Eating Disorders Andersen, Arnold E; Mehler, Philip S
2022
eBook
A comprehensive guide on how to diagnose, treat, and care for those with eating disorders.Eating disorders, which include such conditions as anorexia, bulimia, binge eating, and pica, represent a ...challenge to both patients and health care providers alike. For more than 20 years, health care providers have turned to the expert advice found in Eating Disorders to keep up to date with the latest research in the field and to help them provide the best care available for their patients. In this new, thoroughly revised and expanded edition of their best-selling work, Drs. Philip S. Mehler and Arnold E. Andersen provide a user-friendly and comprehensive guide to treating and managing eating disorders for primary care physicians, mental health professionals, worried family members and friends, and nonmedical professionals (such as teachers and coaches). Mehler and Andersen • identify common medical complications faced by people who have eating disorders• answer questions about how to treat both physical and behavioral aspects of eating disorders• discuss serious complications, including cardiac arrhythmia, electrolyte abnormalities, and gastrointestinal problems• incorporate all-new information on avoidant restrictive food intake disorder (ARFID), binge eating disorder, and the role of social media in promoting disordered eating• offer targeted advice for working with specialists• include four new chapters on eating disorders in children and adolescents; atypical anorexia; eating disorders in transgender individuals; and family therapy• feature engaging clinical vignettes • answer a list of common questions practitioners may have in each chapterThe most comprehensive work on the market and the only book that covers eating disorders in transgender individuals, Eating Disorders is a compassionate, evidence-based, and essential guide.Contributors: Arnold E. Andersen, Ovidio Bermudez, Jeana Cost, Meghan Foley, Dennis Gibson, Neville Golden, Sacha Gorell, Jeffrey Hollis, Mori J. Krantz, Daniel Le Grange, Russell Marx, Jennifer McBride, Philip S. Mehler, Leah Puckett, Katherine Sachs, Michael Spaulding-Barclay, Anna Tanner, Nathalia Trees, Jessica Tse, Kenneth Weiner, Patricia Westmoreland
Abstract Anorexia nervosa and bulimia nervosa are serious psychiatric illnesses related to disordered eating and distorted body images. They both have significant medical complications associated ...with the weight loss and malnutrition of anorexia nervosa, as well as from the purging behaviors that characterize bulimia nervosa. No body system is spared from the adverse sequelae of these illnesses, especially as anorexia nervosa and bulimia nervosa become more severe and chronic. We review the medical complications that are associated with anorexia nervosa and bulimia nervosa, as well as the treatment for the complications. We also discuss the epidemiology and psychiatric comorbidities of these eating disorders.
Objective
Although multiple pathophysiologic changes develop within the gastrointestinal (GI) system in the setting of malnutrition, the etiology of the reported multitude of symptoms in those with ...anorexia nervosa and avoidant restrictive intake disorder, as well as their contribution toward disordered eating, remain poorly understood. This systematic review seeks to better understand how these physiologic changes of malnutrition of the esophagus, stomach, intestines, and pancreas contribute toward the reported GI symptoms, as well as better understand how celiac disease, inflammatory bowel disease, pelvic floor dysfunction, and Ehlers–Danlos syndrome contribute toward disordered eating.
Methods
Studies of any design exploring the pathogenesis of complications and treatment strategies were included. Preferred Reporting Items for Systematic Reviews and Meta‐Analysis guidelines were used to structure and complete the review.
Results
A total of 146 articles were used for the review. The majority of studies were observational or case reports/case series.
Discussion
Pathophysiologic changes of the esophagus, stomach, and intestines develop with malnutrition, although these changes do not consistently correlate with expressed GI symptoms in patients with restrictive eating disorders. Celiac disease and inflammatory bowel disease also contribute to disordered eating through the associated somatic GI complaints, while pelvic floor dysfunction and Ehlers–Danlos syndrome contribute through both somatic symptoms and functional symptoms. Indeed, functional GI symptoms remain problematic during the course of treatment, and further research is required to better understand the extent to which these symptoms are functional in nature and remit or remain as treatment ensues.
Resumen
Objetivo
Aunque en el contexto de la desnutrición se desarrollan múltiples cambios fisiopatológicos dentro del sistema gastrointestinal (GI), la etiología de la multitud de síntomas reportados en aquellos que padecen anorexia nerviosa y trastorno evitativo restrictivo de la ingesta, así como su contribución a la alimentación disfuncional, siguen siendo poco entendidos. Esta revisión sistemática busca entender mejor cómo estos cambios fisiológicos de la desnutrición del esófago, estómago, intestinos y páncreas contribuyen a los síntomas gastrointestinales reportados, así como entender mejor cómo la enfermedad celíaca, la enfermedad inflamatoria intestinal, la disfunción del piso pélvico y el síndrome de Ehlers Danlos contribuyen a la alimentación disfuncional.
Métodos
Se incluyeron estudios de cualquier diseño que exploraran la patogénesis de las complicaciones y las estrategias de tratamiento. Los lineamientos PRISMA se utilizaron para estructurar y completar el examen.
