Cederlöf, M., et al. (2015). “Etiological overlap between obsessive‐compulsive disorder and anorexia nervosa: a longitudinal cohort, multigenerational family and twin study.” World Psychiatry 14(3): 333-338.
Obsessive‐compulsive disorder (OCD) often co‐occurs with anorexia nervosa (AN), a comorbid profile that complicates the clinical management of both conditions. This population‐based study aimed to examine patterns of comorbidity, longitudinal risks, shared familial risks and shared genetic factors between OCD and AN at the population level. Participants were individuals with a diagnosis of OCD (N=19,814) or AN (N=8,462) in the Swedish National Patient Register between January 1992 and December 2009; their first‐, second‐ and third‐degree relatives; and population‐matched (1:10 ratio) unaffected comparison individuals and their relatives. Female twins from the population‐based Swedish Twin Register (N=8,550) were also included. Females with OCD had a 16‐fold increased risk of having a comorbid diagnosis of AN, whereas males with OCD had a 37‐fold increased risk. Longitudinal analyses showed that individuals first diagnosed with OCD had an increased risk for a later diagnosis of AN (risk ratio, RR=3.6), whereas individuals first diagnosed with AN had an even higher chance for a later diagnosis of OCD (RR=9.6). These longitudinal risks were about twice as high for males than for females.
First‐ and second‐degree relatives of probands with OCD had an increased risk for AN, and the magnitude of this risk tended to grow with the degree of genetic relatedness. Bivariate twin models revealed a moderate but significant degree of genetic overlap between self‐reported OCD and AN diagnoses (ra=0.52, 95% CI: 0.26‐0.81), but most of the genetic variance was disorder‐specific. The moderately high genetic correlation supports the idea that this frequently observed comorbid pattern is in part due to shared genetic factors. However, disorder‐specific factors are more important. These results have implications for current gene‐searching efforts and clinical practice.
Harrington, B. C., et al. (2015). “Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa.” Am Fam Physician 91(1): 46-52.
Eating disorders are life-threatening conditions that are challenging to address; however, the primary care setting provides an important opportunity for critical medical and psychosocial intervention. The recently published Diagnostic and Statistical Manual of Mental Disorders, 5th ed., includes updated diagnostic criteria for anorexia nervosa (e.g., elimination of amenorrhea as a diagnostic criterion) and for bulimia nervosa (e.g., the criterion for the frequency of binge episodes decreased to an average of once per week). In addition to the role of environmental triggers and societal expectations of body size and shape, research has suggested that genes and discrete biochemical signals contribute to the development of eating disorders.
Anorexia nervosa and bulimia nervosa occur most often in adolescent females and are often accompanied by depression and other comorbid psychiatric disorders. For low-weight patients with anorexia nervosa, virtually all physiologic systems are affected, ranging from hypotension and osteopenia to life-threatening arrhythmias, often requiring new assessment and hospitalization for metabolic stabilization. In patients with frequent purging or laxative abuse, the presence of electrolyte abnormalities requires prompt intervention. Family-based treatment is helpful for adolescents with anorexia nervosa, whereas short-term psychotherapy, such as cognitive behavior therapy, is adequate for most patients with bulimia nervosa. The use of psychotropic medications is limited for anorexia nervosa, whereas treatment studies have shown a benefit of antidepressant medications for patients with bulimia nervosa. Treatment is most effective when it includes a multidisciplinary, team-based approach.
Keski-Rahkonen, A. and L. Mustelin (2016). “Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors.” Current Opinion in Psychiatry 29(6): 340-345.
