Eating Disorders

by

Kelly R. Theim, Lisa M. Ranzenhofer, Marian Tanofsky-Kraff

• LAST REVIEWED: 25 February 2014
• LAST MODIFIED: 25 February 2014
• DOI: 10.1093/obo/9780199828340-0148

Introduction

Eating disorders are psychiatric conditions of clinical significance. Over the past several decades, knowledge in the field of eating disorders has expanded exponentially in domains of etiology, clinical presentation, prevention, and treatment. The primary adult eating disorder diagnoses are anorexia nervosa, bulimia nervosa, and binge eating disorder. Initially thought of as disorders affecting only upper-class Caucasian females, the literature now increasingly recognizes the impact of eating disorders on boys and men, and on individuals from a range of cultures and ethnicities. Although eating disorders remain more common among females, examining differences in eating disorder presentation across sex and other demographic features has been an important research undertaking in recent years. Although relatively rare, eating disorders are distinct from many psychiatric conditions in their frequent involvement of medical comorbidities. As such, their care typically requires a multidisciplinary approach, including providers from both psychological health and medical fields. Despite the development of effective psychological treatments (e.g., cognitive-behavioral therapy, interpersonal psychotherapy, family-based behavioral therapy), full recovery remains elusive for many individuals with eating disorders. Therefore, early detection and prevention may be the most effective strategies for reducing the individual and societal burden of eating disorders. To date, the majority of systematic research has been conducted within the three primary eating disorder diagnoses. However, there is wide variety to the presentation of disordered eating, and the default “eating disorder not otherwise specified” (EDNOS) category contains the highest proportion of patients seen in clinical practice. Indeed, with controlled empirical studies often excluding patients with EDNOS, current knowledge regarding the etiology and treatment of this most prevalent eating disorder category remains lacking. This is particularly troubling when considering that over half of patients presenting for clinical care receive a diagnosis of EDNOS. Accordingly, the diagnosis and classification of eating disorders has been a focus of much research attention, particularly with the development and publication of the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Similarly, the classification of eating disorders in children has been a topic of much attention and debate. Of note, this article includes studies on eating disorders (as defined by the DSM criteria) rather than the full spectrum of disordered eating behaviors commonly reported by youth and adults, and it does not cover other eating/feeding disorders that occur during early childhood, such as pica, or the new diagnosis of avoidant/restrictive food intake disorder. References are categorized not by disorder, but rather by topic—beginning with general overviews and eating disorder organizations, followed by eating disorder prevalence rates, etiology, diagnosis and assessment, comorbidities, course, and treatment and prevention.

General Overviews and Textbooks

The focus of this section is on broad overviews of eating disorders. The majority of works presented are books, including those that could be used as course textbooks for students, particularly at a graduate level, such as Agras 2010. Alexander, et al. 2013 is a useful text for clinicians or researchers specializing in or wanting to learn more about binge eating disorder, the newest disorder to be recognized as a formal eating disorder diagnosis. Tanofsky-Kraff, et al. 2013 is a more brief discussion of the most recent research in the area of binge eating disorder. Two books—Birmingham and Treasure 2010 and Fairburn and Brownell 2005—examine the additional topics of medical management and obesity, respectively. Birmingham and Treasure 2010 is a practical primer of medical considerations for those treating eating disorders. Fairburn and Brownell 2005 contains many brief overviews relevant to eating disorders and obesity; in addition to their general use by clinicians and researchers, these chapters could also be used for didactic purposes (e.g., course readings). Some of the chapters within these books are cited elsewhere in this article, as they are thorough and highly useful resources, covering a range of topics (e.g., diagnosis and assessment, etiology, and treatment of eating disorders). Alexander and Treasure 2011 is another comprehensive text, with a particular focus on the collaborative, multidisciplinary treatment of eating disorders. For a stand-alone brief overview, Treasure, et al. 2010 is valuable for readers wanting a broad yet concise review of eating disorders. Additionally, one important diagnostic and clinical issue that has faced those who research and treat eating disorders is the broad category of eating disorder not otherwise specified (EDNOS), which describes at least half of patients seen in clinical care. This pattern, along with a detailed examination of patients who fall into this category, is covered in Fairburn, et al. 2007. Among texts published in recent years that provide broad coverage of multiple issues in eating disorders, relatively few specifically focus on pediatric populations. Le Grange and Lock 2011 and Lask and Bryant-Waugh 2013 stand out as important resources for the identification and treatment of eating disorders in children and adolescents. For more brief overviews, Treasure, et al. 2010 is included in this section as well. Treasure, et al. 2010 provides an update to the originally published review by Fairburn and Harrison (“Eating Disorders,” Lancet 361.9355 [2003]: 407–416), and both articles are valuable for readers wanting a broad yet concise review of eating disorders.

