0
0

Chapter 26. Anorexia Nervosa and Bulimia Nervosa

Daniel Le Grange, Ph.D.; Kamryn T. Eddy, Ph.D.; David Herzog, M.D.
DOI: 10.1176/appi.books.9781585623921.461864

Sections

Excerpt

Eating disorders are relatively common psychiatric disorders most often observed in late adolescent and young adult females, with typical onset during adolescence (ages 12–18 years). Eating disorders may be chronic and relapsing conditions and are often associated with significant medical morbidity and psychiatric comorbidity. The etiology, maintaining factors, and treatment of eating disorders have been understudied, particularly in regard to children and adolescents. DSM-IV (American Psychiatric Association 1994) and its text revision, DSM-IV-TR (American Psychiatric Association 2000a), include three eating disorder diagnoses: 1) anorexia nervosa (AN) and 2) bulimia nervosa (BN), which each have specific criteria; and 3) eating disorder not otherwise specified (EDNOS), which is a more heterogeneous diagnosis capturing clinically significant eating disorder presentations that cannot be categorized as AN or BN.

Your session has timed out. Please sign back in to continue.
Sign In Your Session has timed out. Please sign back in to continue.
Sign In to Access Full Content
 
Username
Password
Sign in via Athens (What is this?)
Athens is a service for single sign-on which enables access to all of an institution's subscriptions on- or off-site.
Not a subscriber?

Subscribe Now/Learn More

PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development.

Need more help? PsychiatryOnline Customer Service may be reached by emailing PsychiatryOnline@psych.org or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.).

Table Reference Number
TABLE 26–1. DSM-IV-TR diagnostic criteria for anorexia nervosa
Table Reference Number
TABLE 26–2. DSM-IV-TR diagnostic criteria for bulimia nervosa
Table Reference Number
TABLE 26–3. DSM-IV-TR diagnostic criteria for eating disorder not otherwise specified
Table Reference Number
TABLE 26–4. DSM-IV-TR research criteria for binge-eating disorder
Table Reference Number
TABLE 26–5. Three phases of family-based treatment of anorexia nervosa
Table Reference Number
TABLE 26–6. Three phases of family-based treatment of bulimia nervosa

References

Ackard D, Peterson D: Association between puberty and disordered, body image, and other psychological variables. Int J Eat Disord 29:187–194, 2000
 
Agras WS, Walsh BT, Fairburn CG, et al: A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa. Arch Gen Psychiatry 57:459–466, 2000
[PubMed]
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition. Washington, DC, American Psychiatric Association, 1994
 
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision. Washington, DC, American Psychiatric Association, 2000a
 
American Psychiatric Association: Practice guidelines for the treatment of patients with eating disorders (revision). Am J Psychiatry 157(suppl):1–39, 2000b
 
Apple RF, Agras WS: Overcoming Eating Disorders: A Cognitive-behavioral Treatment for Bulimia Nervosa and Binge Eating Disorder. Client Workbook. San Antonio, TX, Psychological Corporation, 1997
 
Attie I, Brooks-Gunn J: Development of eating problems in adolescent girls: a longitudinal study. Dev Psychol 25:70–79, 1989
 
Binford RB, Mussell MP, Rogers L, et al: Eating disorders: prevention and intervention strategies with children and adolescents, in Intervention With Children and Adolescents: An Interdisciplinary Perspective. Edited by Allen-Meares P, Fraser MW. Boston, MA, Pearson, 2004, pp 515–531
 
Boachie A, Goldfield GS, Spettigue W: Olanzapine use as an adjunctive treatment for hospitalized children with anorexia nervosa. Int J Eat Disord 33:98–103, 2003
[PubMed]
 
Bravender T, Bryant-Waugh, R, Herzog D, et al: Classification of child and adolescent eating disturbances. Workgroup for Classification of Eating Disorders in Children and Adolescents (WCEDCA). Int J Eat Disord 40(suppl):S117–S122, 2007
 
Bryant-Waugh RJ: Overview of eating disorders, in Anorexia Nervosa and Related Eating Disorders in Children and Adolescence. Edited by Lask B, Bryant-Waugh R. East Sussex, UK, Psychology Press Ltd, 2002, pp 27–40
 
Bryant-Waugh RJ, Cooper PJ, Taylor CL, et al: The use of the Eating Disorder Examination with children: a pilot investigation. Int J Eat Disord 19:391–397, 1996
[PubMed]
 
