DOCSLIB.ORG

CNS Drugs 2009; 23 (2): 139-156 REVIEW ARTICLE 1172-7047/09/0002-0139/$49.95/0 ª 2009 Adis Data Information BV

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
CNS Drugs 2009; 23 (2): 139-156 REVIEW ARTICLE 1172-7047/09/0002-0139/$49.95/0 ª 2009 Adis Data Information BV CNS Drugs 2009; 23 (2): 139-156 REVIEW ARTICLE 1172-7047/09/0002-0139/$49.95/0 ª 2009 Adis Data Information BV. All rights reserved. Role of Antiepileptic Drugs in the Management of Eating Disorders Susan L. McElroy,1,2 Anna I. Guerdjikova,1,2 Brian Martens,1,2 Paul E. Keck Jr,1,2 Harrison G. Pope3,4 and James I. Hudson3,4 1 Lindner Center of HOPE, Mason, Ohio, USA 2 Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA 3 Biological Psychiatry Laboratory, McLean Hospital, Belmont, Massachusetts, USA 4 Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA Contents Abstract. 139 1. Overview of Eating Disorders . 140 2. Rationale for Using Antiepileptic Drugs (AEDs) in Eating Disorders. 142 3. First-Generation AEDs in the Treatment of Eating Disorders . 143 3.1 Phenytoin . 143 3.2 Carbamazepine. 144 3.3 Valproate . 145 3.4 Other Agents . 145 4. Second-Generation AEDs in the Treatment of Eating Disorders. 145 4.1 Topiramate . 145 4.2 Zonisamide . 148 4.3 Other Agents . 149 5. Conclusion . 149 Abstract Growing evidence suggests that antiepileptic drugs (AEDs) may be useful in managing some eating disorders. In the present paper, we provide a brief overview of eating disorders, the rationale for using AEDs in the treatment of these disorders and review the data supporting the effectiveness of specific AEDs in the treatment of patients with eating disorders. In addi- tion, the potential mechanisms of action of AEDs in these conditions are discussed. Of the available AEDs, topiramate appears to have the broadest spectrum of action as an anti-binge eating, anti-purging and weight loss agent, as demonstrated in two placebo-controlled studies in bulimia nervosa and three placebo-controlled studies in binge-eating disorder (BED) with obesity. Topiramate may also have beneficial effects in night-eating syndrome and sleep-related eating disorder, but controlled trials in these conditions are needed. The results of one small controlled study suggest that zonisamide may have efficacy in BED with obesity. However, both topiramate and zonisamide are associated with adverse effect profiles that may limit their use 140 McElroy et al. in patients with eating disorders. Phenytoin may be effective in some patients with compulsive binge eating, particularly if co-morbid EEG abnormalities are present, but available data are too varied to allow definitive conclusions to be made. Carbamazepine and valproate may be effective in treating patients with bulimia nervosa or anorexia nervosa when they are used to treat an associated psychiatric (e.g. mood) or neurological (e.g. seizure) dis- order; otherwise, both agents, particularly valproate, are associated with weight gain. In conclusion, AEDs have an emerging role in the management of some eating disorders. Eating disorders are important public health 1. Overview of Eating Disorders problems,[1-4] but a substantial number of afflic- ted patients do not respond adequately to the Eating disorder nosology is an evolving available treatments.[5,6] Growing evidence sug- field.[2,10,11] The two major psychiatric classifica- gests that antiepileptic drugs (AEDs), com- tion systems, namely the International Statistical pounds marketed primarily to prevent epileptic Classification of Diseases, 10th edition (ICD- seizures, may be useful in managing some of these 10)[12] and DSM-IV,[13] each list eating disorders conditions.[7-9] In the present paper, we provide a under two broad categories, one for eating dis- brief overview of eating disorders, the rationale orders only (see table I) and the other for condi- for using AEDs in the treatment of these dis- tions with onset usually in infancy, childhood orders, review the data supporting the effective- and/or adolescence (see table II). Both ICD-10 ness of specific AEDs in treating patients with eating disorders and discuss the potential mecha- Table I. Eating disorders as defined in the International Statistical nisms of action of AEDs in these conditions. We Classification of Diseases, 10th edition (ICD-10)[12] and the DSM-IV[13] conclude that AEDs have an emerging role in the ICD-10 DSM-IV management of some eating disorders. Anorexia nervosa Anorexia nervosa To explore the