• Agras, W. S. 2010. The Oxford handbook of eating disorders. New York: Oxford Univ. Press.

  DOI: 10.1093/oxfordhb/9780195373622.001.0001

  A comprehensive text that is useful for researchers, scholars, and clinicians alike. Could be useful as a textbook for coursework related to eating disorders. Covers a variety of approaches for understanding the causes, assessment, and treatment of eating disorders.

• Alexander, J., A. B. Goldschmidt, and D. Le Grange, eds. 2013. A clinician’s guide to binge eating disorder. New York: Routledge.

  Highlights current knowledge regarding the causes and treatment of binge eating disorder. Includes ample use of illustrative case examples. Appropriate for both researchers and clinicians.

• Alexander, J., and J. Treasure, eds. 2011. A collaborative approach to eating disorders. New York: Routledge.

  This book is intended to provide an introduction to eating disorders to individuals of various training backgrounds, and it highlights the importance of a collaborative approach to support recovery from eating disorders (e.g., across disciplines among care providers, and from family members and other loved ones of individuals with eating disorders).

• Birmingham, C. L., and J. Treasure. 2010. Medical management of eating disorders. New York: Cambridge Univ. Press.

  DOI: 10.1017/CBO9781139150040

  A primer on the medical complications of eating disorders and the identification and medical management of eating disorders in clinical practice. Appropriate for the practicing health-care professional. Includes practical tips for treatment.

• Fairburn, C. G., and K. D. Brownell, eds. 2005. Eating disorders and obesity: A comprehensive handbook. 2d ed. New York: Guilford.

  Includes concise summaries of over one hundred areas of potential interest to clinicians and researchers in the fields of eating disorders and obesity. The text is very readable, in part because brief overviews of each topic are followed by annotated reading lists rather than in-text citations.

• Fairburn, C. G., Z. Cooper, K. Bohn, M. E. O’Connor, H. A. Doll, and R. L. Palmer. 2007. The severity and status of eating disorder NOS: Implications for DSM-V. Behaviour Research and Therapy 45.8: 1705–1715.

  DOI: 10.1016/j.brat.2007.01.010

  Discusses the problematic and common finding that most (i.e., 50–60 percent) eating disorder cases seen in clinical practice fall under the “eating disorder not otherwise specified” category. Compares the clinical correlates of patients with each eating disorder diagnosis, highlighting the significant symptom severity and duration within eating disorder not otherwise specified.

• Lask, B., and R. Bryant-Waugh, eds. 2013. Eating disorders in childhood and adolescence. New York: Routledge.

  Text is narrative in style, heavy in clinical examples and patient testimonials (i.e., chapters written by those personally affected by anorexia nervosa). Could be a resource for clinicians or for laypersons, particularly parents, seeking to understand eating disorders.

• Le Grange, D., and J. Lock, eds. 2011. Eating disorders in children and adolescents: A clinical handbook. New York: Guilford.

  An important resource, in part because of its attention to developmental issues in eating disorder assessment, diagnosis, and treatment. Devotes many chapters to treatment in various pediatric populations.

• Tanofsky-Kraff, M., C. M. Bulik, M. D. Marcus, et al. 2013. Binge eating disorder: The next generation of research. International Journal of Eating Disorders 46.3: 193–207.

  DOI: 10.1002/eat.22089

  Summarizes the proceedings from a 2012 workshop on the state of current knowledge and future directions for research on binge eating disorder. Includes brief synopses of topics covered (e.g., risk factors, addictive processes, relation with obesity, intervention strategies) by leaders in the field.

• Treasure, J., A. M. Claudino, and N. Zucker. 2010. Eating disorders. The Lancet 375:583–593.

  DOI: 10.1016/S0140-6736(09)61748-7

  This article supplements and updates the earlier Fairburn and Harrison Lancet article, “Eating Disorders,” Lancet 361.9355 (2003): 407–416. In particular, this more recent citation reviews biological risk factors for eating disorders in greater detail, following advances in research over time, and notes proposed revisions to eating disorders’ diagnostic classification.