Advances in Diagnosis and Treatment of Anorexia Nervosa and Bulimia Nervosa^*

Abstract

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN) R esearch into anorexia nervosa (AN) and bulimia nervosa (B.N) is progressing at a rapid rate. Meanwhile, patients with eating disorders continue to present major therapeutic challenges to clinicians. In a review of the progress made in clinical research on AN and BN, Garfinkel and colleagues ( I) described a series of risk factors which may both initiate and perpetuate these chronic disorders and highlighted several serious complications. This paper will provide an update on the issues of diagnosis, comorbidity, treatment and outcome in this rapidly changing field. Diagnostic CriteriaMinor changes to the diagnostic criteria in the DSM-III for AN were made for the DSM-III-R. The revised criteria re-*Manuscript received.

Future‐directed thinking in eating disorders

“…One further point deserves mentioning in this context: the anorexics were significantly more depressed than the bulimics or controls; however, their preserved ability for positive future-directed thinking does not reflect this. One possibility is that the HADS (Zigmond & Snaith, 1983) picked up symptoms of starvation, rather than true depression, which are often difficult to distinguish (Kennedy & Garfinkel, 1992).…”

Elevated plasma lipids in patients with binge eating disorders are found only in those who are anorexic

“…Although it was predicted that the AN-B group may have higher cholesterol levels than controls, the differences in lipid levels between the AN-B and BN groups were not expected. Both groups engage in binge eating, both are reported to restrict their food intake when not binge eating (Kennedy & Garfinkel, 1992), and both used self-induced vomiting as the primary purging mechanism. The two distinguishing characteristics between them are weight and the presence or absence of amenorrhea.…”

Erfassung essgestörten Verhaltens bei Patientinnen mit Diabetes mellitus mit Hilfe eines Fragebogens (Diab-Ess)

“…Voraussetzung für unser Vorgehen war weiterhin, dass die Bedeutung psychischer Faktoren bei der Entstehung von Essstörungen evident ist. In einer Vielzahl von Veröffentlichungen werden psychische Merkmale von Essgestörten beschrieben [19 ± 21], so zum Beispiel die Häufigkeit narzisstischer Störungen bei Bulimie [22,23], der Zusammenhang mit depressiven Symptomen und Persönlichkeitsstörungen [24,25] oder zusammengefasst bei Reich und Cierpka [26]. Ebenfalls konnte gezeigt werden, dass Patientinnen mit einer Essstörung und Diabetes mellitus hinsichtlich ihrer psychologischen und soziokulturellen Merkmale Essstörungspatientinnen gleichen [27 ± 29] Zu diesem Vorgehen entschieden wir uns, da eine allgemein verbindliche Definition subklinischer Essstörungen bislang nicht vereinbart werden konnte und auch andere Autoren entsprechend dem Vorschlag der ICD-10 ihre jeweils eigenen Festlegungen vorgenommen haben [34 ± 36].…”