Sparse Data on Eating Disorders Prompt Call for Research

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BETHESDA, MD. -- The release this year of American Psychiatric Association guidelines on treating eating disorders and two analyses of the available evidence to support such treatments have highlighted the dearth of effective, evidence-based interventions for the disorders.

The lack of such data and the funding to support eating disorders research show that much remains to be accomplished before the disorders get the recognition they deserve from the medical community and insurers, said speakers and attendees at the annual conference of the National Eating Disorders Association. At least 5 million Americans have the disorders, and anorexia nervosa has the highest premature mortality of any mental illness.

The National Institute of Mental Health is funding 10 extramural studies on eating disorders at outside locations (seven of which are in New York), but none of the institutes within the National Institutes of Health are conducting any intramural studies on the disorders. In comparison, the NIMH and other NIH institutes are funding 12 intramural studies on schizophrenia and 14 on bipolar disorder, in addition to many more extramural studies, said Dr. Pauline S. Powers of the department of psychiatry at the University of South Florida, Tampa. The total NIMH/NIH funding for schizophrenia, which affects 3 million Americans, is estimated to be $291 million, while about $30 million is spent on eating disorders research, Dr. Powers said.

Efforts aimed at spreading the word about the high prevalence, morbidity, and mortality of eating disorders to legislators may be the best bet for greater funding of eating disorders, which in turn may attract greater interest from researchers to submit research grant proposals, said Dr. Thomas R. Insel, director of the NIMH.

While the lack of research funding has made it difficult to discern which treatments are best for particular eating disorders, the APA's new guidelines will still be helpful for clinicians who "are not real familiar with the kinds of things that you see as complications in patients with eating disorders," said Dr. Powers, who was a member of the APA work group on eating disorders that wrote the guidelines.

For providers to make the best judgment of the level of care and specific type of treatment that a patient needs, the APA guidelines stress the assessment of physical complications and laboratory tests that may be relevant in patients with anorexia nervosa or bulimia nervosa (Am. J. Psychiatry 2006; 163[suppl.]:1-54). For different organ systems, the guidelines list symptoms and signs to look for and particular laboratory tests that may help to diagnose the problem.

"Almost everyone seeing patients with eating disorders should at least know the symptoms and then be able to choose how they're going to work with those particular problems--either by themselves, or [by] consult with a primary care doctor or a specialist," Dr. Powers advised.

Bulimia nervosa patients may have many of the same symptoms as anorexia nervosa patients because they have a past history of anorexia. …