Eating Disorders Essay

Eating Disorders Essay
Eating disorders are serious psychiatric illnesses defined by the disruption in eating behavior. Patients are usually concerned about their body weight, which impairs their psychosocial functioning and body weight. Eating disorders are associated with high morbidity and mortality. Bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorder (BED) are among the eight categories of eating disorders mentioned in the DSM-5 (Crow, 2019). The etiology of eating disorders is heterogeneous. Psychological factors such as perfectionism, obsessive-compulsiveness, and impulsivity are common personality traits associated with eating disorders. Sociocultural factors such as preference for thinness and exposure to media that promote ideas that value slim bodies for women play a role in increasing the prevalence of eating disorders. Other factors such as genetics and neurobiology can also play a role in the etiology of eating disorders.
Among the eating disorders, anorexia nervosa is the most serious of all. It has the highest mortality rate among psychiatric illnesses.  It is characterized by an intense fear of gaining weight, the restriction of energy intake, distorted body image, including denial of underweight status, and weight loss with compensatory behaviors to avoid gaining weight despite being underweight.  The resulting malnutrition may impair health (Crow, 2019). Starvation can affect bone density, brain maturation, and growth, especially in children and adolescents. The age of onset of AN is between middle to late adolescence and occurs more in women than men.
Bulimia nervosa is more common than anorexia nervosa. The disorder is characterized by binge eating, i.e., eating large amounts of food within a short period of time. This is usually followed by compensatory behavior such as vomiting, use of laxatives or diuretics, excessive exercise, or feeding restriction to prevent weight gain. Individuals with BN fear gaining weight despite their weight being within the normal range (Crow, 2019). The DSM-5 criteria for diagnosing this disorder requires at least one episode of binge eating with compensatory behavior in a week for a minimum of three months.
Binge eating disorder (BED) is the most common eating disorder and begins In adolescence. It is characterized by binge eating with a loss of control during binge eating. Patients usually feel guilty about binge eating. However, unlike BN and AN, patients don’t have compensatory behaviors such as food restriction or purging (Crow, 2019). Patients with BED are more likely to develop obesity and complications associated with obesity such as stroke and diabetes
Treatment of Eating disorders is multifaceted. Psychotherapy and pharmacotherapy are the most commonly utilized methods.  Cognitive-behavioral therapy (CBT) is the first-line treatment for BN. The goal for CBT is to break the binge-purge cycle seen in BN. Antidepressants such as Fluoxetine can be used for the treatment of BN. Other antidepressants such as amitriptyline and imipramine can also be used for BN. These medications function by decreasing the binge-purge behavior. Fluoxetine is the only FDA-approved drug for BN.  It is also FDA-approved for BED. Antidepressants have a minor role in the management of AN. Fluoxetine can be used for the treatment of AN only if there is coexisting major depression (Crow, 2019)

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Management of AN is done using enhanced CBT and family based-treatment. The use of low-dose neuroleptics such as olanzapine can also be used to treat AN (Resmark et al., 2019). Its efficiency in managing AN is related to its dopaminergic and serotonergic changes in anorexic patients (Han et al., 2022).  BED can be managed using CBT and interpersonal therapy as the first-line therapy. The use of structured meal plans may give control over food intake. Antidepressants such as Fluoxetine can also be added as they act by decreasing binge-purge behavior.  Lisdexamfetamine is also FDA-approved for the treatment of moderate to severe BED. The exact mechanism of action of this drug is unknown for the treatment of BED (Heo & Duggan, 2017).
References
Crow S. J. (2019). Pharmacologic Treatment of Eating Disorders. The Psychiatric clinics of North America, 42(2), 253–262. https://doi.org/10.1016/j.psc.2019.01.007
Han, R., Bian, Q., & Chen, H. (2022). Effectiveness of olanzapine in treating anorexia nervosa: A systematic review and meta-analysis. Brain and Behavior, 12(2), e2498. https://doi.org/10.1002/brb3.2498
Heo, Y. A., & Duggan, S. T. (2017). Lisdexamfetamine: A Review in Binge Eating Disorder. CNS Drugs, 31(11), 1015–1022. https://doi.org/10.1007/s40263-017-0477-1
Resmark, G., Herpertz, S., Herpertz-Dahlmann, B., & Zeeck, A. (2019). Treatment of Anorexia Nervosa-New Evidence-Based Guidelines. Journal of Clinical Medicine, 8(2), 153. https://doi.org/10.3390/jcm8020153
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Eating Disorders
Introduction
Anorexia nervosa (AN) has proven to be very difficult to treat; there is no strong evidence to support any pharmacological treatment or psychotherapy for this disorder. Treatments for bulimia nervosa (BN) and binge-eating disorder (BED) have more positive evidence to support their place in therapy but the evidence, especially for pharmacological treatment, is still relatively weak due to significant shortcomings like small samples, short treatment durations, high drop out rates, and low abstinence rates. Despite the amount of research that has been completed only two medications have received FDA approval for the treatment of an eating disorder: fluoxetine for the treatment of BN and Vyvanse (lisdexamfetamine) for the treatment of BED (not discussed in your text). (LexiComp, 2016)
Treatment of somatic symptom disorders is mainly focused on treating psychiatric symptoms associated with the diagnosis. Antidepressants can help reduce obsessions, depressive symptoms, and anxiety that are fueled by somatization or illness anxiety which in turn can improve functioning.
When choosing a medication for the treatment of a disorder in either of these illness groups it is important to consider the patient’s predominant symptoms, their comorbid conditions, and their goals of treatment. Eating and somatic disorders commonly occur with affective disorders and patients with somatic disorders can have legitimate physical complaints. Identifying what’s most important to your patient, whether it is to reduce pain, depression, anxiety, gain control of weight, etc. can help you tailor therapy to the patient’s specific needs.
ASSIGNMENT/DISCUSSION
Eating disorders are notoriously difficult to treat and there are only two of these disorders that have FDA approved psychopharmacologic treatment options.
Discuss bulimia nervosa (BN), anorexia nervosa (AN), and binge eating disorder (BED) recommended treatments, the rationale for the treatments, include the MOA and evidence for its use.
 

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