Bulik CM, Fear J, Pickering A: Predictors of the development of bulimia nervosa in women with anorexia nervosa. J Nerv Ment Dis 185:704–707, 1997
[PubMed]
 
Casper R, Troiani M: Family functioning in anorexia by subtype. Int J Eat Disord 30:338–342, 2001
[PubMed]
 
Childress A, Brewerton T, Hodges E, et al: The Kids Eating Disorder Survey (KEDS): a study of middle school students. J Am Acad Child Adolesc Psychiatry 32:843–850, 1993
[PubMed]
 
Commission on Adolescent Eating Disorders: Treatment of eating disorders, in Treating and Preventing Adolescent Mental Health Disorders: What We Know and What We Don't Know. A Research Agenda for Improving the Mental Health of Our Youth. Edited by Evans DL, Foa EB, Gur RE, et al. Oxford, UK, Oxford University Press, 2005
 
Cooper Z, Fairburn CG: The Eating Disorder Examination: a semistructured interview for the assessment of the specific psychopathology of eating disorders. Int J Eat Disord 6:1–8, 1987
 
Dennis K, Le Grange D, Bremer J: Case report of olanzapine use in adolescent anorexia nervosa. Eat Weight Disord 11:e53–e56, 2006
 
Dodge E, Hodes M, Eisler I, et al: Family therapy for bulimia nervosa in adolescents: an exploratory study. J Fam Ther 17:59–77, 1995
 
Eddy K, Keel P, Dorer D, et al: Longitudinal comparison of anorexia nervosa subtypes. Int J Eat Disord 31:191–202, 2002
[PubMed]
 
Eddy K, Tanofsky-Kraff M, Thompson-Brenner H, et al: Eating disorder pathology among overweight treatment-seeking youth: clinical correlates and cross-sectional risk modeling. Behav Res Ther 45:2360–2371, 2007
[PubMed]
 
Eddy K, Celio Doyle A, Hoste R, et al: Eating disorder not otherwise specified (EDNOS): an examination of EDNOS presentations in adolescents. J Am Acad Child Adolesc Psychiatry 47:156–164, 2008
[PubMed]
 
Eisler I, Dare C, Russell GFM, et al: Family and individual therapy in anorexia nervosa: a five-year follow-up. Arch Gen Psychiatry 54:1025–1030, 1997
[PubMed]
 
Eisler I, Dare C, Hodes M, et al: Family therapy for adolescent anorexia nervosa: the results of a controlled comparison of two family interventions. J Child Psychol Psychiatry 41:727–736, 2000
[PubMed]
 
Eisler I, Simic M, Russell GFM, et al: A randomised controlled treatment trial of two forms of family therapy in adolescent anorexia nervosa: a five-year follow-up. J Child Psychol Psychiatry 48:552–560, 2007
[PubMed]
 
Fairburn CG, Cooper Z, Doll H, et al: The natural course of bulimia nervosa and binge eating disorder in young women. Arch Gen Psychiatry 57:659–665, 2000
[PubMed]
 
Fairburn CG, Cooper Z, Shafran R: Cognitive-behavioral therapy for eating disorders: a "transdiagnostic" theory and treatment. Behav Res Ther 41:509–528, 2003
[PubMed]
 
Fairburn CG, Cooper Z, Bohn K, et al: The severity and status of eating disorder NOS: implications for DSM-V. Behav Res Ther 45:1705–1715, 2007
[PubMed]
 
Fischer S, Le Grange D: Comorbidity and high-risk behaviors in treatment seeking adolescents with bulimia nervosa. Int J Eat Disord 40:751–753, 2007
[PubMed]
 
Fisher M, Golden N, Katzman D, et al: Eating disorders in adolescents: a background paper. J Adolesc Health 16:420–437, 1995
[PubMed]
 
Fisher M, Schneider M, Burns J, et al: Differences between adolescents and young adults at presentation to an eating disorder program. J Adolesc Health 28:222–227, 2001
[PubMed]
 
Frank GK, Bailer UF, Henry S, et al: Neuroimaging studies in eating disorders. CNS Spectr 9:539–548, 2004
[PubMed]
 
Franko DL, Keel PK, Dorer DJ, et al: What predicts suicide attempts in women with eating disorders? Psychol Med 34:843–853, 2004
[PubMed]
 
Golden NH, Katzman DK, Kreipe RE, et al: Eating disorders in adolescents: position paper of the Society for Adolescent Medicine. J Adolesc Health 33:496–503, 2003
[PubMed]
 
