of Anorexia Nervosa
and Bulimia Nervosa
B. TIMOTHY WALSH
There has been substantial research on the pharmacotherapy of eating disorders and medication is clearly of benefit for patients with bulimia nervosa. On the other hand, significant questions remain about when and for which patients with bulimia nervosa pharmacotherapy should be employed. Unfortunately, there is only meager evidence suggesting medication is useful in the treatment of anorexia nervosa. (The pharmacological treatment of binge eating disorder is discussed in Chapter 64.)
As described in Chapter 29, individuals with anorexia nervosa exhibit a variety of psychological disturbances, some of which bear a strong resemblance to symptoms or conditions known to respond to pharmacotherapy. The occurrence of such disturbances, coupled with the often refractory nature of anorexia nervosa, has led to clinical trials of a variety of pharmacological agents. For example, the disturbance of thinking about shape and weight in anorexia nervosa at times becomes so severe as to suggest the presence of a delusion. It is not unreasonable to wonder whether antipsychotic medication might be of help in reducing patients’ preoccupation with such thoughts. Similarly, depressed mood is commonly observed. Since many forms of depression respond well to treatment with medication, antidepressant medication would, on theoretical grounds, seem likely to be valuable.
In the decade after the introduction of the first antipsychotic medication, chlorpromazine, the potential utility of this class of medication for a number of psychiatric disorders, including anorexia nervosa, was enthusiastically touted. However, initial optimism