Chapter 25 - Eating Disorders

Summary

Problems in eating behaviors in conjunction with altered cognitions about shape, weight, or food define eating disorders. Behaviors can include restrictive eating patterns, loss-of-control eating episodes, as well as compensatory actions to mitigate caloric intake such as overexercise or vomiting. Cognitive preoccupations can be related to food, eating, body image, and/or weight. Combinations of these behaviors and cognitions define the specific DSM-5 eating disorder diagnoses. Screening by clinicians is important, because many will present for associated comorbidities rather than the eating disorder, and early interventions are associated with better outcomes. Malnutrition, dehydration, infertility, seizures, and cardiac problems are common medical complications of eating disorders. Multiple levels of care can be appropriate for treatment of eating disorders; the least restrictive level that allows the patient to make behavioral changes in eating while still ensuring both medical and psychiatric safety is preferred. Because both physiological and psychological factors are involved in eating pathology, the treatment team should ideally include expertise from medicine, psychiatry, nutrition, and talk therapy. Communication across the team about the patient’s current goals is essential, as all members can influence the patient’s motivation to make changes necessary for recovery.