Granillo T, Jones-Rodriguez G, Carvajal SC: Prevalence of eating disorders in Latina adolescents: associations with substance use and other correlates. J Adolesc Health 36:214–220, 2005
[PubMed]
 
Gunewardene A, Huon G, Zheng R: Exposure to westernization and dieting: a cross-cultural study. Int J Eat Disord 29:289–293, 2001
[PubMed]
 
Herzog DB, Nussbaum KM, Marmor AK: Comorbidity and outcome in eating disorders. Psychiatr Clin North Am 19:843–859, 1996
[PubMed]
 
Herzog DB, Dorer DJ, Keel PK, et al: Recovery and relapse in anorexia and bulimia nervosa: a 7.5-year follow-up study. J Am Acad Child Adolesc Psychiatry 38:829–837, 1999
[PubMed]
 
Herzog DB, Greenwood DN, Dorer DJ, et al: Mortality in eating disorders: a descriptive study. Int J Eat Disord 28:20–26, 2000
[PubMed]
 
Herzog DB, Franko DL, Dorer DJ, et al: Drug abuse in patients with eating disorders. Int J Eat Disord 39:434–442, 2006
[PubMed]
 
Hoste R, Le Grange D: Expressed emotion among white and ethnic minority families of adolescents with bulimia nervosa. Eur Eat Disord Rev 16:395–400, 2008
[PubMed]
 
Hudson JI, Hiripi E, Pope HG, et al: The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication. Biol Psychiatry 61:348–358, 2007
[PubMed]
 
Johnson JG, Cohen P, Kotler L, et al: Psychiatric disorders associated with risk for the development of eating disorders during adolescence and early adulthood. J Consult Clin Psychol 70:1119–1128, 2002
[PubMed]
 
Kaye WH, Grendall K, Strober M: Serotonin neuronal function and selective serotonin reuptake inhibitor treatment in anorexia nervosa. Biol Psychiatry 44:825–838, 1998
[PubMed]
 
Keel PK, Mitchell JE: Outcome in bulimia nervosa. Am J Psychiatry 154:313–321, 1997
[PubMed]
 
Keel PK, Heatherton TF, Dorer DJ, et al: Point prevalence of bulimia nervosa in 1982, 1992, and 2002. Psychol Med 36:119–127, 2006
[PubMed]
 
Kendler KS, Walters EE, Neale MC, et al: The structure of genetic and environmental risk factors for six major psychiatric disorders in women. Arch Gen Psychiatry, 52:374–383, 1995
[PubMed]
 
Kent A, Lacey H, McClusky SE: Premenarchal bulimia nervosa. J Psychosom Res 36:205–210, 1992
[PubMed]
 
Kotler L, Devlin B, Davies M, et al: An open trial of fluoxetine in adolescents with bulimia nervosa. J Child Adolesc Psychopharmacol 13:329–325, 2003
[PubMed]
 
Le Grange D, Lock J: The dearth of psychological treatment studies for anorexia nervosa. Int J Eat Disord 37:79–91, 2005
 
Le Grange D, Lock J: Treating Bulimia in Adolescents: A Family-Based Approach. New York, Guilford, 2007
 
Le Grange D, Schmidt U: The treatment of adolescents with bulimia nervosa. J Ment Health 14:587–597, 2005
 
Le Grange D, Eisler I, Dare C, et al: Evaluation of family treatments in adolescent anorexia nervosa: a pilot study. Int J Eat Disord 12:347–357, 1992
 
Le Grange D, Loeb KL, Orman S, et al: Bulimia nervosa: a disorder in evolution? Arch Pediatr Adolesc Med 158:478–482, 2004
 
Le Grange D, Binford R, Loeb KL: Manualized family-based treatment for anorexia nervosa: a case series. J Am Acad Child Adolesc Psychiatry 44:41–46, 2005
 
Le Grange D, Binford R, Peterson C, et al: DSM-IV threshold versus subthreshold bulimia nervosa. Int J Eat Disord 39:462–467, 2006
 
Le Grange D, Crosby RD, Rathouz PJ, et al: A randomized controlled comparison of family-based treatment and supportive psychotherapy for adolescent bulimia nervosa. Arch Gen Psychiatry 64:1049–1056, 2007
 
Leit R, Pope HG, Gray J: Cultural expectations of muscularity in men: the evolution of playgirl centerfolds. Int J Eat Disord 29:90–93, 2001
[PubMed]
 
