge eating disorder are frequently contacted by family members who express concern, ask for help and guidance in dealing with the problem, and directly or indirectly seek support for themselves. Even when they do not initiate the contact, they usually welcome an opportunity to be involved in the treatment process. Family involvement ranges from receiving information about the eating disorder to participating in formal family therapy.

In addition to providing general information about working with the families of individuals with...

Most people desire good health, and a balanced diet is an important factor in the maintenance of good health. Surprisingly, healthful eating is confusing and difficult to achieve for many people. Fast-paced lifestyles, disappearance of family meals, and the proliferation of convenience foods and take-out meals make healthful eating increasingly challenging. Even though many people desire to improve the quality of their diets, national food consumption surveys indicate otherwise. For example, on an average day only 23% of Americans consume the recommended five servings or more of fruits and vegetables (Subar et al., 1995). Daily calcium intakes also fall below...

Counseling patients with eating disorders is a challenging and rewarding field for dietitians. It is also a relatively new field, where dietitians often find themselves with little formal training. The purpose of this chapter is to help the dietitian become aware of strategies to use when counseling patients, and to identify professional and patient resources. One area of this field that is different from the traditional clinical dietitian practice is the emphasis on counseling instead of nutrition education. It is imperative that dietitians work in supervision with a therapist/treatment team for the best management of these patients, and also to...

The topic of exercise in the treatment of eating disorders is only in the early stages of scientific study. The issue is complex, being in fluenced by the numerous medical complications of eating disorders as well as by the presence of compulsive exercising in some of these patients. Few firm conclusions can currently be drawn from the literature as to specific exercise prescriptions for eating disorder patients. The information in this chapter will include basic principles of exercise science and musculoskeletal medicine that can reasonably be applied to this patient population. Wherever possible, specific information regarding exercise in the eating...

The eating disorders—anorexia nervosa, bulimia nervosa, and binge eating disorder—are associated with serious medical risks (Comerci, 1990; de Zwaan & Mitchell, 1992; Mcgilley & Pryor, 1998; Mehler, Gray, & Schulte, 1997; Mitchell, Seim, Colon, & Pomeroy, 1987; Pomeroy & Mitchell, 1989; Sharp & Freeman, 1993; Wiseman, Harris, & Halmi, 1998). Patients with eating disorders may develop medical complications involving virtually every organ system. A thorough medical evaluation and appropriate follow-up of medical complications are critical to the management and successful treatment of eating disorders (Becker, Grinspoon, Klibanski, & Herzog, 1999; Carney & Andersen, 1996). The medical clinician is...