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4. Eating Disorders Not Otherwise Specified

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a. Subsyndromal Eating Disorders

  • For patients with subsyndromal anorexia nervosa or bulimia nervosa, who meet most but not all of the DSM-IV-TR criteria, provide treatment similar to that provided for patients who fulfill all criteria.

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b. Binge Eating Disorder

  • Provide nutritional rehabilitation.

    • Behavioral weight control programs incorporating low- or very-low-calorie diets may help with weight loss and usually reduce symptoms of binge eating.

    • Weight loss is often difficult to maintain, and binge eating can recur with weight gain.

    • Obese binge eaters who primarily wish to lose weight should be treated with the same approaches as other obese individuals.

  • Provide psychosocial treatment.

    • Cognitive-behavioral therapy has evidence for efficacy in individual and group formats as well as in self-help and guided self-help sequenced treatment programs.

    • Interpersonal therapy and dialectical behavior therapy also have efficacy in treating behavioral and psychological symptoms.

    • Other diets, behavior therapies, psychodynamic psychotherapy, and non-weight-directed psychosocial treatments are less well studied but may be of benefit for binge eating, weight loss, or stabilization in some patients.

    • Self-help organizations and 12-step-based approaches have been tried, but no systematic outcome studies are available.

  • Consider if the patient would benefit from an antidepressant or other medication.

    • Antidepressant treatment is associated with short-term reductions in binge eating but generally does not result in substantial weight loss.

    • SSRIs have the fewest difficulties with adverse effects and the most evidence for efficacy when used at the high end of the recommended dosage range.

    • Sibutramine, an appetite suppressant medication, is effective for binge suppression in the short-term and can produce significant weight loss.

    • Topiramate, an anticonvulsant, can reduce bingeing and decrease weight, but its use may be limited by side effects.

  • Consider if the patient would benefit from the combination of psychotherapy and pharmacotherapy.

    Although limited evidence is available, combined treatment is frequently used in clinical practice.

References

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