TREATMENT
BN1 can usually be treated on an outpatient basis (Figure 65-1). Cognitive behavioral therapy (CBT) is a short-term (4 to 6 months) psychological treatment that focuses on the intense concern with shape and weight, the persistent dieting, and the binge eating and purging that characterize this disorder. Patients are directed to monitor the circumstances, thoughts, and emotions associated with binge/purge episodes, to eat regularly, and to challenge their assumptions linking weight to self-esteem. CBT produces symptomatic remission in 25 to 50% of patients.

Numerous double-bind, placebo-controlled trials have documented that antidepressant medications are useful in the treatment of BN1 but are probably somewhat less effective than CBT6. Although efficacy has been established for virtually all chemical classes of antidepressants, only the selective serotonin reuptake inhibitor fluoxetine (Prozac) has been approved for use in BN by the U.S. Food and Drug Administration. Antidepressant medications are helpful even for patients with BN who are not depressed, and the dose of fluoxetine recommended for BN (60 mg/d) is higher than that typically used to treat depression. These observations suggest that different mechanisms may underlie the utility of these medications in BN and in depression.

A subset of patients with BN1 does not respond adequately to CBT7, antidepressant medication, or their combination. More intensive forms of treatment, including hospitalization, may be required for such patients.

 

FURTHER READING

AMERICAN PSYCHIATRIC ASSOCIATION: Practice guideline for the treatment of patients with eating disorders (revision). Am J Psychiatry 157(Suppl 1):1, 2000.

BECKER AE et al: Eating disorders. N Engl J Med 340:1092, 1999

KAYE WH et al: Anorexia and bulimia nervosa. Annu Rev Med 51:299, 2000

MEHLER PS : Diagnosis and care of patients with anorexia nervosa in primary care settings. Ann Intern Med 134:1048, 2001

WALSH BT, DEVLIN MJ : Eating disorders: Progress and problems. Science 280:1387, 1998

BIBLIOGRAPHY

CHIAL HJ et al: Anorexia nervosa: Manifestations and management for the gastroenterologist. Am J Gastroenterol 97:255, 2002

KEEL PK et al: Long-term outcome of bulimia nervosa. Arch Gen Psychiatry 56:63, 1999

SULLIVAN PF : Mortality in anorexia nervosa. Am J Psychiatry 152:1073, 1995

1Bulimia nervosa (BN)

2anorexia nervosa (AN)

3body mass index (BMI

4Diagnostic and Statistical Manual of Mental Disorders (DSM-IV)

5central nervous system (CNS)

6Cognitive behavioral therapy (CBT)

7Cognitive behavioral therapy (CBT)

 

Location In Book:

 

HARRISON'S PRINCIPLES OF INTERNAL MEDICINE - 16th Ed. (2005)
   PART FOUR - NUTRITION
       65. EATING DISORDERS - B. Timothy Walsh
         INTRODUCTION