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Am Fam Physician. 2000;62(1):185-188

The American Psychiatric Association (APA) has revised a practice guideline on the treatment of eating disorders. The APA states that patients with eating disorders display a broad range of symptoms that occur along a continuum between those of anorexia nervosa and those of bulimia nervosa. The care of these patients requires a comprehensive array of approaches to provide them with the best chance of treatment success.

The clinical features of anorexia and bulimia are varied, but criteria from the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) may be used to establish the diagnosis (see the accompanying tables). There is a significant amount of overlap in the symptoms of these two eating disorders. The primary symptoms of anorexia and bulimia are preoccupation with weight and excessive self-evaluation of weight and shape.

The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.
The rightsholder did not grant rights to reproduce this item in electronic media. For the missing item, see the original print version of this publication.

Among women, the lifetime prevalence of anorexia nervosa is 0.5 to 3.7 percent, and the lifetime prevalence of bulimia is 1.1 to 4.2 percent. The male-to-female prevalence ratio ranges from 1:6 to 1:10.

The percentage of patients with anorexia nervosa who fully recover is modest. Although some improve over time, many continue to suffer from a distorted body image, disordered eating habits and psychiatric difficulties. Little is known about the long-term prognosis of patients with untreated bulimia. In a long-term study of patients with bulimia who were treated in an intensive program, 60 percent had a good outcome six years after successful treatment.

The goals of treatment for anorexia nervosa are to restore patients to a healthy weight, treat the physical complications, enhance the patient's motivation to cooperate with treatment and provide education about healthy nutrition and eating habits. Other goals of treatment include correcting maladaptive thoughts, attitudes and feelings related to the eating disorder; treating associated psychiatric conditions; enlisting family support; and attempting to prevent relapse. Medication should be considered in the treatment of anorexia but should not be the sole or primary treatment.

Patients with bulimia require specific nutritional counseling and psychosocial intervention. Antidepressants are an effective component of the initial treatment of this eating disorder. This is particularly true if the patient has significant symptoms of depression, anxiety, obsessions or impulse disorders. Selective serotonin reuptake inhibitors are considered to be the safest medication option in these patients, especially if they have the potential to commit suicide.

According to the APA, this guideline contains clinical factors that must be considered when treating patients with eating disorders. The ultimate treatment plan depends on the individual patients who have these disorders.

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