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  • Print publication year: 2004
  • Online publication date: May 2010

38 - Eating disorders in adolescence

from Part III - Management of specific disorders



The main eating disorders so far described are anorexia nervosa, bulimia nervosa and binge-eating disorder. This chapter will concentrate, for reasons of space, on the first two.

Historically, the eating disorders have all suffered from being seen as a “backwater” of psychiatry and medicine, as seen by the late acceptance of all of them as illnesses, the still prevalent view of anorexia and bulimia nervosa as “slimmers' diseases” and the fact that binge-eating disorder has only established itself as a diagnosable disorder in the fourth edition of The Diagnostic Standard Manual (DSM-IV; American Psychiatric Association, 1994). This has occurred despite the description of anorexia nervosa as an illness since the 1860s (Gull, 1874; Lasegue, 1873) and bulimia nervosa since 1979 (Russell, 1979).

Two other profound discrepancies exist between the emphasis that these illnesses have been afforded and the reality regarding them. Anorexia has the highest morbidity and mortality of any psychiatric illness (Nielsen et al., 1998) and presents a similar burden of care to that of severe psychoses (Treasure and Serpell, 2001).

Both anorexia and bulimia present primarily, but not exclusively, as disorders of adolescence for a number of postulated reasons (see below); however, as the illnesses often run a chronic course, professionals in all disciplines, beyond childhood, will see “graduate” cases as well as those of primary onset. Consequently, paediatricians and psychiatrists managing adolescents (traditionally puberty—adult; usually considered as 14–18 years) will see prepubertalonset child “graduates” and pre- and postpubertal adolescent-onset patients.

