Skip to main content

Advertisement

Log in

Anorexia Nervosa and Bulimia Nervosa: Brains, Bones and Breeding

  • Child and Adolescent Disorders (T Benton, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gull WW. Anorexia Nervosa (Apepsia Hysterica, Anorexia Hysterica). R Clin Soc Lond Trans. 1873;vii:22.

    Google Scholar 

  2. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5: DSM-5th ed. Arlington: American Psychiatric Publishing; 2013. Less restrictive criteria, supported by clinical evidence, should facilitate earlier recognition.

    Google Scholar 

  3. Ornstein RM, Rosen DS, Mammel KA, et al. Distribution of eating disorders in children and adolescents using the proposed DSM-5 criteria for feeding and eating disorders. J Adolesc Health. 2013;53:303–5.

    Article  PubMed  Google Scholar 

  4. Rosen DS, American Academy of Pediatrics Committee on Adolescence. Identification and management of eating disorders in children and adolescents. Pediatrics. 2010;126:1240–53.

    Article  PubMed  Google Scholar 

  5. Wooldridge T, Lytle P. An overview of anorexia nervosa in males. Eat Disord J Treat Prev. 2012;20:68–78. Males are increasingly identified as underdiagnosed.

    Article  Google Scholar 

  6. Xanthopoulos MS, Borradaile KE, Hayes S, et al. The impact of weight, sex, and race/ethnicity on body dissatisfaction among urban children. Body Image. 2011;8:385–9.

    Article  PubMed  Google Scholar 

  7. Gordon KH, Sitnikov L, Castro Y, et al. Cultural body shape ideals and eating disorder symptoms among White, Latina, and Black college women. Cult Divers Ethn Minor Psychol. 2010;16:135–43. Cultural and ethnic norms affect eating disorders.

    Article  Google Scholar 

  8. Marques L, Alegria M, Becker AE, et al. Comparative prevalence, correlates of impairment, and service utilization for eating disorders across US ethnic groups: implications for reducing ethnic disparities in health care access for eating disorders. Int J Eat Disord. 2011;44:412–20.

    Article  PubMed Central  PubMed  Google Scholar 

  9. Rogers-Wood NA, Petrie TA. Body dissatisfaction, ethnic identity, and disordered eating among African American women. J Couns Psychol. 2010;57:141–53.

    Article  PubMed  Google Scholar 

  10. Becker AE, Arrindell AH, Perloe A, et al. A qualitative study of perceived social barriers to care for eating disorders: perspectives from ethnically diverse health care consumers. Int J Eat Disord. 2010;43:633–47.

    Article  PubMed Central  PubMed  Google Scholar 

  11. Becker AE, Fay K, Agnew-Blais J, et al. Social network media exposure and adolescent eating pathology in Fiji. Br J Psychiatr. 2011;198:43–50. Landmark anthropological study of eating disorders developing in remote Pacific islands.

    Article  Google Scholar 

  12. Peebles R, Wilson JL, Litt IF, et al. Disordered eating in a digital age: eating behaviors, health, and quality of life in users of websites with pro-eating disorder content. J Med Internet Res. 2012;14(5):e148.

    Article  PubMed Central  PubMed  Google Scholar 

  13. Datlof S, Coleman W, Forbes GB, et al. Ventricular dilation on CAT scans of patients with anorexia nervosa. Am J Psychiatr. 1986;143:96–8.

    PubMed  CAS  Google Scholar 

  14. Lask B, Frampton I, editors. Eating disorders and the brain. Oxford: Wiley-Blackwell; 2011. Comprehensive, integrated book defining eating disorders as brain disorders.

  15. Frank GKW, Kaye WH. Current status of functional imaging in eating disorders. Int J Eat Disord. 2012;45:723–36. Leading neuroscientists review brain-imaging studies.

    Article  PubMed  Google Scholar 

  16. Miller KM, Lee EE, Lawson EA, et al. Determinants of skeletal loss and recovery in A.N. J Clin Endocrinol Metab. 2006;91(8):2931–7.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  17. Misra M, Klibanski A. Bone health in anorexia nervosa. Curr Opin Endocrinol Diabetes Obes. 2011;18(6):376–82. Review by leading researchers studying bone health.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  18. Grinspoon S, Thomas L, Miller K, et al. Effects of recombinant human IGF-I and oral contraceptive administration on bone density in anorexia nervosa. J Clin Endocrinol Metab. 2002;87(6):2883–91.

    Article  PubMed  CAS  Google Scholar 

  19. Misra M, Katzman D, Miller KK, et al. Physiologic estrogen replacement increases bone density in adolescent girls with anorexia nervosa. J Bone Miner Res. 2011;26(10):2430–8. Multicenter controlled clinical trial to increase BMD with treatment mirroring puberty.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  20. Javed A, Tebben PJ, Fischer PR, Lteif AN. Female athlete triad and its components: toward improved screening and management. Mayo Clin Proc. 2013;88(9):996–1009.

    Article  PubMed  Google Scholar 

  21. Klump KL, Miller KB, Keel PK, et al. Genetic and environmental influences on anorexia nervosa syndromes in a population-based twin sample. Psychol Med. 2001;31:737–40.

    Article  PubMed  CAS  Google Scholar 

  22. Bulik CM, Sullivan PF, Wade TD, et al. Twin studies of eating disorders: a review. Int J Eat Disord. 2000;27:1–20.

    Article  PubMed  CAS  Google Scholar 

  23. Slane JD, Burt SA, Klump KL. Genetic and environmental influences on disordered eating and depressive symptoms. Int J Eat Disord. 2011;44(7):605–11.

