We searched the Cochrane Library, Medline, and Embase up to March, 2009. We used the search terms: “anorexia nervosa”, “bulimia nervosa”, “binge eating disorder”, and “eating disorders” in combination with the terms “treatment”, “biology”, “outcome”, “epidemiology”, “comorbidity”, “personality”, “osteoporosis”, “medical”, “neuropsychology”, “neuroimaging”, “psychotherapy”, and “pharmacotherapy”. We manually searched the main eating disorder specialist journals and reference lists of
SeminarEating disorders
Introduction
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.
Section snippets
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
Psychiatric comorbidity
Comorbidity is the rule rather than the exception for patients with eating disorders.19, 20 Developmental disorders (eg, those of the autistic spectrum and attention-deficit hyperactivity disorder) have been reported to affect about a fifth of patients with anorexia nervosa.21, 22 Moreover, a small proportion of adults with attention-deficit hyperactivity disorder have additional symptoms of eating disorders.23 Obsessive compulsive traits24, 25 or disorder,26 and anxiety disorders27, 28 and
Epidemiology
Eating disorders and related behaviours are common in young people. Investigators of a study of a large sample of American children aged 9–14 years reported that 7·1% of boys and 13·4% of girls displayed disordered eating behaviours.35 The pivotal effect on health has led to the inclusion of eating disorders among the priority mental illnesses for children and adolescents identified by WHO.36 Eating disorders have been reported worldwide both in developed regions and emerging economies such as
Pathogenesis
A comprehensive review published in 2004 summarised the risk factors for eating disorders,39 and a position paper from the Academy of Eating Disorders outlined the evidence supporting these diseases as biologically-based forms of severe mental illnesses.40 In this section we draw attention to some present areas of emphasis.
Medical complications
Although eating disorders can begin in adulthood, the highest incidence is between 10 and 19 years of age,79 potentially disrupting optimum growth and development. Most pathophysiological complications are reversible with improved nutritional status or remittance of abnormal eating and purging behaviours. However, some physical consequences can be life-threatening, such as electrolyte imbalances (eg, hypokalaemia) due to excessive vomiting or laxative and diuretic misuse. Additionally,
Prognosis
Recovery from anorexia nervosa becomes much less likely the longer that the illness has persisted. This finding contrasts with that of bulimia nervosa, for which the chance of recovery becomes higher the longer the illness duration.147 A systematic review148 has compiled data for all outcomes for eating disorders and reported an increased mortality rate for anorexia nervosa (the reported range is wide, varying with case mix and length of follow-up) and persistent psychiatric problems in many
Conclusions
This Seminar has attempted to synthesise new developments in eating disorders that have arisen since the previous Lancet Seminar, and to integrate these developments into the knowledge that is relevant for clinicians. The diagnostic criteria for anorexia nervosa and bulimia nervosa are under consideration and could be broadened in DSM-V, reducing the size of the population in the category for eating disorders not otherwise specified. Binge eating disorders will probably be accepted as an
Search strategy and selection criteria
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