Child and Adolescent Disorders (T Benton, Section Editor)

Current Psychiatry Reports

, 16:441

Anorexia Nervosa and Bulimia Nervosa: Brains, Bones and Breeding

  • Taylor B. StarrAffiliated withDepartment of Pediatrics, Division of Adolescent Medicine, Western New York Comprehensive Care Center for Eating Disorders, University of Rochester, Golisano Children’s Hospital Email author 
  • , Richard E. KreipeAffiliated withDepartment of Pediatrics, Division of Adolescent Medicine, Western New York Comprehensive Care Center for Eating Disorders, University of Rochester, Golisano Children’s Hospital

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Abstract

Recent research has modified both the conceptualization and treatment of eating disorders. New diagnostic criteria reducing the “not otherwise specified” category should facilitate the early recognition and treatment of anorexia nervosa (AN) and bulimia nervosa (BN). Technology-based studies identify AN and BN as “brain circuit” disorders; epidemiologic studies reveal that the narrow racial, ethnic and income profile of individuals no longer holds true for AN. The major organs affected long term—the brain and skeletal system—both respond to improved nutrition, with maintenance of body weight the best predictor of recovery. Twin studies have revealed gene x environment interactions, including both the external (social) and internal (pubertal) environments of boys and of girls. Family-based treatment has the best evidence base for effectiveness for younger patients. Medication plays a limited role in AN, but a major role in BN. Across diagnoses, the most important medicine is food.

Keywords

Anorexia nervosa Bulimia nervosa Eating disorders Brain circuitry Limbic system Cingulate gyrus fMRI Bone mineral density Osteopenia Osteoporosis Genetics Gene-environment interaction Epigenetics Family-based treatment Cognitive behavioral therapy SSRIs Atypical antipsychotics Mood stabilizers