    Article  PubMed  Google Scholar 

  24. Favro A. Brain development and neurocircuit modeling are the interface between genetic/environmental risk factors and eating disorders. Int J Eat Disord. 2013;46:443–6.

    Article  Google Scholar 

  25. Klump KL, Culbert KM, Slane JD, et al. The effects of puberty on genetic risk for disordered eating: evidence for a sex difference. Psychol Med. 2012;42(3):627–37. Leading researchers in twin studies continue elegant work in gene x environment and epigenetic effects.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  26. Klump KL, Keel PK, Sisk C, et al. Preliminary evidence that estradiol moderates genetic influences on disordered eating attitudes and behaviors during puberty. Psychol Med. 2010;40(10):1745–53.

    Article  PubMed Central  PubMed  CAS  Google Scholar 

  27. Klump KL, Burt AS, Spanos A, et al. Age differences in genetic and environmental influences on weight and shape concerns. Int J Eat Disord. 2010;43:679–88.

    Google Scholar 

  28. Trace SE, Baker JH, Pefias-Lledó E, et al. The genetics of eating disorders. Ann Rev Clin Psychol. 2013;9:589–620. Comprehensive review of genetics in eating disorders.

    Article  Google Scholar 

  29. Katzman DK, Peebles R, Sawyer SM, et al. The role of the pediatrician in family-based treatment for adolescent eating disorders: Opportunities and challenges. J Adolesc Health. 2013;53:433–40.

    Article  PubMed  Google Scholar 

  30. Lock J, leGrange D. Help your teenager beat an eating disorder. New York: Guilford Press; 2005.

    Google Scholar 

  31. leGrange D, Lock J. Eating disorders in children and adolescents: a clinical handbook. New York: Guilford Press; 2011. Comprehensive evidence-based clinical guide edited by leading researchers in family-based treatment.

    Google Scholar 

  32. Couturier J, Kimber M, Szatmari P. Efficacy of family-based treatment for adolescents with eating disorders: a systematic review and meta-analysis. Int J Eat Disord. 2013;46:3–11.

    Article  PubMed  Google Scholar 

  33. Tantillo MD, Kreipe RE. Improving connections for adolescents across high-intensity settings for the treatment of eating disorders, Chapter in, eating disorders in children and adolescents: a clinical handbook. New York: Guilford Press; 2011. p. 199–222.

    Google Scholar 

  34. Milano W, De Rosa M, Milano L, et al. The pharmacological options in the treatment of eating disorders. ISRN Pharmacol. 2013;Jul 15: 352865. eCollection. Comprehensive review of all medications with potential therapeutic effects in eating disorders.

  35. Hay PJ, Claudino AM. Clinical psychopharmacology of eating disorder: a research update. Int J Neuropsychopharmacol. 2011;6:1–14.

    Google Scholar 

  36. Lebow J, Sim LA, Erwin PJ, Murad MH. The effect of atypical antipsychotic medications in individuals with anorexia nervosa: A systematic review and meta-analysis. Internat J Eat Disord 2013;46:332-39.

    Google Scholar 

  37. Powers PS, Santana C. Available pharmacological treatments for anorexia nervosa. Expert Opin Pharmacother. 2004;5:2287–92.

    Article  PubMed  CAS  Google Scholar 

  38. Hedges DW, Reimherr FW, Hoopes SP, et al. Treatment of bulimia nervosa with topiramate in a randomized, double-blind, placebo-controlled trial—part 2: improvement in psychiatric measures. J Clin Psychiatry. 2003;64:1449–54.

    Article  PubMed  CAS  Google Scholar 

  39. Hoopes SP, Reimherr FW, Hedges DW, et al. Treatment of bulimia nervosa with topriamate in a randomized, double-blind, placebo controlled trial—part 1: improvement in psychiatric measures. J Clin Psychiatry. 2003;64:1335–41.

    Article  PubMed  CAS  Google Scholar 

  40. Ricca V, Castellini G, LoSauro C, et al. Zonisamide combined with cognitive behavioral therapy in binge eating disorder: a one-year follow-up study. Psychiatry. 2009;6:23–8.

    PubMed Central  PubMed  Google Scholar 

  41. Halmi KA, Eckert E, LaDu TJ, et al. Anorexia nervosa: treatment efficacy of cyproheptadine and Amitriptyline. Arch Gen Psychiatry. 1986;43:177–81.

    Article  PubMed  CAS  Google Scholar 

  42. Hotta M, Ohwada R, Akamizu T, et al. Therapeutic potential of ghrelin in restricting-type anorexia nervosa. Methods Enzymol. 2012;514:381–98.

    Google Scholar 

Download references

Compliance with Ethics Guidelines

Conflict of Interest

Taylor B. Starr and Richard E. Kreipe declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Taylor B. Starr.

Additional information

This article is part of the Topical Collection on Child and Adolescent Disorders

Rights and permissions

Reprints and permissions

About this article

Cite this article

Starr, T.B., Kreipe, R.E. Anorexia Nervosa and Bulimia Nervosa: Brains, Bones and Breeding. Curr Psychiatry Rep 16, 441 (2014). https://doi.org/10.1007/s11920-014-0441-4

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-014-0441-4

Keywords

Navigation