Purpose of review Eating disorders – anorexia nervosa, bulimia nervosa, and binge eating disorder – affect numerous Europeans. This narrative review summarizes European studies on their prevalence, incidence, comorbidity, course, consequences, and risk factors published in 2015 and the first half of 2016. Recent findings Anorexia nervosa is reported by <1–4%, bulimia nervosa <1–2%, binge eating disorder <1–4%, and subthreshold eating disorders by 2–3% of women in Europe. Of men, 0.3–0.7% report eating disorders. Incidences of anorexia appear stable, whereas bulimia may be declining. Although the numbers of individuals receiving treatment have increased, only about one-third is detected by healthcare. Over 70% of individuals with eating disorders report comorbid disorders: anxiety disorders (>50%), mood disorders (>40%), self-harm (>20%), and substance use (>10%) are common. The long-term course of anorexia nervosa is favorable for most, but a substantial minority of eating disorder patients experience longstanding symptoms and physical problems. The risk of suicide is elevated. Parental psychiatric disorders, prenatal maternal stress, various family factors, childhood overweight, and body dissatisfaction in adolescence increase the risk of eating disorders. Summary Eating disorders are relatively common disorders that are often overlooked, although they are associated with high comorbidity and severe health consequences.
Kupfer, D. J., et al. (2013). “Dsm-5 —the future arrived.” JAMA 309(16): 1691-1692.
The next revision of psychiatry’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5)1 will be published in May 2013 and is the first revision of this psychiatric nomenclature in almost two decades. DSM-5 involved an international, multidisciplinary team of more than 400 individuals who volunteered vast amounts of their time throughout this 6-year official process, as well as many contributions from numerous international conferences that were held during the last decade.
Mehler, P. S. and C. Brown (2015). “Anorexia nervosa – medical complications.” Journal of Eating Disorders 3(1): 11.
In contrast to other mental health disorders, eating disorders have a high prevalence of concomitant medical complications. Specifically, patients suffering from anorexia nervosa (AN) have a litany of medical complications which are commonly present as part of their eating disorders. Almost everybody system can be adverse, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a thriving program of nutritional rehabilitation and weight restoration. Within this article, we will review all body systems affected by AN. There is also salient information about both, how to diagnose these medical complications and which are the likely ones to result in permanent sequelae if not diagnosed and addressed early in the course of AN. In a subsequent article, the definitive medical treatment for these complications will be presented in a clinically practical manner.
Rikani, A. A., et al. (2013). “A critique of the literature on etiology of eating disorders.” Ann Neurosci 20(4): 157-161.
The development of eating disorders including anorexia nervosa, bulimia nervosa, binge eating disorder, and atypical eating disorders that affect many young women and even men in the productive period of their lives is complex and varied. While numbers of presumed risk factors contributing to the development of eating disorders are increasing, previous evidence for biological, psychological, developmental, and sociocultural effects on the development of eating disorders have not been conclusive. Despite the fact that a considerable body of research has carefully examined the possible risk factors associated with the eating disorders, they have failed not only to uncover the exact etiology of eating disorders but also to understand the interaction between different causes of eating disorders. This failure may be due complexities of eating disorders, limitations of the studies or combination of two factors. In this review, some risk factors including biological, psychological, developmental, and sociocultural are discussed.
Smink, F. R. E., et al. (2012). “Epidemiology of Eating Disorders: Incidence, Prevalence and Mortality Rates.” Current Psychiatry Reports 14(4): 406-414.
Eating disorders are relatively rare among the general population. This review discusses the literature on the incidence, prevalence and mortality rates of eating disorders. We searched online Medline/Pubmed, Embase and PsycINFO databases for articles published in English using several key terms relating to eating disorders and epidemiology. Anorexia nervosa is relatively common among young women. While the overall incidence rate remained stable over the past decades, there has been an increase in the high risk-group of 15– 19-year-old girls. It is unclear whether this reflects the earlier detection of anorexia nervosa cases or an earlier age at onset. The occurrence of bulimia nervosa might have decreased since the early nineties of the last century. All eating disorders have an elevated mortality risk; anorexia nervosa the most striking over the rest. Compared with the other eating disorders, binge eating disorder is more common among males and older individuals.