Eating Disorders

Eating disorders are complex mental health problems that often have physical manifestations. The American Psychiatric Association (1) has described two major types of eating disorders, Anorexia Nervosa and Bulimia Nervosa, and offered a third category for eating disorder problems that do not fulfill criteria for Anorexia Nervosa or Bulimia Nervosa. This third group is termed "Eating Disorders, Not Otherwise Specified" (ED NOS). Binge eating disorder is a problem that would be included in this third category.

Estimates of the lifetime prevalence of anorexia nervosa and bulimia nervosa in women range up to about 3-4% (2,3). Women with these eating disorders outnumber men by about 6-10 to 1. These problems frequently are diagnosed first in adolescence or young adulthood, although sometimes they begin even in childhood. Both anorexia nervosa and bulimia nervosa may be associated with other psychiatric problems, such as depression, anxiety and substance abuse.

Physical manifestations of the eating disorders can be severe. Anorexia Nervosa, for example, which includes severe weight loss and refusal to maintain a minimally appropriate body weight, can be associated with heart complications, including cardiac arrest, electrolyte disturbances, thinning of the bones, muscle loss, lack of menstruation, low blood pressure and death. The long term mortality for people with severe anorexia nervosa may be over 10%. Death may be due to starvation, suicide or electrolyte imbalance. Bulimia nervosa, which is characterized by frequent and recurrent binge eating (that is, eating in a discrete period of time an amount of food larger than most people would eat during that time), a feeling of lack of control over the eating and attempts to compensate for the binges through vomiting, laxatives or other means, may be associated with gastrointestinal problems, such a reflux, mouth and teeth problems, and dehydration.

The specific criteria for anorexia nervosa that have been defined by the American Psychiatric Association (1) include: refusal to maintain body weight at or above a minimally normal weight for age and height, intense fear of gaining weight or becoming fat (even when underweight), disturbance in the way the person's body weight or shape is perceived despite the seriousness of the low weight, and the absence of menstrual cycles in women who would be expected to be menstruating. Some patients with anorexia nervosas are binge eaters who purge to reduce their weight. Others do not binge or purge, but severely restrict their food intake to lose weight.

The specific criteria for bulimia nervosa include: recurrent episodes of binge eating, a sense of lack of control over eating during this binge period, undue influence of body shape and weight on self evaluation, and the use of inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretic or enemas.

Treatment options or patients with eating disorders are varied, depending on the particular disorder, its manifestations and severity. Coordinating care with medical providers in patients with extreme low weight or physical manifestations of the eating disorder is crucial. Depending on the severity of the problem, treatment may occur in inpatient, residential, day hospital or outpatient settings. Individual therapy, and often family therapy, is a component of a broad treatment approach. Sometimes medication is helpful in bulimia nervosa. Nutritional rehabilitation is important also. Seriously underweight patients must gain weight and restore their weight to appropriate levels. Self help groups may be of value for some patients. Treatment approaches should be planned so that there is adequate follow up after treatment of the acute phases of eating disorders. Ongoing treatment over several years often is needed to prevent and treat relapses.

References:

1. American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision. American Psychiatric Association, Washington, D.C., 2000.
2. Workgroup on Eating Disorders: Practice Guidelines for the treatment of patients with Eating Disorders, third edition. American Psychiatric Association, Washington, D.C., 2006 (accessed at http://www.psych.org ).
3. National Institute of Mental Health: Eating Disorders. (accessed at http://www.nimh.nih.gov/health/publications/eating-disorders/summary.shtml )

Read more information from OMH on Eating disorders.

Eating Disorders Treatment in New York State

Primary care physicians, pediatricians and mental health care providers are among the treatment resources available for patients and their families. In addition, the New York State Department of Health has identified three Comprehensive Care Centers for Eating Disorders (CCCEDs) which specialize in providing comprehensive and integrated treatment specifically for patients with eating disorders. The Comprehensive Care Centers for Eating Disorders provide inpatient and outpatient services and ensure the patient's care is integrated across care settings through clinical collaboration among the providers.

Northeast Comprehensive Care Center for Eating Disorders (NECCCED) comprised of:
Albany Medical Center, Albany New York
Four Winds Hospital - Saratoga, Saratoga Springs, New York
1-888-747-4727
http://www.amc.edu/Patient/services/NECCCED/index.html

Metropolitan Comprehensive Care Center (Metro) comprised of:
Columbia University Medical Center, New York State Psychiatric Institute, New York City
Schneider Children's Hospital, Long Island Jewish Hospital, Lake Success, New York
New York Presbyterian Hospital, Westchester Division/Weill Cornell Medical Center, White Plains NY
1-877-669-2332
http://cumc.columbia.edu/dept/eatingdisorders/

Western New York Comprehensive Care Center for Eating Disorders
The Eating Disorders Recovery Center of Western New York comprised of:
Golisano Children's Hospital at Strong Memorial Hospital, Rochester New York
Unity Health Care System, Rochester New York
1-800-700-4573
http://www.nyeatingdisorders.org/

There are several web sites that provide additional information about eating disorders. These include:

• New York State Department of Health
  http://www.health.state.ny.us

• National Eating Disorders Association
  http://www.nationaleatingdisorders.org

• Academy for Eating Disorders (Access the Intenational Journal of Eating Disorders through AED site)
  www.aedweb.org

• National Association of Anorexia Nervosa and Associated Disorders
  www.anad.org

• Eating Disorders Coalition for Research, Policy & Action
  www.eatingdisorderscoalition.org

• National Eating Disorders Information Center (Canada)
  www.nedic.ca/index.shtml

• American Psychiatric Association
  www.psych.org

• American Academy of Child and Adolescent Psychiatry
  www.aacap.org/

• The American Academy of Pediatrics
  www.aap.org/

• National Institute for Health
  www.nih.gov

• National Institute for Mental Health
  www.nimh.nih.gov