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INTRODUCTION

Eating disorders are complex psychiatric illnesses characterized by pathological eating and related behaviors, and disturbances in body image that cause significant distress and/or impairment. In the United States, approximately 30 million individuals are affected by an eating disorder in their lifetime, with prevalence rates of about 1% for anorexia nervosa (AN), 1.5% for bulimia nervosa (BN), and 3% for binge eating disorder (BED). Eating disorders that have more recently been included in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) include avoidant/restrictive food intake disorder (ARFID) and other specified feeding and eating disorders, including atypical AN, BN, and BED of insufficient frequency and/or duration, and purging disorder. Preliminary estimates suggest that prevalence rates are approximately 5% for ARFID, 3% for atypical AN, 4% for BN or BED of insufficient frequency and/or duration, and 3% for purging disorder. Eating disorders are more common in women than men. Among women in the United States, the prevalence of AN, BN, and BED is similar across major racial/ethnic groups (non-Latina Whites, Latinas, Asians, and African Americans). However, prevalence is higher in gay men and transgender individuals, with some research suggesting that prevalence is lower in lesbian women than heterosexual women.

Eating disorders can have severe medical complications and carry the highest mortality rate of any psychiatric disorder due to high suicide rates, particularly in AN, and serious medical concerns, including cardiovascular, pulmonary, gastrointestinal, and electrolyte complications requiring medical intervention. Prevention and early identification are critical as these disorders can become chronic and have serious psychiatric, psychosocial, and medical consequences. Unfortunately, only about one-third of those with an eating disorder ever receive treatment. Primary care providers are often well-poised to identify potential risky behaviors and to recognize the onset of an eating disorder early on where medical management (sometimes including medical stabilization on an inpatient unit) is critical. Indeed, about one in five individuals with an eating disorder require medical hospitalization, and two in five of those require rehospitalization within 1 year. Despite knowledge about eating disorders, most medical and psychiatric practitioners lack competence in the treatment of eating disorders. Because of the complexity and breadth of clinical presentations, extent of co-occurring psychopathology, general lack of familiarity and training in the assessment and treatment of eating disorders, and the importance of a multidisciplinary treatment approach, referral to a specialist is typically required. Comprehensive treatment includes evidence-based psychotherapy in the context of medical management, in which nutrition counseling can also play a complementary role. Pharmacological interventions have less empirical support as direct targets of eating disorder behavior, though may enhance effects of psychotherapy, particularly among individuals with BN or BED. Psychotropic medications are often used in those with eating disorders to address common comorbid anxiety and mood disorders.

DIFFERENTIAL DIAGNOSIS

Anorexia Nervosa

AN is characterized by persistent dietary restriction leading to a significantly low body weight (in context of what is minimally ...

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