role of AEDs in eating dis- Atypical anorexia nervosa Bulimia nervosa orders, we surveyed the literature for available Bulimia nervosa Eating disorder NOSa first- and second-generation AEDs in the treat- Atypical bulimia nervosab ment of all recognized and potential eating Overeating associated with other disorders. A MEDLINE search of the English psychological disturbancesc language literature from January 1966 to April Vomiting associated with other d 2008 was performed using the following terms: psychological disturbances e ‘eating disorders’, ‘anorexia nervosa’ (AN), ‘bu- Other eating disorders limia nervosa’ (BN), ‘binge eating disorder’ Eating disorder, unspecified a Includes subthreshold anorexia nervosa, subthreshold bulimia (BED), ‘eating disorder not otherwise specified’ nervosa, self-induced vomiting without binge eating, (NOS), ‘pica’, ‘rumination’, ‘night eating syn- repeatedly chewing and spitting out large amounts of food drome’ (NES), ‘sleep-related eating disorder’ and binge-eating disorder. (SRED) and ‘weight’, as well as ‘antiepileptic’, b Includes bulimia NOS and hyperorexia nervosa. ‘anticonvulsant’, ‘barbiturate’, ‘benzodiazepine’, c Includes overeating due to stressful events, such as ‘carbamazepine’, ‘clonazepam’, ‘diphenylhydan- bereavement, accident, childbirth etc., and psychogenic toin’, ‘felbamate’, ‘gabapentin’, ‘lamotrigine’, overeating. ‘levetiracetam’, ‘oxcarbazepine’, ‘phenytoin’, d Includes psychogenic vomiting. ‘pregabalin’, ‘tiagabine’, ‘topiramate’, ‘valproate’, e Includes pica in adults and psychogenic loss of appetite. ‘vigabatrin’ and ‘zonisamide’. NOS = not otherwise specified. ª 2009 Adis Data Information BV. All rights reserved. CNS Drugs 2009; 23 (2) Role of Antiepileptic Drugs in the Management of Eating Disorders 141 Table II. Eating disorders as defined in the International Statistical is reduced awareness during the nocturnal eat- Classification of Diseases, 10th edition (ICD-10)[12] and the DSM-IV,[13] ing.[3,20,21] The relationship between NES and with onset usually occurring in infancy, childhood and/or adoles- SRED is presently unclear. Although some au- cence thorities have argued that these two conditions ICD-10 DSM-IV are separate entities, others have proposed that Pica of infancy and childhood Pica NES and SRED are related along a continuum Rumination disorder of altered awareness during the nocturnal inges- Feeding disorder of infancy or [3] early childhood tions. Finally, although eating disorders re- sulting from general medical conditions and substances have been described in the literature, and DSM-IV recognize AN, BN and pica, and neither is listed as a category in the DSM-IV or define these syndromes similarly. Key defining ICD-10.[22,23] features of AN are deliberate weight loss, a fear Of note, neither obesity nor drug-induced of fatness, disturbed body image and amenor- weight gain are categorized as eating disorders in rhoea. Defining features of BN are recurrent either the ICD-10 or DSM-IV, even though both episodes of binge eating with inappropriate conditions may be associated with disturbed eat- compensatory behaviours aimed at preventing ing behaviour, including binge eating.[23-26] In weight gain. Pica is defined as the repetitive or addition, neuropsychiatric syndromes character- persistent eating of non-nutritive substances. ized by polyphagia are usually not categorized as Both classification systems also include cate- eating disorders.[27-29] Although all these condi- gories for sub-syndromal or atypical presenta- tions have been investigated in some studies as tions of AN and BN, which are categorized in the potential targets for intervention with AEDs, DSM-IV as eating disorder NOS.[14,15] Examples these topics will not be the focus of the present include AN without amenorrhoea and purging paper.[9] without binge eating. Unlike ICD-10, DSM-IV No single study has evaluated the epidemio- includes rumination disorder and BED. Rumi- logy of all potential eating disorders. However, nation is defined as the repeated regurgitation growing evidence indicates that eating disorder and re-chewing of food, and is listed under dis- NOS may be more common than BN and AN.[14] orders with onset usually in infancy, childhood or In particular, BED may be more common than adolescence, although it may occur at any age.