scholarly journals Description of characteristics and outcomes of a cohort of patients with severe and enduring eating disorders (SE-ED)

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Ana Piñar-Gutiérrez ◽  
Elena Dios-Fuentes ◽  
Pablo Remón-Ruiz ◽  
Diego Del Can-Sánchez ◽  
Antonio Vázquez-Morejón ◽  
...  

Abstract Objective To describe the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (> 7 years evolution despite evidence-based conventional treatment). Methods A descriptive observational study was conducted. Patients with a diagnosis of SE-ED (anorexia nervosa and bulimia nervosa) treated in the Endocrinology and Nutrition service of the Virgen del Rocío University Hospital between 2014 and 2019 were included. Results 67 patients were contacted and accepted to participate in the study. 95.5% were women. 67.2% were diagnosed with AN (anorexia nervosa) and 32.8% with BN (bulimia nervosa). Their median ages (years) at the onset of symptoms, beginning of follow-up and at present were 17, 32 and 42.5 respectively. Their median time of follow-up was 9 years. 73.1% had mental comorbitidy and AN patients had more osteoporosis (48.9% vs 22.7%, p = 0.04) and hypogonadotropic hypogonadism (31.1% vs. 4.5%, p = 0.014). Discussion The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. This emphasizes the importance of an early diagnosis in eating disorders. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis and hypogonadotropic hypogonadism than patients with BN. Level of evidence Level III: Evidence obtained from well-designed cohort or case–control analytic studies. Plain English summary At present, the criteria for severe and enduring eating disorders (SE-ED) are not sufficiently clearly defined. It has been calculated that approximately 20% of patients with anorexia nervosa (AN) and 10% of patients with bulimia nervosa (BN) suffer a chronification. We evaluated the characteristics of the patients, as well as the treatment outcomes for the people treated in an Endocrinology and Nutrition unit with a diagnosis of SE-ED (which was made based on an evolution greater than 7 years despite conventional treatment). The SE-ED patients in our sample began treatment years after the onset of symptoms, which may have led to their chronification. They presented with a high rate of physical complications and mental comorbidity. In the current sample, it was determined that patients with AN presented with higher rates of osteoporosis (health condition that weakens bones, making them fragile and more likely to break) and hypogonadotropic hypogonadism (illness in which testes or ovaries produce little or no sex hormones due to a problem in the pituitary gland) than patients with BN.

1992 ◽  
Vol 37 (5) ◽  
pp. 309-315 ◽  
Author(s):  
Sidney H. Kennedy ◽  
Paul E. Garfinkel

This paper reviews four areas of research into anorexia nervosa (AN) and bulimia nervosa (BN). First, in terms of diagnosis, the psychological concerns about weight and shape are now addressed in BN, bringing it more in line with the related disorder, anorexia nervosa. Second, studies of psychiatric comorbidity confirm the overlap between eating disorders and depression, obsessive compulsive disorder, substance abuse, and personality disorder. Nevertheless, there are reasons to accept the distinct qualities of each syndrome, and eating disorders are not merely a variant of these other conditions. Third, treatment advances in BN involve mainly cognitive-behavioural or interpersonal psycho-therapies and pharmacotherapies primarily with antidepressants. The effect of combining more than one approach is beginning to be addressed. Finally, outcome studies involving people with both AN and BN have shown that the disorders “cross over” and that both conditions have a high rate of relapse. A renewed interest in the treatment of AN is needed.


2004 ◽  
Vol 34 (8) ◽  
pp. 1395-1406 ◽  
Author(s):  
MANFRED M. FICHTER ◽  
NORBERT QUADFLIEG

Background. Since little is known about the long-term course and outcome of bulimia nervosa, the authors designed a 12-year prospective longitudinal study with five cross-sectional assessments based on a large sample of consecutively treated females with bulimia nervosa (purging type) (BN-P).Method. One hundred and ninety-six females with BN-P were assessed (1) at the beginning of treatment, (2) at the end of treatment, (3) at 2-year follow-up, (4) at 6-year follow-up, and (5) at 12-year follow-up. In self-ratings as well as expert ratings based on interviews we assessed specific eating-disorder and general psychopathology.Results. The general pattern of results over time showed substantial improvement during treatment, slight (in most cases non-significant) decline during the first two years after the end of treatment, and further improvement and stabilization until 12-year follow-up. At that point the majority of patients (70·1%) showed no major DSM-IV eating disorder, 13·2% had eating disorders not otherwise specified, 10·1% had BN-P and 2% had died. Very few had undergone transition to anorexia nervosa or binge-eating disorders. Logistic regression analyses showed that psychiatric co-morbidity was the best and most stable predictor for eating-disorder outcome at 2, 6 and 12 years.Conclusions. Course and outcome of BN-P was generally more favourable than for anorexia nervosa.


