PURPOSE:

To determine the distribution of eating disorders (ED) in children and adolescents comparing the fourth edition of the Diagnostic and Statistical Manual (DSM) to the proposed fifth edition DSM criteria.

METHODS:

A total of 215 consecutive patients (15.4 ± 3.3 years) presenting for initial ED evaluation to adolescent medicine physicians from six institutions were assigned ED diagnoses using current DSM-IV criteria as well as proposed DSM-5 criteria.

RESULTS:

Diagnoses of anorexia nervosa and bulimia nervosa increased using the proposed DSM-5 criteria (from 30.0% to 40.0% and from 7.3% to 11.8%, p < .001). Approximately 14% of patients received the presumptive DSM-5 diagnosis of avoidant/restrictive food intake disorder. Cases of ED not otherwise specified decreased from 62.3% to 32.6% (p < .001).

CONCLUSIONS:

Proposed DSM-5 criteria substantially decreased the frequency of ED not otherwise specified diagnoses and increased the number of cases of anorexia nervosa and bulimia nervosa in a population of young patients presenting for ED treatment. Avoidant/restrictive food intake disorder appears to be a significant diagnosis.

EATING DISORDERS (EDS) ARE A GROUP OF SEVERELY IMPAIRED EATING BEHAVIORS, WHICH INCLUDE THREE SUBGROUPS: anorexia nervosa (AN), bulimia nervosa (BN), and ED not otherwise specified (EDNOS). The precise mechanism of EDs is still unclear and the disorders cause remarkable agony for the patients and their families. Although there are many available treatment methods for EDs today, such as family therapy, cognitive behavioral therapy, medication, psychotherapy, and so on, almost half of the patients are refractory to all current medical treatment and never fully recover. For treatment-refractory EDs, stereotactic surgery may be an alternative therapy. This review discusses the history of stereotactic surgery, the modern procedures, and the mostly used targets of stereotactic surgery in EDs. In spite of the limited application of stereotactic surgery in ED nowadays, stereotactic lesion and deep brain stimulation (DBS) are promising treatments with the development of modern functional imaging techniques and the increasing understanding of its mechanism in the future.

OBJECTIVE

The pathophysiology of anorexia nervosa remains obscure, but structural brain alterations could be functionally important biomarkers. The authors assessed taste pleasantness and reward sensitivity in relation to brain structure, which may be related to food avoidance commonly seen in eating disorders.

METHOD

The authors used functional MRI to study gray and white matter volumes in women with current restricting-type anorexia nervosa (N=19), women recovered from restricting-type anorexia nervosa (N=24), women with bulimia nervosa (N=19), and healthy comparison women (N=24).

RESULTS

All eating disorder groups exhibited increased gray matter volume of the medial orbitofrontal cortex (gyrus rectus). Manual tracing confirmed larger gyrus rectus volume, and volume predicted taste pleasantness ratings across all groups. Analyses also indicated other morphological differences between diagnostic categories. Antero-ventral insula gray matter volumes were increased on the right side in the anorexia nervosa and recovered anorexia nervosa groups and on the left side in the bulimia nervosa group relative to the healthy comparison group. Dorsal striatum volumes were reduced in the recovered anorexia nervosa and bulimia nervosa groups and predicted sensitivity to reward in all three eating disorder groups. The eating disorder groups also showed reduced white matter in right temporal and parietal areas relative to the healthy comparison group. The results held when a range of covariates, such as age, depression, anxiety, and medications, were controlled for.

CONCLUSION

Brain structure in the medial orbitofrontal cortex, insula, and striatum is altered in eating disorders and suggests altered brain circuitry that has been associated with taste pleasantness and reward value.

OBJECTIVE:

The aim of this pilot study was to test the acceptability and benefit of a guided self-help intervention incorporating a mobile component in eating disorders (EDs).

METHOD:

Eighteen people with Anorexia Nervosa and eleven people with Bulimia Nervosa were included in the study for 3 weeks and self-report and behavioural assessments were made before and after the intervention which included 10 video clips, a manual, and limited guidance.

RESULTS:

The most reported positive comment associated with the use of the vodcasts was the increased awareness about the illness. Adherence was good (29/31 subjects completed). A medium sized increase in Body Mass Index was found in participants with Anorexia Nervosa, and significantly lowered EDs and mood symptoms (effect size range = 0.72/1.35), and improvement in cognitive flexibility were reported post-intervention.

DISCUSSION:

A guided self-help intervention incorporating a mobile component was both acceptable and associated with symptom change in people with EDs. Copyright © 2013 John Wiley & Sons, Ltd and Eating Disorders Association.

OBJECTIVE:

To review the literature regarding internet-based treatment of eating disorders (ED).

METHOD:

Relevant studies were identified by searching electronic databases (including Medline, Embase, PsycInfo, and Web of Science). Eligible studies evaluated an internet-based treatment for ED, or an ED treatment that included at least one internet-based component.

RESULTS:

Twenty-one studies were included. Methodological quality varied. Internet-based treatments were superior to waiting lists in reducing ED psychopathology, frequency of binge eating and purging, and in improving (ED-related) quality of life. Internet-based treatment was more effective for individuals with less comorbid psychopathology, binge eating as opposed to restrictive problems, and individuals with binge eating disorder as opposed to bulimia nervosa. Higher levels of compliance were related to more improvements in ED symptoms. Study dropout ranged from 5.3 to 76.8%. Inclusion of face-to-face assessments and therapist support seemed to enhance study compliance. Overall, the internet can be considered an acceptable vehicle for delivering ED treatment.