[16] BN and AN combined, with the lifetime pre- BED is proposed to be a possible new diagnostic valence estimates of DSM-IV BED, BN and AN entity and is given as an example of eating dis- from the National Comorbidity Survey Replica- order NOS. BED is defined by recurrent, dis- tion (NCS-R) being 2.8%, 1.0% and 0.6%, re- tressing episodes of binge eating that are not spectively.[1] In addition, 4.5% of the population accompanied by regular inappropriate compen- had any lifetime binge eating, defined as binge- satory weight loss behaviours. eating episodes occurring at least twice weekly for Several other eating disorders have been pro- at least 3 months. Although it is not known posed but are not mentioned in either the ICD-10 whether prevalence rates of eating disorders are or DSM-IV. For example, NES is characterized changing over time, data from the NCS-R sug- by morning anorexia, evening hyperphagia and gest that the incidence of BN and BED has in-
Load more

Recommended publications
  • Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches
    nutrients Commentary Obesity with Comorbid Eating Disorders: Associated Health Risks and Treatment Approaches Felipe Q. da Luz 1,2,3,* ID , Phillipa Hay 4 ID , Stephen Touyz 2 and Amanda Sainsbury 1,2 ID 1 The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, Camperdown, NSW 2006, Australia; [email protected] 2 Faculty of Science, School of Psychology, the University of Sydney, Camperdown, NSW 2006, Australia; [email protected] 3 CAPES Foundation, Ministry of Education of Brazil, Brasília, DF 70040-020, Brazil 4 Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia; [email protected] * Correspondence: [email protected]; Tel.: +61-02-8627-1961 Received: 11 May 2018; Accepted: 25 June 2018; Published: 27 June 2018 Abstract: Obesity and eating disorders are each associated with severe physical and mental health consequences, and individuals with obesity as well as comorbid eating disorders are at higher risk of these than individuals with either condition alone. Moreover, obesity can contribute to eating disorder behaviors and vice-versa. Here, we comment on the health complications and treatment options for individuals with obesity and comorbid eating disorder behaviors. It appears that in order to improve the healthcare provided to these individuals, there is a need for greater exchange of experiences and specialized knowledge between healthcare professionals working in the obesity field with those working in the field of eating disorders, and vice-versa. Additionally, nutritional and/or behavioral interventions simultaneously addressing weight management and reduction of eating disorder behaviors in individuals with obesity and comorbid eating disorders may be required.
    [Show full text]
  • Eating Disorders Toolkit
    Coach & Trainer TOOLKIT NEDA TOOLKIT for Coaches and Trainers Table of contents Introduction . 1 PREVENTION . 2 Types of eating disorders . 3 Eating disorder signs and symptoms specific to an athletic setting . 4 Factors that protect or put athletes at risk for eating disorders . 5 Physiological impact of eating disorders on athletic performance . 6 The Female Athlete Triad . 7 Encouraging healthy and appropriate exercise and training for athletes . 9 Eating disorders prevention and the middle or high school athlete . 10 E A R LY INTERVENTION . 11 The potential role of the coach . 12 Tips on how to positively intervene . 13 Tips on how to provide a healthy sport environment conducive to recovery . 14 Confidentiality issues . 15 Talking with… coach interviews . 16 Coaches guide to sports nutrition . 19 Talking with… nutritionist interviews . 21 T R E AT M E N T . 23 Talking with… psychologist interviews . 24 Eating disorders and the team dynamic . 26 Athletes’ own stories: Patrick Bergstrom . 27 Diane Israel . 28 Whitney Post . 29 Kimiko Soldati . 30 The Walker family . 31 M O R E INFORMATION . 32 Frequently asked questions . 33 Common myths about eating disorders . 35 Glossary . 37 RESOURCES . 41 Books, Resources, Curricula, Position Papers . 42 Acknowledgements . 43 © 2010 National Eating Disorders Association. Permission is granted to copy and reprint materials for educational purposes only. National Eating Disorders Association must be cited and web address listed. NEDA TOOLKIT for Coaches and Trainers Introduction The benefits of sport are well recognized: organized Though most athletes with eating disorders are female, male athletes are also at risk—especially those competing in sports athletics builds self-esteem, promotes physical condi- that tend to emphasize diet, appearance, size and weight.