Resultados
Se utilizaron un total de 146 artículos para la revisión. La mayoría de los estudios fueron observacionales o reporte de caso o series de casos.
Discusión
Los cambios fisiopatológicos del esófago, el estómago y los intestinos se desarrollan con la desnutrición, aunque estos cambios no se correlacionan consistentemente con los síntomas gastrointestinales expresados en pacientes con trastornos de la conducta alimentaria restrictivos. La enfermedad celíaca y la enfermedad inflamatoria intestinal también contribuyen a la alimentación disfuncional a través de las quejas gastrointestinales somáticas asociadas, mientras que la disfunción del piso pélvico y el síndrome de Ehlers Danlos contribuyen a través de síntomas somáticos y síntomas funcionales. De hecho, los síntomas gastrointestinales funcionales siguen siendo problemáticos durante el curso del tratamiento, y se requiere más investigación para comprender mejor hasta qué punto estos síntomas son de naturaleza funcional y se remiten o permanecen a medida que se produce el tratamiento.
Anorexia nervosa and bulimia nervosa are mental illnesses with associated complications affecting all body systems with arguably the highest mortality of all mental health disorders. A comprehensive ...medical evaluation is an essential first step in the treatment of anorexia nervosa and bulimia nervosa. Weight restoration and cessation of purging behaviors are often essential components in the management of medical complications of these illnesses.
The etiology of anorexia nervosa (AN) remains to be fully elucidated, and current theories also fail to account for the direct effect of starvation on the health of the organs and tissues, ...specifically the connective tissue present in most organs of the body. Individuals with hereditary disorders of connective tissue manifest with clinical symptoms that overlap with AN, as the abnormal connective tissue also contributes to many of the other extra‐articular manifestations of these hereditary disorders. This article hypothesizes that a similar pathophysiology may also contribute to the clinical presentation of AN. Therefore, a better understanding is needed to elucidate: (1) the relationship between abnormal connective tissue and AN, (2) the impact of starvation toward the development of abnormal connective tissue and how this manifests clinically, (3) the etiology of autonomic nervous system changes contributing to the dysautonomia in AN, and (4) how the sensory signals sent from potentially abnormal connective tissue to the central nervous system impact interoception in AN. A conceptual model incorporating abnormal connective tissue is provided.
Public Significance
The etiology of AN remains poorly understood and current theories fail to account for the direct impact of starvation on the health of the organs and tissues of the body. There is significant clinical overlap between AN and hereditary connective tissue disorders. This paper attempts to provide a new conceptual model for AN in which abnormal connective tissue contributes to the underlying pathogenesis.
The pathogenesis of an increasing number of chronic diseases is being attributed to effects of the immune system. However, its role in the development and maintenance of anorexia nervosa is seemingly ...under-appreciated. Yet, in examining the available research on the immune system and genetic studies in anorexia nervosa, one becomes increasingly suspicious of the immune system's potential role in the pathophysiology of anorexia nervosa. Specifically, research is suggestive of increased levels of various pro-inflammatory cytokines as well as the spontaneous production of tumor necrosis factor in anorexia nervosa; genetic studies further support a dysregulated immune system in this disorder. Potential contributors to this dysregulated immune system are discussed including increased oxidative stress, chronic physiological/psychological stress, changes in the intestinal microbiota, and an abnormal bone marrow microenvironment, all of which are present in anorexia nervosa.
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 every body system can be adversely, affected by this state of progressive malnutrition. Moreover, some of the complications can have permanent adverse effects even after there is a successful 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.
The exact medical complications, leading to the well‐known high risk of death in patients with anorexia nervosa (AN), remain elusive. Such deaths are often abrupt with no satisfactory explanation. ...Suspected causes include cardiac QTc prolongation and, in turn, torsade de pointes (TdP). Psychotropic medications often prescribed to these patients are linked to QTc prolongation. AN is also presumed to cause heart failure due to malnutrition with increased susceptibility to QTc prolongation, and TdP, resulting in sudden cardiac death. Recent literature, however, is conflicting, and the likely cause of death may involve other cardiac abnormalities, such as low heart rate, abnormal heart rate variability, or increased QT dispersion. With an ongoing gap in research explaining the high mortality rate in AN, a compelling need to define the exact proximate causes of death in these patients remains. Because low serum potassium is the most common trigger for TdP, we postulate the early signal of sudden cardiac death, especially in patients with AN who purge, is hypokalemia. We also speculate that hypoglycemia could be a major factor in the sudden death of patients with AN as well as bradycardia or sinus arrest. A path forward to elucidate potential causes is offered.
Medical Complications of Binge Eating Disorder Wassenaar, Elizabeth; Friedman, Julie; Mehler, Philip S
The Psychiatric clinics of North America,
06/2019, Letnik:
42, Številka:
2
Journal Article
Recenzirano
Binge eating disorder (BED) is the most common eating disorder and is accompanied by multiple medical comorbidities, many of which are associated with obesity-related diseases. However, the BED ...itself is likely to confer additional risk factors. BED presents with medical symptoms in virtually every body system and can have devastating consequences on both quality and length of life. This review covers the major comorbidities of BED and highlights areas of ongoing research in this disorder.
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