Adams J (1993). The role of pelvic ultrasound in the management of paediatric endocrine disorders. In Clinical Paediatric Endocrinology, Brook C G D, eds., pp. 675–691. Blackwell Science, Oxford
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders 4th edn. American Psychiatric Association, Washington DC
Argente, J, Caballo, N, Barrios, V et al. (1997). Multiple endocrine abnormalities of the growth hormone and insulin-like growth factor axis in patients with anorexia nervosa: effects of short and long term weight recuperation. J Clin Endocrinol Metab 82, 2084–2092
Audit Commission (1997). Department of Health, London
Bruch H (1973). The Golden Cage: The Enigma of Anorexia Nervosa. Open Books, London
Bryant-Waugh R, Lask B (1999). Eating Disorders in Childhood and Adolescence: A Parent's Guide. Penguin, London
*Danziger, Y, Mukamel, M, Zeharia, A, Dinari, G, Mimouni, M (1994). Stunting of growth in anorexia nervosa during the prepubertal and pubertal period. Israeli J Med Sci 30, 581–584
Dreizen, S, Spirakis, C, Stone, R (1967). A comparison of skeletal growth and maturation in undernourished and well nourished girls before and after menarche. J Paediatr 70, 256–263
Fairburn C G (1997). Eating disorders. In Science and Practice of Cognitive Behaviour Therapy, Clark D M, Fairburn C G, eds., pp. 209–241. Oxford University Press, Oxford
Fosson, A, Knibbs, J, Bryant-Waugh, R, Lask, B (1987). Early onset anorexia nervosa. Arch Dis Child 62, 114–118
Garfinkel P E et al. (1985). Special problems of inpatient management. In Handbook of Psychotherapy for Anorexia Nervosa and Bulimia, Garner D M, Garfinkel P E, eds., pp. 344–359. Guilford Press, New York
Goldstein, D J, Wilson, M C, Ascroft, R C, Al-Banna, M (1999). Effectiveness of fluoxetine therapy in bulimia nervosa regardless of co-morbid depression. Int J Eating Disord 25, 19–27
Grinspoon, S, Herzog, D, Klibanski, A (1997). Mechanisms and treatment options for bone loss in anorexia nervosa. Psychopharmacol Bull 33, 399–404
Gull, W W (1874). Anorexia nervosa (apepsia hysterica, anorexia hysterica). Trans Clin Soc Lond 7, 22
Hall, R C W, Beresford, T P (1989). Medical complications of anorexia and bulimia. Psychiatr Med 7, 165–192
Hansen, L (1999). Olanzapine in the treatment of anorexia nervosa. Br J Psychol 175, 592
Hoek, H W (1991). The incidence and prevalence of anorexia nervosa and bulimia nervosa in primary care. Psychol Med 21, 455–460
Holland, A, Sicotte, N, Treasure, J (1998). Anorexia nervosa: evidence for a genetic basis. J Psychosom Res 32, 549–554
Honig P, Sharman W (2000). Inpatient treatment. In Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence, Lask B, Bryant-Waugh R, eds., pp. 265–288. Psychology Press, Hove, UK
Jensen, V S, Mejlhede, A (2000). Anorexia nervosa: treatment with olanzapine. Br J Psychol 177, 87
Katzmann, M, Lee, S (1997). Beyond body image: the integration of feminist and transcultural theories in the understanding of self starvation. Int J Eating Disord 22, 385–394
Kendler, K S, MacLean, C, Neale, M, Kessler, R, Heath, A, Eaves, L (1991). The genetic epidemiology of bulimia nervosa. Am J Psychiatry 148, 1627–1637
*King, M B (1990). Eating disorders in general practice. J Roy Soc Med 83, 229–232
Klibanski, A, Biller, B, Shoenfeld, D et al. (1995). The effects of oestrogen administration on trabecular bone loss in young women with anorexia nervosa. J Clin Endocrinol Metab 80, 898–904
Kog E, Vandereycken W (1998). The facts: a review of research data on eating disorder families. In The Family Approach to Eating Disorders: Assessment and Treatment of Anorexia Nervosa and Bulimia, van der Eycken W, Kog E, Vanderlinden J, eds., pp. 25–26. PMA, New-York
Lai, K Y, Bruin, R, Lask, B, Bryant-Waugh, R, Hankins, M (1994). Use of pelvic ultrasound to monitor ovarian and uterine maturity in childhood onset anorexia nervosa. Arch Dis Child 71, 228–231
Lasegue, C (1873). De l'anorexie hysterique. Arch Gen Med 21, 385–403
Grange, D, Eisler, I, Dare, C, Hodes, M (1992). Family criticism and self starvation: a study of expressed emotion. J Fam Ther 14, 190
Lee, S, Lee, A, Ngai, E, Dominic, T S, Wing, Y K (2001). Rationales for food refusal in Chinese patients with anorexia nervosa. Int J Eating Dis 29, 224–229
Magagna J (2000). Individual psychotherapy. In Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence, Lask B, Bryant-Waugh R, eds. Psychology Press, Hove, UK
McCallum, R W, Grill, B B, Lange, R, Planky, M, Glass, E E, Greenfeld, D G (1985). Definition of a gastric emptying abnormality in patients with anorexia nervosa. Acta Paedopsychiatr 52, 1–11
Muller, E E, Cavagnini, F, Panerai, A E, Massironi, R, Ferrari, E, Brambilla, F (1987). Neuroendocrine measures in anorexia nervosa: comparisons with primary affective disorders. Adv Biochem Psychopharmacol 43, 261–271
Newman, M M, Halmi, K A (1988). The endocrinology of anorexia nervosa and bulimia nervosa. Neurol Clin 6, 195–212
*Nicholls D, deBruyn R, Gordon I (2000). Physical assessment and complications. In Anorexia Nervosa and Related Eating Disorders in Childhood and Adolescence, Lask B, Bryant-Waugh R, eds. Psychology Press, Hove, UK
Nielsen, S, Moller-Madsen, S, Isager, T, Jorgensen, J, Pagsberg, K, Theander, S (1998). Standardized mortality in eating disorders: a quantitative summary of previously published and new evidence. J Psychosom Res 44, 413–434
Rigotti, N A, Nussbaum, S R, Herzog, D B, Neer, R M (1984). Osteoporosis in women with anorexia nervosa. N Engl J Med 311, 1601–1606
Russell, G (1979). Bulimia nervosa: an ominous variant of anorexia nervosa. Psychol Med 9, 429–448
Russell, G, Szmukler, G, Dare, C, Eisler, I (1987). An evaluation of family therapy in anorexia nervosa and bulimia nervosa. Arch Gen Psychiatry 44, 1047–1056
Selvini Palazzoli, M (1974). Self-starvation. Chancer, London
Sherman, B M, Halmi, K A, Zamudio, R (1975). LH and FSH response to gonadotropin-releasing hormone in anorexia nervosa: effect of nutritional rehabilitation. J Clin Endocrinol Metab 41, 135–142
Shoebridge, P, Gowers, S G (2000). Parental high concern and adolescent-onset anorexia nervosa. A case control study to investigate direction of causality. Br J Psychol 176, 132–137
Strober, M et al. (1990). A controlled family study of anorexia nervosa: evidence of familial aggregation and lack of shared transmission with affective disorders. Int J Eating Disord 1, 28–43
Theander, S (1970). Anorexia nervosa: a psychiatric investigation of 94 female patients. Acta Psychiatr Scand Suppl 214, 1–194
Treasure J, Holland A J (1995). Genetic factors in eating disorders. The Eating Disorders: Handbook of Theory Treatment and Research, Szmukler G, Dare C, Treasure J, eds., pp. 65–82. Wiley, Chichester, UK
Treasure, J, Serpell, L (2001). Osteoporosis in young people: research and treatment in eating disorders. Psychiatr Clin North Am 24, 359–370
Treasure J, Holland A (1990). Genetic vulnerability to eating disorders: evidence in twin and family studies. In Anorexia Nervosa, Remschmidt H, Schmidt M, eds., pp. 59–69. Hargrefe & Huber, Toronto, Canada
Treasure, J, Collier, D, Campbell, I (1997). Ill fitting genes: the biology of weight and appetite control. Psychol Med 27, 505–508
Treasure J (1997). Anorexia Nervosa. A Survival Guide for Sufferers and Those Caring for Someone with an Eating Disorder. Psychology Press, Hove, UK
*Bisbergen, C J M, Bennink, H J T C, Odink, J, Haspels, A A, Koppeschaar, H P F (1990). A comparative and longitudinal study on endocrine changes related to ovarian function in patients with anorexia nervosa. J Clin Endocrinol Metab 71, 705–711
Ward, A, Brown, N, Treasure, J (1997). Persistent osteopenia after recovery from anorexia nervosa. Int J Eating Dis 22, 71–75
Ward, A, Ramsay, R, Treasure, J (2000). Attachment research in eating disorders. Br J Med Psychol 73, 35–51
*Weiner, H (1985). The physiology of eating disorders. Int J Eating Disord 4, 347–388
World Health Organization (1992). International Classification of Diseases, 10th edn. World Health Organization, Geneva