Eating Disorders: Anorexia Nervosa & Bulimia Nervosa. Helen Keeley January 2002. Eating Disorders. (ICD F50). Two syndromes are described [separate (ICD 10 )or on continuum (DSM1V)]:- Anorexia Nervosa (restricting type) Bulimia. (purging/ binging type)
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Twin studies suggest genetic predisposition important esp. for AN. Cultural factors also very important and AN is largely disorder of developed world.
Disorder characterised by:
For a definite diagnosis all of the following are required:
Not as severe as Anorexia Nervosa unless occurs as a complication thereof, when it indicates poor prognosis.
Long term Prognosis
50% recover; 30% partly improved
20% run chronic course;>5% mortality
Minority progress from restrictive to binge and then to BN
Good prognostic features:
Early onset; good parent- child relationships; early detection and treatment.
Poor Prognostic indicators
Greater weight loss; vomiting; binge-eating; greater chronicity and premorbid abnormalities.
Can occur on out-patient basis. Gradual but steady weight restoration is aim within 10% of expected weight.
Family Rx to restructure parent child relationships; individual Rx. Include behavioural; antidepressants for weight gain and depression
Under-represented in clinical samples but studies suggest that it may be more common in the general population.
Often episodic course with remissions and relapses. Long term disturbed eating persists and depression is common
Outpatient with cognitive-behavioural or group Rx. (better than meds.)