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Eating disorders are syndromes characterized by significant disturbances in eating behavior and by distress or excessive concern about body shape or weight. Disturbance in the way one's body weight or shape are experienced, undue influence of body weight or shape on self evaluation, or denial of the seriousness of the current low body weight.
Eating disorder not otherwise specified includes disorders of eating that do not meet the criteria for any specific eating disorder. For female patients, all of the criteria for anorexia nervosa are met except that the patient has regular menses. All of the criteria for anorexia nervosa are met except that, despite significant weight loss, the patient's current weight is in the normal range.
All of the criteria for bulimia nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur less than twice a week or for less than 3 months. As a general guideline, it appears that one third of patients fully recover, one third retain subthreshold symptoms, and one third maintain a chronic eating disorder.
The essential features of anorexia nervosa are refusal to maintain a minimally normal body weight, intense fear of gaining weight, and significant disturbance in the perception of the shape or size of one’s body.


Maudsley Hospital developed a successful treatment that allows families to refeed patients at home. Selective serotonin reuptake inhibitors (SSRIs) (eg, fluoxetine) are commonly considered for patients with anorexia nervosa who have depressive, obsessive, or compulsive symptoms that persist in spite of or in the absence of weight gain.
Anorexia nervosa and bulimia nervosa respond well to a combination of individual, family, and group psychotherapy interventions that focus on the recovery of normal eating behavior. Children of patients with anorexia nervosa have a lifetime risk for anorexia nervosa that is tenfold that of the general population (5%). Several computed tomography (CT) studies of the brain have revealed enlarged sulci and ventricles, a finding that is reversed with weight gain. Monteleone and Maj reported not only that specific receptor but also the brain derived neurotrophic factor gene to be associated with restrictive type anorexia nervosa.11 The melancortin 4 receptor gene is hypothesized to regulate weight and appetite.
Binge eating is typically triggered by dysphoric mood states, interpersonal stressors, intense hunger following dietary restraints, or negative feelings related to body weight, shape, and food. Patients with depressive disorder generally do not have an intense fear of obesity or body image disturbance.


1).29 The patient’s weight and cardiac and metabolic status determines the acuteness of the illness and the need for hospitalization (Box 5).
This might help explain why manual-driven self-help and psychoeducational programs that emphasize improvement of self-esteem and reassessment of body image have achieved some success. Many patients have a combination of eating disorder symptoms that cannot be strictly categorized as either anorexia nervosa or bulimia nervosa and are technically diagnosed as eating disorder not otherwise specified.
However, children as young as 5 years have reported awareness of dieting and know that inducing vomiting can produce weight loss.
In one study using positron emission tomography (PET), metabolism was higher in the caudate nucleus during the anorectic state than after hyperalimentation.
However, they should be used with caution, because they have greater risks of cardiac complications, including arrhythmias and hypotension.



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