Eating Disorders: The Facts PDF
Preview Eating Disorders: The Facts
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Oxford is a registered trade mark of Oxford University Press in the UK and in certain other countries © Oxford University Press 2016 The moral rights of the author have been asserted First Edition published in 1984 Seventh Edition published in 2016 Impression: 1 All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, without the prior permission in writing of Oxford University Press, or as expressly permitted by law, by licence or under terms agreed with the appropriate reprographics rights organization. Enquiries concerning reproduction outside the scope of the above should be sent to the Rights Department, Oxford University Press, at the address above You must not circulate this work in any other form and you must impose this same condition on any acquirer Published in the United States of America by Oxford University Press 198 Madison Avenue, New York, NY 10016, United States of America British Library Cataloguing in Publication Data Data available Library of Congress Control Number: 2015944826 ISBN 978–0–19–871560–3 Printed and bound by Ashford Colour Press Ltd, Gosport, Hampshire Oxford University Press makes no representation, express or implied, that the drug dosages in this book are correct. Readers must therefore always check the product information and clinical procedures with the most up-to-date published product information and data sheets provided by the manufacturers and the most recent codes of conduct and safety regulations. The authors and the publishers do not accept responsibility or legal liability for any errors in the text or for the misuse or misapplication of material in this work. Except where otherwise stated, drug dosages and recommendations are for the non-pregnant adult who is not breast-feeding Links to third party websites are provided by Oxford in good faith and for information only. Oxford disclaims any responsibility for the materials contained in any third party website referenced in this work. Preface and acknowledgements This book is written for patients, their families, and health professionals, par- ticularly family doctors. The previous edition of this book (the sixth edition) was highly commended at the 2009 British Medical Association Medical Book Awards in the category of popular medicine. This edition has retained the pre- vious successful format and updates the information in the light of recent and proposed changes to the diagnostic criteria for eating disorders and scientific thinking, including the field of epigenetics. With globalization, eating disorders can no longer be considered as culture or class bound. To allow more women to receive help for their disordered eating there has been a softening of the diagnostic criteria for anorexia and bulimia nervosa, the acceptance of binge-eating disorder as a formal diagno- sis, and the introduction by the American Psychiatric Association of avoidant/ restrictive food intake disorder. This latter diagnosis resembles our eating dis- order ‘anorexia not for weight and shape’ that we had previously described in the fifth edition. These recent changes make the diagnosis a clinical decision based on the mental and physical health and quality of life of the person rather than specific measures, for example body mass index. At present, there is no easy way of classifying the eating disorders. It is prob- ably easier during assessment and treatment to think of a single eating dis- order with different characteristics that must be taken into account. In this book I have chosen to classify the eating disorders as: (1) anorexia nervosa and anorexia nervosa-like disorders; (2) bulimia nervosa and bulimia nervosa-like disorders; and (3) binge-eating disorder and binge-eating-like disorders. I hope this will allow readers to select the features from the dif- ferent sections that are relevant for them at the time. I have included ano- rexia nervosa not for weight or shape with anorexia nervosa-like disorders and v Eating disorders · facts purging disorder and regurgitation disorder with bulimia nervosa and bulimia nervosa-like disorders. Obesity is considered a disorder by physicians but not by psychiatrists. Obesity and eating disorders related to overeating are includ- ed with binge-eating and binge-eating-like disorders. I wanted this seventh edition to remain faithful to my original aims, which were: first, to provide accurate information that will allow people who suffer from eating and weight problems to obtain information that improves their quality of life; and secondly, to provide a balanced approach that is useful for the general practitioner, as they will be consulted by people with transitory, easily resolved problems as well as the chronic cases frequently portrayed in books or found on the internet. The following questions are typical of those asked by carers of patients with eating disorders: ◆ What causes the illness? ◆ What do you do to make her better? ◆ How can we help her? ◆ Should we comment on her eating and weight? ◆ Should you say anything when her behaviour is unacceptable? ◆ Why can’t she eat? ◆ Why can’t she stop eating? ◆ Will she ever get better or will she always have an eating disorder? ◆ How long will she need treatment? ◆ Will her bones recover? ◆ Will her heart and kidneys be permanently damaged? ◆ Has the family caused the eating disorder? ◆ Is it genetic? ◆ Will she be able to have children? ◆ Is it because her grandmother suffered depression? ◆ Will she ever be her old self again? vi Preface and acknowledgements ◆ Do you ever really recover from an eating disorder? ◆ Why does she keep saying we do not understand? I have attempted to answer these questions as fully as possible in this book. Nowadays most people with eating disorders recover and maintain a good quality of life. They frequently form relationships and desire children; and if they are not achieving pregnancy they will seek assisted conception. Not a lot is known about disordered eating and pregnancy. The chapter on pregnancy and the post-partum period addresses many issues including the challenge of pregnancy and the possible outcomes for both mothers and their babies. Eating Disorders: the Facts could never have been written without discussions and help from our colleagues and friends. They include: Tarek Ali, Catherine Boyd, Janet Conti, Susan Hart, John Kellow, Astrid von Lojewski, Maala Lal, Michael Mira, Sarah Maguire, Sian Ong, Amanda McBride, Janice Russell, Jim Telfer, Kathryn Velickovic, and Jeremy Wang. For this edition I am very grateful to my colleagues Jessica Anderson, Elise Coker, Hannah Kluckow, Victor Lam, and Georgina Luscombe. Most of all I would like to thank our patients. Without them there would be no book. I would particularly like to thank those patients who permitted us to use their emails and diaries (appropriately modified for reason of privacy) for the case histories and quotations. This book is not intended to glamorize or sensationalize eating disorders. I have presented the facts in the key points at the beginning of each chapter and highlighted others throughout the book. Some suggestions have also been added that will allow people to help themselves in conjunction with their usual treatment. Note Because of problems of gender in the English language, and because we treat more women than men with eating disorders, we have chosen to use ‘she’ rather than ‘he’ in most cases. We believe that an increasing interest in appear- ance among men and easy access to online information is resulting in a greater number of men seeking treatment. The generally accepted measure of body thinness and fatness is the body mass index (BMI, kg/m2) (see Appendix A). Conversion for height and weight units is given in Appendices A and B. vii Eating disorders · facts We have been very careful to use the word obesity to mean a BMI of 30 kg/m 2 or greater (depending on ethnic variations in fat distribution) and not to con- fuse with overweight BMI (25–29 kg/m2).The formal diagnostic criteria for the eating disorders are available online: 1. World Health Organization. ICD-10 Classification of Mental and Behavioural Disorders. http://www.who.int/classifications/icd/en/blue- book.pdf 2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). http://dsm.psychiatryonline.org/ doi/book/10.1176/appi.books.9780890425596 viii Contents 1 Adolescent eating behaviour 1 2 Eating disorders—an overview 19 3 Why do eating disorders occur? 39 4 Infertility, pregnancy, and the post-partum period 53 5 Investigation of eating disorders 75 6 General management of eating disorders 89 7 Anorexia nervosa and anorexia nervosa-like disorders 103 8 Treatment and outcome of anorexia nervosa and anorexia nervosa-like disorders 129 9 Bulimia nervosa and bulimia nervosa-like disorders 153 10 Treatment and outcome of bulimia and bulimia nervosa-like disorders 173 11 Investigation and treatment of binge-eating and binge-eating-like disorders 199 Appendix A: Body mass index (BMI) charts and height conversion 225 Appendix B: Pounds to kilograms chart 231 Appendix C: Quality of Life for Eating Disorders (QOL ED) questionnaire 237 Glossary 249 Index 255 ix
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