    [Show full text]
  • Clinical Practice Guidelines for the BC Eating Disorders Continuum of Services September 1, 2012
    CLINICAL PRACTICE GUIDELINES for the BC EATING DISORDERS CONTINUUM OF SERVICES SEPTEMBER 1, 2012 < ONLY REVERSE OUT OF PHC BLUE, BLACK AND PHC OCHRE Ministry of Health (Project Leader) Gerrit van der Leer, MSW, Director, Mental Health and Addictions Authors Josie Geller, PhD, R. Psych, Director of Research, Eating Disorders Program, Providence Health Care. Associate Professor, Department of Psychiatry, University of British Columbia. Shawna Goodrich, MSW, Former Clinical Director, Eating Disorders Program, Providence Health Care Kathy Chan, MA, Graduate Student, University of Ottawa Sarah Cockell, PhD, R. Psych, Psychologist, Heart Centre, Providence Health Care Suja Srikameswaran, PhD., R. Psych, Professional Practice Leader, Psychology, Providence Health Care, Outpatient Psychologist, Eating Disorders Program, SPH, Clinical Associate Professor, Department of Psychiatry, University of British Columbia Provincial Advisory Committee Connie Coniglio, EdD, Clinical Director, Provincial Specialized Eating Disorder Program for Children and Adolescents, BC Children’s Hospital. Pei Yoong Lam, MD, FRACP, Assistant Clinical professor, Division of Adolescent Medicine, Department of Pediatrics, University of BC. Provincial Specialized Eating Disorders Program for Children and Adolescents, BC Children’s Hospital. Kim Williams, RD, Dietician, Eating Disorders Program, Providence Health Care Randy Murray, Practice Lead, Mental Health and Substance Use, Interior Health Shelagh Bouttell, MSc RD, Nutrition Therapist, Fraser South Eating Disorder Program,
    [Show full text]
  • Mental Illness
    MENTAL ILLNESS WHAT IS MENTAL ILLNESS? A broad range of medical conditions that are marked primarily by sufficient disorganization of personality, mind, or emotions to impair normal psychological functioning and cause marked distress or disability and that are typically associated with a disruption in normal thinking, feeling, mood, behavior, interpersonal interactions, or daily functioning ANXIETY ADD & ADHD SCHIZOPHRENIA ADDICTION DEPRESSION SELF HARM BIPOLAR DISORDERS PERSONALITY EATING DISORDERS WWW.THELEMONADEPROJECT.COM ANXIETY DISORDERS WHAT IS ANXIETY? Anxiety is an emotion characterized by an unpleasant state of inner turmoil, often accompanied by nervous behavior such as pacing back and forth, somatic complaints, and rumination. It is the subjectively unpleasant feelings of dread over anticipated events. Anxiety is a feeling of uneasiness and worry, usually generalized and unfocused as an overreaction to a situation that is only subjectively seen as menacing.It is often accompanied by muscular tension,restlessness, fatigue and problems in concentration. Anxiety is closely related to fear, which is a response to a real or perceived immediate threat; anxiety involves the expectation of future threat. TYPES OF ANXIETY AGORA SELECTIVE MUTISM PTSD CAFFINE INDUCED OCD ANDROPHOBIA PANIC DISORDER SPECIFIED SOCIAL ANXIETY PHOBIA ILLNESS ANXIETY GENERALIZED SUBSTANCE INDUCED SEPERATION ANXIETY WWW.THELEMONADEPROJECT.COM EATING DISORDERS WHAT ARE EATING DISORDERS? Eating disorders are serious conditions related to persistent eating behaviors that negatively impact your health, your emotions and your ability to function in important areas of life. The most common eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder.Most eating disorders involve focusing too much on your weight, body shape and food, leading to dangerous eating behaviors.