1995 ◽  
Vol 167 (1) ◽  
pp. 80-85 ◽  
Author(s):  
Christine M. Vize ◽  
Peter J. Cooper

BackgroundA history of sexual abuse has been widely reported in patients with eating disorders. However, the association does not appear to be specific, because a high rate of such abuse has also been found in other psychiatric patients.MethodA standardised interview method was used to elicit details of sexual abuse in a psychiatrically normal control group and samples of patients with anorexia nervosa, bulimia nervosa, or depression.ResultsAn equally high rate of abuse was found in all three clinical samples. Among the patients with anorexia nervosa the presence of bulimic episodes was not found to be associated with reports of abuse; and among the patients with bulimia nervosa there was no relationship between abuse and a history of anorexia nervosa. Among the patients with eating disorders, borderline personality disorder, assessed by means of self-report questionnaire, was not found to be related to reports of abuse, although there was an association between abuse and both indices of impulsive behaviour and the overall level of personality disturbance.ConclusionsChildhood sexual abuse appears to be a vulnerability factor for psychiatric disorder in general and not eating disorders in particular. The way in which abuse interacts with other aetiological factors to produce different psychopathological trajectories remains to be elucidated.


Author(s):  
Susan McElroy ◽  
Anna I. Guerdjikova ◽  
Nicole Mori ◽  
Paul E. Keck

This chapter addresses the pharmacotherapy of the eating disorders (EDs). Many persons with EDs receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. This chapter first provides a brief rationale for using medications in the treatment of EDs. It then reviews the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES). It concludes by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.


Author(s):  
Pamela Keel

The epidemiology of eating disorders holds important clues for understanding factors that may contribute to their etiology. In addition, epidemiological findings speak to the public health significance of these deleterious syndromes. Information on course and outcome are important for clinicians to understand the prognosis associated with different disorders of eating and for treatment planning. This chapter reviews information on the epidemiology and course of anorexia nervosa, bulimia nervosa, and two forms of eating disorder not otherwise specified, binge eating disorder and purging disorder.


Author(s):  
Susan L. McElroy ◽  
Anna I. Guerdjikova ◽  
Anne M. O’Melia ◽  
Nicole Mori ◽  
Paul E. Keck

Many persons with eating disorders (EDs) receive pharmacotherapy, but pharmacotherapy research for EDs has lagged behind that for other major mental disorders. In this chapter, we first provide a brief rationale for using medications in the treatment of EDs. We then review the data supporting the effectiveness of specific medications or medication classes in treating patients with anorexia nervosa (AN), bulimia nervosa, binge eating disorder (BED), and other potentially important EDs, such as night eating syndrome (NES) and sleep-related eating disorder (SRED). We conclude by summarizing these data and suggesting future areas for research in the pharmacotherapy of EDs.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jannike Karlstad ◽  
Cathrine Fredriksen Moe ◽  
Mari Wattum ◽  
Berit Støre Brinchmann

Abstract Background Caring for an individual with an eating disorder involves guilt, distress and many extra burdens and unmet needs. This qualitative study explored the experiences of parents with adult daughters suffering from anorexia nervosa or bulimia nervosa and the strategies they adopted. A subsidiary aim of the study was to explore the relationship between the caregivers’ perceived need for professional support and the support they reported receiving in practice from the health services. Methods Semi-structured interviews were conducted with 11 mothers and fathers from across Norway. Data collection, coding and analysis was conducted using the principles of constructivist grounded theory in an iterative process. The main concern shared by participants was identified by this process and their “solution” to the main concern then formed the content of the core category. Results ″Wearing all the hats″ emerged as the core category, indicating that the parents have to fulfil several roles to compensate the lack of help from health services. The three subcategories: “adapting to the illness”, “struggling for understanding and help” and “continuing to stay strong” described how the participants handled their situation as parents of adult daughters with eating disorders. Conclusions In daily life, the parents of adults with eating disorders have to attend to a wide range of caregiver tasks to help their ill daughters. This study suggests that the health services that treat adults with eating disorders should be coordinated, with a professional carer in charge. The parents need easy access to information about the illness and its treatment. They also need professional support for themselves in a demanding situation.


Author(s):  
Marco La Marra ◽  
Walter Sapuppo ◽  
Giorgio Caviglia

The aim of this study has been to investigate the dissociative phenomena and the difficulties related to perceive, understand and describe the proper ones and other people's emotional states in a sample of 53 patients with Eating Disorders. The recruited sample is made by 14 Anorexia Nervosa (AN) patients, 15 with Bulimia Nervosa (BN), 12 with Eating Disorder Non Otherwise Specified (EDNOS) and 12 with Binge Eating Disorder (BED). To all subjects was administred the Eating Disorder Inventory-2, the Dissociative Experiences Scale and the Scala Alessitimica Romana. In according with literature, we confirme the relationships among Eating Disorders, the dissociative phenomena and Alexithymia.


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