Lock J: Adjusting cognitive behavior therapy for adolescents with bulimia nervosa: results of case series. Am J Psychotherapy 59:267–281, 2005
[PubMed]
 
Lock J, Le Grange D: Help Your Teenager Beat an Eating Disorder. New York, Guilford, 2005
 
Lock J, Le Grange D, Agras WS, et al: Treatment Manual for Anorexia Nervosa: A Family-Based Approach. New York, Guilford, 2001a
 
Lock J, Reisel B, Steiner H: Associated health risks of adolescents with disordered eating: how different are they from their peers? Results from a high school survey. Child Psychiatry Hum Dev 31:249–265, 2001b
 
Lock J, Agras WS, Bryson S, et al: A comparison of short- and long-term family therapy for adolescent anorexia nervosa. J Am Acad Child Adolesc Psychiatry 44:632–639, 2005
[PubMed]
 
Lock J, Couturier J, Agras WS: Comparison of long-term outcomes in adolescents with anorexia nervosa treated with family therapy. J Am Acad Child Adolesc Psychiatry 45:666–672, 2006
[PubMed]
 
Loeb KL, Walsh BT, Lock J, et al: Open trial of family-based treatment for adolescent anorexia nervosa: evidence of successful dissemination. J Am Acad Child Adolesc Psychiatry 46:792–800, 2007
[PubMed]
 
Maloney MJ, McGuire JB, Daniels SR: Reliability testing of a children's version of the Eating Attitude Test. J Am Acad Child Adolesc Psychiatry 27:541–543, 1988
[PubMed]
 
McCabe M, Ricciardelli L, Finemore J: The role of puberty, media and popularity with peers on strategies to increase weight, decrease weight and increase muscle tone among adolescent boys and girls. J Psychosom Res 52:145–153, 2001
 
Mehler C, Wewetzer C, Schulze U, et al: Olanzapine in children and adolescents with chronic anorexia nervosa. Eur Child Adol Psychiatry 10:151–157, 2001
[PubMed]
 
Minuchin S, Rosman B, Baker I: Psychosomatic Families: Anorexia Nervosa in Context. Cambridge, MA, Harvard University Press, 1978
 
Misra M, Klibanski A: Anorexia nervosa and osteoporosis. Rev Endocr Metab Disord 7:91–99, 2006
[PubMed]
 
Mitchell JE, Raymond N, Specker S: A review of the controlled trials of pharmacotherapy and psychotherapy in the treatment of bulimia nervosa. Int J Eat Disord 14:229–247, 1993
[PubMed]
 
Mitchell J, Agras WS, Wonderlich S: Treatment of bulimia nervosa: where are we and where are we going? Int J Eat Disord 39:95–101, 2006
 
National Collaborating Centre for Mental Health: Eating Disorders: Core Interventions in the Treatment and Management of Anorexia Nervosa, Bulimia Nervosa and Related Eating Disorders. London, UK, British Psychological Society and Gaskell, 2004
 
Ohring R, Graber J, Brooks-Gunn J: Girls' recurrent and concurrent body dissatisfaction: correlates and consequences over 8 years. Int J Eat Disord 31:404–415, 2001
 
Perez M, Voelz Z, Pettit J, et al: The role of acculturative stress and body dissatisfaction in predicting bulimic symptomatology across ethnic groups. Int J Eat Disord 31:442–454, 2002
[PubMed]
 
Perkins S, Winn S, Murray J, et al: A qualitative study of the experience of caring for a person with bulimia nervosa, part 1: the emotional impact of caring. Int J Eat Disord 36:256–268, 2004
[PubMed]
 
Pirke M, Platte P: Neurobiology of eating disorders in adolescents in Eating Disorders in Adolescence: Anorexia and Bulimia Nervosa. Edited by Steinhausen H. New York, DeGruyter, 1995, pp 171–179
 
Robin AL, Siegel PT, Moye AW, et al: A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa. J Am Acad Child Adolesc Psychiatry 38:1482–1489, 1999
[PubMed]
 
Russell GFM, Szmukler GI, Dare C, et al: An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry 44:1047–1056, 1987
[PubMed]
 
Schapman A, Lock J, Couturier J: Cognitive-behavioral therapy for adolescents with binge eating syndromes: a case series. Int J Eat Disord 39:252–255, 2006
 