    [Show full text]
  • Disordered Eating Attitudes and Behaviors in Overweight Youth Andrea B
    nature publishing group REVIEWS BEHAVIOR AND PSYCHOLOGY Disordered Eating Attitudes and Behaviors in Overweight Youth Andrea B. Goldschmidt1, Vandana Passi Aspen1, Meghan M. Sinton2, Marian Tanofsky-Kraff3 and Denise E. Wilfley2 Disordered eating attitudes and behaviors appear to be quite common in youth, and overweight youth have been identified as a subset of the population at particularly high risk for endorsing such symptoms. Overweight and eating disorder (ED) symptomatology independently confer significant threats to one’s physical and psychosocial health, showing strong links with body weight gain and risk for ED development. When concurrent, the risk for negative health outcomes may be compounded. The purpose of this article is to review the current state of the literature as it concerns disordered eating and its correlates in overweight children and adolescents. Extant literature on the prevalence, distribution, correlates, and etiology of disordered eating attitudes and behaviors (i.e., negative attitudes toward shape and weight, unhealthy weight control behaviors, and binge eating) in overweight youth is reviewed and consolidated in order to make assessment and treatment recommendations for healthcare providers. The current literature suggests that early detection of disordered eating in overweight youth should be a priority to provide appropriate intervention, thereby helping to slow the trajectory of weight gain and prevent or reduce the long-term negative consequences associated with both conditions. Future research should
    [Show full text]
  • Eating Disorders
    EATING DISORDERS Over five million men and women in America suffer from some type of eating disorder. Anorexia Nervosa, Bulimia and Binge Eating disorder are all serious psychiatric illnesses that without treatment can have life-threatening consequences. The depression, shame and agonizing sense of isolation caused by eating disorders can disrupt families, interrupt schooling, and destroy relationships. Most men and women with an eating disorder are aware they have a problem, but are unlikely to seek treatment. What is an Eating Disorder? An eating disorder is an excessive preoccupation with weight and food issues which result in a loss of self-control, obsession, anxiety and guilt. Eating disorders can also cause alienation from self and others and physiological imbalances which are potentially life threatening. Eating disorders include Anorexia Nervosa, Bulimia Nervosa and Binge Eating disorder. What Causes an Eating Disorder? Eating disorders come from a combination of psychological, interpersonal, and social conditions as well as feelings of inadequacy, depression and loneliness. Difficult family issues and personal relationships may also contribute to the development of an eating disorder. The presence of low self- esteem is the common denominator that is inherently present in all eating disorder sufferers. Warning Signs: » A dramatic increase or decrease in weight » Abnormal eating habits such as severe dieting, withdrawn behavior at mealtime, or secretive bingeing » An intense preoccupation with weight and body image » Excessive or compulsive exercising » Self-induced vomiting, periods of fasting or abuse of laxatives, diet pills or diuretics » Feelings of isolation, depression, or irritability Anorexia Nervosa Anorexia Nervosa is a disorder in which a preoccupation with dieting and thinness leads to excessive weight loss.
    [Show full text]
  • Long Term Physiological Impact of Malnutrition Bulimia Nervosa
    UCLA Nutrition Noteworthy Title Long Term Health Risks Due to Impaired Nutrition in Women with a Past History of Bulimia Nervosa Permalink https://escholarship.org/uc/item/6vt2k42t Journal Nutrition Noteworthy, 7(1) Author Sagar, Ashwini Publication Date 2005 Peer reviewed eScholarship.org Powered by the California Digital Library University of California Introduction Bulimia nervosa serves as a disease model for a variety of physiological problems associated with improper nutritional intake. Bulimia occurs in women whose daily routine involves binge eating followed by attempts to rid their bodies of the excess food (1). The most common method of compensation following a binge involves self-induced vomiting. Other methods include laxative use, enemas, diuretics, severe caloric restriction, and compulsive exercising (2). It is estimated that 1.1 to 4.2 percent of females have bulimia nervosa in their lifetime (3). Five to 10 years after the diagnosis of bulimia, approximately 50% of women fully recover from their disorder. About 20% continue to meet criteria for bulimia (4). Of those who have recovered, approximately 30% relapse. Bulimia can also become a chronic disorder for some women. Physicians monitor a patient’s nutritional status and physiological health while a patient is bulimic. But follow-up on these women when they have recovered from bulimia is also of crucial importance because of the potential long term health consequences of their eating disorder. Unfortunately, research on the long- term outcome for women diagnosed with bulimia nervosa is rare (5). Amenorrhea, anemia, constipation, severe dehydration, arrhythmias, osteoporosis, and diabetes can all be health risks due to impaired nutrition while a patient is bulimic (3).
