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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. Major eating disorders can be classified as anorexia nervosa (Box 1), bulimia nervosa (Box 2), and eating disorder not otherwise specified (Box 3).
Adapted from American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 4th ed, text rev. Eating disorder not otherwise specified includes disorders of eating that do not meet the criteria for any specific eating disorder. Binge-eating disorder is recurrent episodes of binge eating in the absence if regular inappropriate compensatory behavior characteristic of bulimia nervosa. Listed in the DSM IV-TR appendix, binge eating disorder is defined as uncontrolled binge eating without emesis or laxative abuse. Eating disorders are more common in industrialized societies where there is an abundance of food and being thin, especially for women, is considered attractive.4 Eating disorders are most common in the United States, Canada, Europe, Australia, New Zealand, and South Africa.
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. Other psychiatric disorders with disturbed appetite or food intake include depression, somatization disorder, and schizophrenia. One unique approach is a behavioral family-based therapy for elementary schoola€“age children with behavioral problems, disordered eating, and obesity. When there is no psychiatric comorbidity like depression, the evidence for significant efficacy is lacking, with very few methodologically sound studies.2, 29, 39 Although medication is less successful in anorexia nervosa than in bulimia nervosa, it is most often used in anorexia nervosa after weight has been restored but may begin earlier when indicated. 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.

Antidepressants are used primarily to reduce the frequency of disturbed eating and treat comorbid depression, anxiety, obsessions, and certain impulse-disorder symptoms.
Prevention programs presented in schools to both genders or through organizations like the Girl Scouts have been successful in reducing risk factors for eating disorders. The rate of mood, anxiety, and substance use disorders is higher in the families of bulimic than anorectic patients.
Hudson American Psychiatric Association Work Group on Eating Disorders: Practice guideline for the treatment of patients with eating disorders.
Presentation varies, but eating disorders often occur with severe medical or psychiatric comorbidity. Although criteria of the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM IV-TR), allow diagnosis of a specific eating disorder, many patients demonstrate a mixture of both anorexia and bulimia.
The most common age at onset for anorexia nervosa is the mid teens; in 5% of the patients, the onset of the disorder is in the early twenties. Patients with depressive disorder generally do not have an intense fear of obesity or body image disturbance.
Patients with borderline personality disorder sometimes binge eat but do not have other criteria for bulimia nervosa. Environmental and genetic risk actors for eating disorders: what the clinician needs to know.
Genetic susceptibility to eating disorders: associated polymorphisms and pharmacogenetic suggestions. The duration of severe insulin omission is the factor most closely associated with the microvascular complications of type 1 diabetic females with clinical eating disorders.

Medical complications of eating disorders in Annual review of Eating Disorders Part 1-2007. The relationship between obstetric complications and temperament in eating disorders: a mediation hypothesis. Transdiagnostic cognitive-behavioral therapy for patients with eating disorders two site trial with 60-week follow-up.
A preliminary controlled evaluation of a school-based media literacy program and self-esteem program for reducing eating disorder risk factors. 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. Pica and rumination are not considered eating disorders, but rather are feeding disorders of infancy and childhood. In the United States, eating disorders are common in young Latin American, Native American, and African American women, but the rates are still lower than in white women. Families of patients with bulimia nervosa have higher rates of substance abuse, particularly alcoholism, affective disorders, and obesity.
The National Comorbidity Survey Replication reported Binge Eating Disorders in 3.5% of women and 2% of men.
Severe weight loss and amenorrhea of more than 3 months are unusual in somatization disorder.

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