Schmidt U, Lee S, Beecham J, et al: A randomized controlled trial of family therapy and cognitive behavioral guided self-help for adolescents with bulimia nervosa and related conditions. Am J Psychiatry 164:591–598, 2007
[PubMed]
 
Schur E, Sanders M, Steiner H: Body dissatisfaction and eating attitudes in young children. Int J Eat Disord 27:74–82, 1999
 
Shore R, Porter J: Normative and reliability data for 11–18 year olds on the Eating Disorder Inventory. Int J Eat Disord 9:201–207, 1990
 
Society for Adolescent Medicine: Eating disorders in adolescents: position paper for the Society for Adolescent Medicine. J Adolesc Health 33:496–503, 2003
 
Spitzer RL, Devlin MJ, Walsh BT, et al: Binge eating disorder: a multisite field trial for the diagnostic criteria. Int J Eat Disord 11: 191–203, 1992
 
Spitzer RL, Yanovski S, Wadden T, et al: Binge eating disorder: its further validation in a multisite trial. Int J Eat Disord 13:137–153, 1993
[PubMed]
 
Steiger H, Gauvin L, Israel M, et al: Association of serotonin and cortisol indices with childhood abuse in bulimia nervosa. Arch Gen Psychiatry 58:837–843, 2001
[PubMed]
 
Steiner H, Kwan W, Walker S, et al: Risk and protective factors for juvenile eating disorders. Eur Child Adolesc Psychiatry 12(suppl):38–46, 2003
 
Steinhausen HC: The outcome of anorexia nervosa in the 20th century. Am J Psychiatry 159:1284–1293, 2002
[PubMed]
 
Stice E, Agras WS: Predicting onset and cessation of bulimic behaviors during adolescence. Behav Ther 29:257–276, 1998
 
Striegel-Moore RH, Dohm FA, Kraemer HC, et al: Eating disorders in white and black women. Am J Psychiatry 160:1326–1331, 2003
[PubMed]
 
Strober M, Freeman R, Morrell W: The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10–15 years in a prospective study. Int J Eat Disord 22:339–360, 1997
[PubMed]
 
Strober M, Freeman A, Lampert C, et al: Controlled family study of anorexia nervosa and bulimia nervosa: evidence of shared liability and transmission of partial syndromes. Am J Psychiatry 157:393–401, 2000
[PubMed]
 
Sullivan PF: Mortality in anorexia nervosa. Am J Psychiatry 152:1073–1074, 1995
[PubMed]
 
Tanofsky-Kraff M, Yanovski SZ, Wilfley DE, et al: Eating-disordered behaviors, body fat, and psychopathology in overweight and normal-weight children. J Consult Clin Psychol 72:53–61, 2004
[PubMed]
 
Thompson-Brenner H, Eddy KT, Satir D, et al: Personality subtypes in adolescent eating disorders: validation of a classification approach. J Child Psychol Psychiatry 49:170–180, 2008
[PubMed]
 
Tozzi F, Thornton LM, Klump KL, et al: Symptom fluctuation in eating disorders: correlate of diagnostic crossover. Am J Psychiatry 162:732–740, 2005
[PubMed]
 
Von Ranson KM, Iacono WG, McGue M: Disordered eating and substance use in an epidemiological sample, I: associations within individuals. Int J Eat Disord 31:389–403, 2002
 
Walsh BT, Wilson GT, Loeb KL, et al: Medication and psychotherapy in the treatment of bulimia nervosa. Am J Psychiatry 154:523–531, 1997
[PubMed]
 
Ward A, Ramsey R, Turnbull SJ, et al: Attachment in anorexia nervosa: a transgenerational perspective. Br J Med Psychol 74:497–505, 2001
[PubMed]
 
Westen D, Harnden-Fischer J: Personality profiles in eating disorders: rethinking the distinction between axis I and axis II. Am J Psychiatry 158:547–562, 2001
[PubMed]
 
+

CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
In a study examining the relative rates of eating disorder diagnoses in an adolescent clinical sample, what was the most common diagnosis?
2.
In a recent national comorbidity survey, the lifetime prevalence rate of binge-eating disorder (BED) among women was
3.
The mortality rate in young women with anorexia nervosa is how many times higher than in young women in the general population?
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Related Content
Articles
Books
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 1.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 2.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 3.  >
Dulcan's Textbook of Child and Adolescent Psychiatry > Chapter 4.  >
Topic Collections
Psychiatric News
PubMed Articles
 
  • Print
  • PDF
  • E-mail
  • Chapter Alerts
  • Get Citation