    [Show full text]
  • Eating Disorders Related to Obesity
    REVIEW Eating disorders related to obesity Varsha Vaidya 1† & Obesity is a chronic disease with multifactorial cause, associated with significant mortality Abdul Malik2 and morbidity. It impacts every aspect of the patient’s life. This review discusses the eating †Author for correspondence disorders that are related to obesity. Binge eating disorder is more frequently seen in 1Johns Hopkins University School of Medicine, obese patients, but bulimia nervosa/disordered-eating behaviors have been included in the Assistant Professor of review as they can sometimes be associated with obesity. However, it is important to note Psychiatry & Internal that most patients with bulimia tend to be of normal weight or overweight. The two Medicine, Baltimore, MD, USA disorders are reviewed with diagnostic criteria, risk factors, medical complications, Tel.: +1 410 6050 180 evaluation and treatment recommendations. There is also a comparison between the two Fax: +1 410 6050 181 disorders. The essential key point is that eating disorders are impulse-control disorders and Email: vvaidya@ obesitypsychiatry.com are similar to addictive behaviors in some aspects. It is essential to treat a patient with 2Psych Associates of obesity and eating disorders multimodally to ensure success. Maryland, Towson, MD, USA The global explosion of obesity has resulted in reported that 80% of black women aged increased awareness and research leading to 40 years or over is overweight; 50% are obese. innovative new diets, medications and surger- Asians have lower obesity prevalence when com- ies. However, the problem continues to grow at pared with other ethnic groups. However, an alarming rate, especially in adolescents. The Asians born in the USA are four times more Center for Disease Control and prevention likely to be obese than their foreign-born coun- (CDC) has reported that data from two terparts.
    [Show full text]
  • PRACTICE GUIDELINE for the Treatment of Patients with Eating Disorders Third Edition
    PRACTICE GUIDELINE FOR THE Treatment of Patients With Eating Disorders Third Edition WORK GROUP ON EATING DISORDERS Joel Yager, M.D., Chair Michael J. Devlin, M.D. Katherine A. Halmi, M.D. David B. Herzog, M.D. James E. Mitchell III, M.D. Pauline Powers, M.D. Kathryn J. Zerbe, M.D. This practice guideline was approved in December 2005 and published in June 2006. A guideline watch, summarizing significant developments in the scientific literature since publication of this guideline, may be available in the Psychiatric Practice section of the APA web site at www.psych.org. 1 Copyright 2010, American Psychiatric Association. APA makes this practice guideline freely available to promote its dissemination and use; however, copyright protections are enforced in full. No part of this guideline may be reproduced except as permitted under Sections 107 and 108 of U.S. Copyright Act. For permission for reuse, visit APPI Permissions & Licensing Center at http://www.appi.org/CustomerService/Pages/Permissions.aspx. AMERICAN PSYCHIATRIC ASSOCIATION STEERING COMMITTEE ON PRACTICE GUIDELINES John S. McIntyre, M.D., Chair Sara C. Charles, M.D., Vice-Chair Daniel J. Anzia, M.D. Ian A. Cook, M.D. Molly T. Finnerty, M.D. Bradley R. Johnson, M.D. James E. Nininger, M.D. Paul Summergrad, M.D. Sherwyn M. Woods, M.D., Ph.D. Joel Yager, M.D. AREA AND COMPONENT LIAISONS Robert Pyles, M.D. (Area I) C. Deborah Cross, M.D. (Area II) Roger Peele, M.D. (Area III) Daniel J. Anzia, M.D. (Area IV) John P. D. Shemo, M.D. (Area V) Lawrence Lurie, M.D.
