Eating disorders

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Abstract

The term ‘eating disorder’ describes a range of conditions characterized by abnormal eating habits and methods of weight control which lead to a significant impairment of psychological, social, and physical functioning. Eating disorders are serious, complex conditions; they are not simply a problem of eating too much or too little, or an attempt to achieve the perfect physique. Anorexia nervosa has the highest mortality of any psychiatric disorder, and it is notoriously difficult both to engage eating- disordered patients, and to treat them success­fully. There is a positive association between early diag­nosis and prognosis, so the skills to recognize an eating disorder— whether they present with psychological or physical symptoms— are essential for all clinicians. At the time of writing, the description of eating dis­orders within diagnostic classification systems has been undergoing considerable change. Under the ICD- 10 and DSM- IV classification systems, three main eating disorders were recognized (Fig. 27.1): … 1 anorexia nervosa; 2 bulimia nervosa; 3 eating disorder not otherwise specified (EDNOS). … However, this classification has been shown to have various difficulties: … ● The majority of cases were attracting an ‘EDNOS’ label, whereas it was supposed to be a residual category (Fig. 27.1). ● EDNOS contained within it the subdiagnosis ‘binge eating disorder’ (BED). Recent research has demonstrated BED accounts for approximately 10 per cent of eating disorders in clinical cohorts. ● The categorical nature of the system does not allow for the fact that most eating disorders change over time, and frequently move back and forth along the spectrum of presentations. ● The DSM- 5 classification system (see ‘Further reading’) has tried to tackle the first two of these difficulties, and the upcoming ICD- 11 will echo these changes (Table 27.1) There is now a separate category for BED, and three other defined conditions. This is a positive change, but has only reduced the ‘NOS/ unspecified’ percentage to some extent, and has not considered the changeable nature of eating disorder symptomatology. Hopefully in the future a solution to the difficulty of turning a spectrum of pathology into a categorical system will emerge.