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Chapter 23. Eating DisordersAnorexia Nervosa, Bulimia Nervosa, and Obesity

Katherine A. Halmi, M.D.
DOI: 10.1176/appi.books.9781585623402.333583

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Excerpt

The eating disorders anorexia nervosa and bulimia nervosa and the condition of obesity have been known since earliest times in Western civilization. Well-documented case reports of anorexia nervosa are found in literature describing early Christian saints. Bell (1985) reported the severe starving behavior and bingeing episodes of Saint Catherine of Siena, described the kind of reed she used to induce vomiting, and listed the herbal cathartics that she used for purging. Although binge eating and purging behavior are certainly described in Roman civilization, the disorder of bulimia nervosa as we define it today has not been so well documented.

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FIGURE 23–1. Body mass index values used to assess weight for adults.Source. Reprinted from An Invitation to Health (with ThomsonNOW(T) and InfoTrac(R) 1-Semester Printed Access Card), 12th Edition, by Hales, Dianne. 2007. Used with permission of Brooks/Cole, a division of Thomson Learning: www.thomsonrights.com. Fax 800-730-2215.
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TABLE 23–1. DSM-IV-TR diagnostic criteria for anorexia nervosa
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TABLE 23–2. Medical complications of anorexia nervosa
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TABLE 23–3. Common reasons for severe food deprivation
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TABLE 23–4. Satiety peptides
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TABLE 23–5. Neurotransmitters and neuropeptides in anorexia nervosa
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TABLE 23–6. Treatment of anorexia nervosa
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TABLE 23–7. DSM-IV-TR diagnostic criteria for bulimia nervosa
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TABLE 23–8. DSM-IV-TR diagnostic criteria for eating disorder not otherwise specified
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TABLE 23–9. DSM-IV-TR research criteria for binge-eating disorder
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TABLE 23–10. Medical complications of bulimia nervosa
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TABLE 23–11. Treatment of bulimia nervosa
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TABLE 23–12. Medical complications of obesity
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Chronic anorexia nervosa is best prevented by early diagnosis and early intensive treatment.

Adolescents with anorexia nervosa are most effectively treated with family therapy, either conjoint or with separate parental counseling.

CBT specific for bulimia is the most effective treatment for bulimia nervosa.

Serotonin reuptake inhibitors are effective in reducing bingeing episodes and have a more benign side-effect profile compared with tricyclic antidepressants.

Obesity is a complex medical disorder with no single etiology. There is no guaranteed effective treatment over time. Behavioral modification is the treatment of choice for overweight children.

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