    [Show full text]
  • Weight Loss and Bulimia Treatment
    WEIGHT LOSS AND BULIMIA TREATMENT Treating Bulimia Nervosa and Achieving Medically Required Weight Loss: A Case Study Julia B. McDonald, M.A., & Diana Rancourt, Ph.D. Department of Psychology, University of South Florida, Tampa, Florida, USA Author Note The authors declare having no conflicts of interest. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. Correspondence concerning this article should be addressed to Julia B. McDonald, Department of Psychology, University of South Florida, 4202 E. Fowler Avenue, PCD 4118G, Tampa, Florida, 33620. Email: [email protected] Preprint draft version 3.0, 06/21/21. Please do not copy or cite without author’s permission. 2 WEIGHT LOSS AND BULIMIA TREATMENT Abstract Eating disorder and weight loss interventions have typically been regarded as distinct or antithetical, despite a growing number of individuals with comorbid eating pathology and obesity. This siloing of research and practice has created a clinical conundrum for providers seeking to treat individuals with an eating disorder seeking to lose weight (e.g., required pre- surgical weight loss). To date, integrated treatment research targeting both eating disorders and weight loss is rare and practical guidance is lacking, especially for restrictive/binge-purge subtypes. This case example describes how an integrated approach was applied within a naturalistic outpatient clinical practice setting to successfully treat a client presenting with excess weight and severe bulimia nervosa who was medically required to lose weight for orthopedic surgery. We conclude by reviewing the benefits and challenges of integrating eating disorder and behavioral weight loss treatments and providing practical insights for treatment providers.
    [Show full text]
  • Feeding and Eating Disorders
    Feeding and Eating Disorders The chapter on Feeding and Eating Disorders in the fifth edition of the Diagnostic and Statistical Manu- al of Mental Disorders (DSM-5) includes several changes to better represent the symptoms and behav- iors of patients dealing with these conditions across the lifespan. Among the most substantial changes are recognition of binge eating disorder, revisions to the diagnostic criteria for anorexia nervosa and bulimia nervosa, and inclusion of pica, rumination and avoidant/restrictive food intake disorder. DSM-IV listed the latter three among Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, a chapter that will not exist in DSM-5. In recent years, clinicians and researchers have realized that a significant number of individuals with eating disorders did not fit into the DSM-IV categories of anorexia nervosa and bulimia nervosa. By default, many received a diagnosis of “eating disorder not otherwise specified.” Studies have suggested that a significant portion of individuals in that “not otherwise specified” category may actually have binge eating disorder. Binge Eating Disorder Binge eating disorder was approved for inclusion in DSM-5 as its own category of eating disorder. In DSM-IV, binge-eating disorder was not recognized as a disorder but rather described in Appendix B: Criteria Sets and Axes Provided for Further Study and was diagnosable using only the catch-all category of “eating disorder not otherwise specified.” Binge eating disorder is defined as recurring episodes of eating significantly more food in a short period of time than most people would eat under similar circumstances, with episodes marked by feelings of lack of control.
    [Show full text]
  • Eating Disorders and Obesity the Challenge for Our Times
    nutrients Eating Disorders and Obesity The Challenge for Our Times Edited by Phillipa Hay and Deborah Mitchison Printed Edition of the Special Issue Published in Nutrients www.mdpi.com/journal/nutrients Eating Disorders and Obesity Eating Disorders and Obesity The Challenge for Our Times Special Issue Editors Phillipa Hay Deborah Mitchison MDPI • Basel • Beijing • Wuhan • Barcelona • Belgrade Special Issue Editors Phillipa Hay Deborah Mitchison School of Medicine Western Sydney University Macquarie University Australia Australia Editorial Office MDPI St. Alban-Anlage 66 4052 Basel, Switzerland This is a reprint of articles from the Special Issue published online in the open access journal Nutrients (ISSN 2072-6643) from 2018 to 2019 (available at: https://www.mdpi.com/journal/nutrients/ special issues/Eating Disorders Obesity) For citation purposes, cite each article independently as indicated on the article page online and as indicated below: LastName, A.A.; LastName, B.B.; LastName, C.C. Article Title. Journal Name Year, Article Number, Page Range. ISBN 978-3-03897-998-2 (Pbk) ISBN 978-3-03897-999-9 (PDF) c 2019 by the authors. Articles in this book are Open Access and distributed under the Creative Commons Attribution (CC BY) license, which allows users to download, copy and build upon published articles, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. The book as a whole is distributed by MDPI under the terms and conditions of the Creative Commons license CC BY-NC-ND. Contents About the Special Issue Editors ..................................... vii Phillipa Hay and Deborah Mitchison Eating Disorders and Obesity: The Challenge for Our Times Reprinted from: Nutrients 2019, 11, 1055, doi:10.3390/nu11051055 .................
    [Show full text]