PubMed · 8990999
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J Garrow. Gluttony.. https://doi.org/10.1136/bmj.313.7072.1595
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Over the past few decades, there has been significant progress in research on eating disorders that has informed the clinical management of these difficult, and sometimes refractory, disorders. Indeed, sufficient progress has been made such that practice guidelines have been offered to delineate standards of clinical care and guidance to clinicians in the treatment of bulimia nervosa and anorexia nervosa. Out of necessity, however, the practice guidelines are based on a combination of research-based recommendations and clinical consensus because of significant gaps in the extant research. Nonetheless, clinicians must confront these clinical issues. The purpose of this special series is to address areas of significant clinical importance that have a very modest research literature, and to briefly summarize the existing research. The authors of the individual papers, all noted experts in eating disorders treatment, then offer practical clinical management recommendations drawing both on the modest available research and their extensive clinical experience.
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Anorexia nervosa (AN) and bulimia nervosa (BN) are currently classified as eating disorders. Both disorders are the product of a complex interaction between psychological and physiological processes and both show considerable comorbidity with other psychiatric disorders. Physiological and endocrine abnormalities, including primary or secondary amenorrhea and menstrual dysfunction, are common and for the most part a function of the severity of weight loss, malnutrition and/or abnormal eating habits. Therefore, assessment needs to include several steps: (1) Clinical evaluation to ascertain the diagnosis, including weight and height measurements; (2) Determination of co-existing psychiatric illnesses; and (3) Physical examination and evaluation of the physiological and endocrine status. Eating disorders interfere with reproductive function. In view of the fact that dieting has reached epidemic proportions among the young female population, and given the high association between eating disorders and endocrine abnormalities as well as menstrual disturbances, all women participating in research studies should be screened for the presence of eating disorders, disordered eating, and excessive exercise.