DISCUSSION:

Future research should determine the utility of internet-based treatment by comparing them to face-to-face treatment. Research should furthermore focus on unraveling predictors and mediators of treatment outcome, compliance, and dropout, respectively. Studies with good methodological quality are needed with reports according to CONSORT guidelines. © 2013 Wiley Periodicals, Inc. (Int J Eat Disord 2013).

This article seeks to estimate the prevalence of eating disorders among workers living in urban areas of Feira de Santana, Bahia. It involves an epidemiologic, descriptive and exploratory cross-sectional study of 1,273 randomly selected workers. Socio-demographic and work characteristics, lifestyle, psychosocial aspects at work and eating behavior were investigated. Females were predominant (60.2%), the youngest 51.7% were up to 35 years old, married (53.1%), Afro-Brazilian descent (55.2%), with high school education (51.5%) and with low incomes (81.2%). The prevalence of Binge Eating Disorder and Bulimia Nervosa were, respectively, 4.3% and 1%. The prevalence of these disorders was higher among workers who indulged in excessive alcohol consumption, were dissatisfied with their personal appearance and weight, reported violence in childhood and had financial problems or related worries. Also included were those involved in house care services and commerce, who had informal work arrangements or were in highly demanding work environments. Besides investigating the relation between eating disorders and work, data was provided about these disorders in a population-based study. It is hoped that this study may encourage investments in health policies for these disorders.

Although evidence-based treatments (EBTs) exist for both bulimia nervosa and binge eating disorder, there is far less evidence underpinning the treatment of anorexia nervosa (AN). Furthermore, there is no clearly defined standardized approach to patients who have not responded to treatment over an extended period of time. Chronic eating disorder patients in particular might need long-term engagement with treatment providers offering a wide range of interventions. This case study highlights how an experienced private practitioner systematically employed a variety of EBT techniques for a patient with a severe, long-term eating disorder and its comorbidities, within a model of attachment and collaboration. The practice of utilizing a wide variety of EBT techniques in a systematic manner guided by clinical expertise and supported by a therapy relationship of collaboration and attachment may prove to be a fruitful avenue for future research. © 2013 by Wiley Periodicals, Inc.

To provide a comprehensive review of pharmacotherapy and other biological treatments for eating disorders.Literature on this topic was systematically reviewed.The bulimia nervosa (BN) literature underscores the utility of antidepressants, particularly SSRIs, in improving the symptoms of the disorder. The literature on binge eating disorder supports efficacy on reduction in binge eating frequency for a variety of compounds. However, such compounds have only modest effects on weight. Certain antiepileptic agents such as topiramate, if tolerated, are probably more useful in terms of weight loss. The number of controlled trials in patients with anorexia nervosa (AN) in particular has been quite small, and recent meta-analyses show disappointing results using atypical antipsychotics in AN.The pharmacological treatment of eating disorders remains an underdeveloped field although drug therapy clearly plays a role in the treatment of those with BN and binge eating disorder. Other biological therapies have not been adequately studied. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:470-477).

To update new evidence for psychotherapies in eating disorders (EDs) since 2005-September 2012.Completed and published in the English language randomized controlled trials (RCTs) were identified by SCOPUS search using terms "bulimia" or "binge eating disorder" (BED) or "anorexia nervosa" (AN) or "eating disorder" and "treatment," and 36 new RCTs met inclusion criteria.There has been progress in the evidence for family based treatment in adolescents with AN, for cognitive behavior therapy (CBT) in full and guided forms, and new modes of delivery for bulimia nervosa (BN), BED, and eating disorder not otherwise specified with binge eating. Risk of bias was low to moderate in 22 (61%) of RCTs.The evidence base for AN has improved and CBT has retained and extended its status as first-line therapy for BN. However, further research is needed, in particular noninferiority trials of active therapies and the best approach to addressing ED features and weight management in co-morbid BED and obesity. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:462-469).

Eating disorders are serious psychosomatic disorders with high morbidity and lifetime mortality. Inadequate response to current therapeutic interventions constitutes a challenging clinical problem. A better understanding of the underlying neurobiological mechanisms could improve psychotherapeutic and drug treatment strategies.A review highlighting the current state of brain imaging in eating disorders related to the anxiety and pathological fear learning model of anorexia nervosa (AN) and the impulsivity model of binge eating in bulimia nervosa (BN).Available neuroimaging studies in patients with acute AN primarily suggest a hyper-responsive emotional and fear network to food, but not necessarily to eating disorder-unrelated, salient stimuli. Furthermore, patients with AN show decreased activation in the ventral fronto-striatal circuits during the performance of a cognitive flexibility task. Results in patients with BN primarily suggest a hypo-responsive reward system to food stimuli, especially to taste reward. Additionally, patients with BN exhibit impaired brain activation in the inhibitory control network during the performance of general response-inhibition tasks.Anxiety and pathological fear learning may lead to conditioned neural stimulus-response patterns to food stimuli and increased cognitive rigidity, which could account for the phobic avoidance of food intake in patients with acute AN. However, further neurobiological studies are required to investigate pathological fear learning in patients with AN. Patients with BN may binge eat to compensate for a hypo-responsive reward system. The impaired brain activation in the inhibitory control network may facilitate the loss of control over food intake in patients with BN. © 2013 by Wiley Periodicals, Inc. (Int J Eat Disord 2013; 46:425-432).