Management of Anorexia and Bulimia Nervosa: An Evidence-Based Review

By Chakraborty, Kaustav; Basu, Debasish | Indian Journal of Psychiatry, April-June 2010 | Go to article overview

Management of Anorexia and Bulimia Nervosa: An Evidence-Based Review


Chakraborty, Kaustav, Basu, Debasish, Indian Journal of Psychiatry


Byline: Kaustav. Chakraborty, Debasish. Basu

Anorexia nervosa and bulimia nervosa are primarily psychiatric disorders characterized by severe disturbances of eating behavior. Eating disorders are most prevalent in the Western culture where food is in abundance and female attractiveness is equated with thinness. Eating disorders are rare in countries like India. Despite a plethora of management options available to the mental health professionals, no major breakthrough has been achieved in recent years. Nutritional rehabilitation along with some form of re educative psychotherapy remains the mainstay of management of anorexia nervosa. In bulimia nervosa, both fluoxetine and cognitive behavior therapy have been found to be effective. Although the above-mentioned management options have been in use for decades, the active ingredient is still to be ascertained.

Introduction

Eating disorder is defined as a persistent disturbance of eating behavior or behavior intended to control weight, which significantly impairs physical health or psychosocial functioning.[sup] [1] Anorexia nervosa (AN) is a type of eating disorder marked by an inability to maintain a normal healthy body weight, often dropping below 85% of ideal body weight (IBW). Bulimia nervosa (BN) is characterized by recurrent episodes of binge eating in combination with some form of inappropriate compensatory behavior.

In young females in Western Europe and the United States, the mean prevalence estimates are 0.3% for AN, 1.0% for BN; sub threshold conditions of clinical concern are more prevalent.[sup] [2] Eating disorders are chronic psychiatric conditions. Although some patients with AN improve symptomatically over time, a substantial proportion continues to have body image disturbances, disordered eating, and other psychiatric difficulties.[sup] [3],[4],[5] A review of a large number of studies of patients of AN who were hospitalized or who received tertiary-level care and were followed up at least four years after the onset of illness indicates that "good" outcomes occurred in 44% of the patients and approximately 5% of the patients died.[sup] [3] In case of BN, the overall short term success rate for patients receiving psychosocial treatment or medication has been reported to be 50 - 70%.[sup] [4] Relapse rates of 30 - 85% have been reported for successfully treated patients at six months to six years of follow-up.[sup] [6],[7]

Although widely described in Western literature, anorexia nervosa and related eating disorders are rare in non-western cultures. In India, the information regarding these disorders is very limited.[sup] [8] Indian patients chiefly present with refusal to eat, persistent vomiting, marked weight loss, amenorrhea and other somatic symptoms, but do not show over activity or disturbances in body image seen characteristically in anorexia nervosa.[sup] [9]

Mortality rates in eating disorders, specifically anorexia nervosa, are among the highest in the mental disorders.[sup] [3],[7],[10] The scenario does not appear to have improved during the 20th century despite the plethora of options available to the psychiatrists as very few patients utilize the healthcare facilities.[sup] [11]

Thus it becomes prudent to review the management of eating disorder to have a better understanding of this puzzling topic. For this purpose the wealth of evidence has been subdivided under two broad categories namely - anorexia nervosa and bulimia nervosa.

Data search methodology The data search strategies for this review included electronic databases as well as hand-search of relevant publications or cross-references. The electronic search included PUBMED and other search engines (e.g. Google Scholar, PsychINFO). Cross-searches of electronic and hand search key references often yielded other relevant material. The search terms used, in various combinations, were: anorexia, bulimia, treatment, management, medications, behavioral interventions, psychosocial interventions. …

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