Janet Treasure, Angélica M Claudino, Nancy Zucker
This Seminar adds to the previous Lancet Seminar about eating disorders, published in 2003, with an emphasis on the biological contributions to illness onset and maintenance. The diagnostic criteria are in the process of review, and the probable four new categories are: anorexia nervosa, bulimia nervosa, binge eating disorder, and eating disorder not otherwise speciﬁed. These categories will also be broader than they were previously, which will aﬀect the population prevalence; the present lifetime prevalence of all eating disorders is about 5%. Eating disorders can be associated with profound and protracted physical and psychosocial morbidity. The causal factors underpinning eating disorders have been clariﬁed by understanding about the central control of appetite. Cultural, social, and interpersonal elements can trigger onset, and changes in neural networks can sustain the illness. Overall, apart from studies reporting pharmacological treatments for binge eating disorder, advances in treatment for adults have been scarce, other than interest in new forms of treatment delivery.
Lancet 2010; 375: 583–93 Published Online November 19, 2009 DOI:10.1016/S01406736(09)61748-7 Section of Eating Disorders, Institute of Psychiatry, King’s College London, London, UK (Prof J Treasure FRCPsych); Eating Disorders Programme, Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil (A M Claudino PhD); Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, NC, USA (N Zucker PhD); and Department of Psychology and Neuroscience, Duke University, Durham, NC, USA (N Zucker) Correspondence to: Prof Janet Treasure, Box P059, Section of Eating Disorders, Institute of Psychiatry, King’s College London, De Crespigny Park, Denmark Hill, London SE5 8AF, UK firstname.lastname@example.org
This Seminar adds to the previous Lancet Seminar about eating disorders, which was published in 2003.1 We provide a concise review of eating disorders in young people, focusing on factors of particular relevance to the clinician such as diagnosis, epidemiology, pathogenesis, treatment, and prognosis. In this Seminar we draw attention to biological factors that could contribute to new interventions. Eating disorders also occur in prepubertal children, but studies in this age group are scarce and there is no consensus about either diagnosis or treatment.
Classiﬁcation and diagnosis
Diagnosis is challenging because diagnostic symptoms and associated behaviours substantially overlap across the range of eating disorders. For example, extreme dietary restraint, binge eating, and overvalued ideas about weight and shape can be present in all forms of eating disorder. Additionally, the subjective interpretation and justiﬁcation behind diagnostic behaviours is often not clear or is limited by developmental constraints (as in childhood anorexia nervosa), further complicating diagnosis. In the diagnostic and statistical manual of mental disorders fourth edition (DSM-IV),2 three broad categories are delineated: anorexia nervosa, bulimia nervosa, and eating disorder not otherwise speciﬁed. The international classiﬁcation of diseases tenth revision (ICD-10) has three categories: anorexia nervosa, bulimia nervosa, and atypical eating disorder.3 Brieﬂy, anorexia nervosa is characterised by extremely low bodyweight and a fear of its increase; bulimia nervosa comprises repeated binge eating, followed by behaviours to counteract it. The category of eating disorder not otherwise speciﬁed encompasses variants of these disorders, but with subthreshold symptoms (eg, menstruation still present despite clinically signiﬁcant weight loss, purging without objective binging). The panel shows some key symptoms of eating disorders in general (more detailed information about the clinical features of each disorder is available in the...
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