Eating Disorders

An eating disorder is a definite disturbance of eating habits or weight-control behaviors, most often seen in adolescent girls and young adult women (much less frequently in men), which significantly impairs health or functioning. At its core the disorder features a disturbance in eating and preoccupation with shape or weight. The behavioral disturbance seen in this diagnosis does not stem from any other general medical disorder or any other psychiatric condition.

There are four types of eating disorders, each named and explained below:

Anorexia nervosa

Anorexia nervosa involves an over-evaluation of shape and weight—i.e., judging self-worth largely, or exclusively, in terms of shape and weight; active maintenance of an unduly low body weight (body mass index, or BMI, greater than or equal to 17.5*); and skipping at least three consecutive menstrual cycles when not taking an oral contraceptive.

Bulimia nervosa

Bulimia nervosa also involves over-evaluation of shape and weight—i.e., judging self-worth largely, or exclusively, in terms of shape and weight; recurrent binge eating—that is, recurrent episodes of uncontrolled overeating; and extreme weight-control behaviour—such as strict dietary restriction, frequent self-induced vomiting or laxative misuse.

Binge eating disorder

Binge eating disorder represents eating an unusually large amount of food in a short period of time and feeling a loss of control during this episode. Binge eaters do not purge afterwards, but often feel a lot of shame or guilt about their binge eating.

Eating disorder not otherwise specified (EDNOS)

EDNOS involves some combination of symptoms of the other eating disorders such as an intense fear of weight gain and a preoccupation with food (thinking about food or having food-related thoughts most of the day), but may not meet the exact criteria, and therefore is diagnosed as EDNOS.

Eating disorders are very dangerous illnesses and can lead to permanent consequences, especially in anorexia and bulimia patients. Common signs and symptoms include loss of subcutaneous fat (beneath the skin), light-headedness upon standing up, slow heart rate, impaired menstruation, hair loss and low body temperature. Other psychiatric conditions often coexist with eating disorders, such as major depression or generally depressed mood, anxiety disorders and obsessive-compulsive disorder (OCD), personality changes, alcohol or substance abuse—more often among those with bulimia nervosa, in whom the rate of impulsive behavior is also higher, than among those with anorexia nervosa.

Since the 1990s the treatment of eating disorders has attracted worldwide attention. Primary forms of management include psychological treatment, such as cognitive behavior therapy, cognitive analytic therapy, family-based therapy, or similar counseling, and drug treatment, such as antidepressants, antipsychotics, or related medications. So far there is no specific drug treatment for the management of anorexia and bulimia nervosa.

Most forms of medical management only focus on medical complications of anorexia nervosa. In general, the results of current forms of medical management are not optimistic and almost 20% of patients with anorexia nervosa eventually fail to respond, or become medically refractory, to all current medical treatments. Compared to the general population, patients with anorexia nervosa have an 11.6% higher risk of death from any cause, and an especially elevated risk for suicide, 56.9% higher than in the general population. (1)

Deep brain stimulation (DBS) in the nucleus accumbens (NAc) has been explored as a treatment option for medically refractory life-threatening anorexia nervosa with encouraging therapeutic effects. The patients’ BMI recovered to normal after 3-6 months stimulation, the coexistent psychiatric conditions such as OCD and anxiety symptoms also improved slowly but steadily. There are no severe side effects or complications in these patients. But the same bilateral NAc DBS failed in patients with bulimia nervosa who have other severe psychological co-existing conditions like substance misuse, compulsive hair-tugging or twisting (trichotillomania) or self-injury behaviors. Early results indicate bilateral anterior capsulotomy, surgical destruction of a discrete part of the brain, may effectively alleviate symptoms in these patients. (1-5)

* BMI is found by dividing weight by the square of a person’s height, for instance, kg/m2


References:

1. Wu H, Van Dyck-Lippens PJ, Santegoeds R, van Kuyck K, Gabriëls L, Lin G, Pan G, Li Y, Li D, Zhan S, Sun B, Nuttin B. Deep-Brain Stimulation for Anorexia Nervosa. World Neurosurg. 2012 Jun 25. [Epub ahead of print] PubMed PMID: 22743198. 

2. Barbier J, Gabriëls L, van Laere K, Nuttin B. Successful anterior capsulotomy  in comorbid anorexia nervosa and obsessive-compulsive disorder: case report. Neurosurgery. 2011 Sep;69(3):E745-51; discussion E751. PubMed PMID: 21471837.

3. Liu K, Zhang H, Liu C, Guan Y, Lang L, Cheng Y, Sun B, Wang H, Zuo C, Pan L, Xu H, Li S, Shi L, Qian J, Yang Y. Stereotactic treatment of refractory obsessive compulsive disorder by bilateral capsulotomy with 3 years follow-up. J Clin Neurosci. 2008 Jun;15(6):622-9. Epub 2008 Apr 10. PubMed PMID: 18406144.

4. Greenberg BD, Rauch SL, Haber SN. Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology. 2010;35(1):317-336.

5. Doshi, PK. Anterior capsulotomy for refractory OCD: First case as per the core group guidelines. Indian J Psychiatry. 2011 Jul-Sep; 53(3): 270–273.

Clinical Trials:

Deep Brain Stimulation for the Treatment of Refractory Anorexia Nervosa
http://clinicaltrials.gov/show/NCT01476540

Deep Brain Stimulation and Capsulotomy for the Treatment of Refractory Anorexia Nervosa
http://clinicaltrials.gov/show/NCT0167801


Reviewed Nov. 13, 2012
Bomin Sun, MD
Member, International Neuromodulation Society
Dianyou Li, MD
Department of Stereotactic and Functional Neurosurgery, Shanghai Jiaotong University School of Medicine Ruijin Hospital, Shanghai, China

Last Updated on Tuesday, April 25, 2017 11:26 AM