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Rates of diagnosable anorexia nervosa (AN) and bulimia nervosa (BN) are low in youth because DSM criteria is not typically applicable to adolescents. Therefore, the majority of teens seeking treatment qualify for Eating Disorder Not Otherwise Specified. This chapter reviews the evidence basis for the treatment of eating disorders. The vast majority of studies on eating disorders pertain to adults, and there is a lack of study on AN, in general. The Maudsley Model of family therapy has received attention for adolescent AN but there is not yet convincing evidence that it is more effective than supportive therapy. Considering the adult literature, CBT, interpersonal therapy, and antidepressants may be helpful for bulimia symptoms in adolescence. More treatment outcome studies on adolescent eating disorders are needed before such manifestations develop into full-blown disorders and entrenched patterns of dysfunctional attitudes and behaviors result.

Studies indicate an ongoing “epidemic of psychopathology.” These newly popular pathologies range widely, not just in their incidence but in their presentation: social anxiety disorder, panic disorder, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder, generalized anxiety disorder, anorexia nervosa, bulimia, and attention deficit hyperactivity, to name a few. A number of new conditions have also emerged alongside these commonly accepted disorders—such as fibromyalgia, chronic fatigue syndrome, and repetitive stress injury—whose very status as mental disorders is hotly disputed. This chapter examines this recent upsurge in mental disorder. It identifies four factors at work: the ascendancy of biomedicine as the dominant way of understanding and explaining psychological distress; the success of biomedicine in treating mental illness; the growth of support and advocacy groups; and the commercial availability of medications.

Clinical neuropsychology plays a crucial role in the assessment of cognitive impairment in clinical practice and in research in psychiatry. Recent advances in knowledge have allowed for more fine-grained cognitive analysis of specific impairments. This in turn can lead to a greater understanding of the neural basis of abnormal behaviour. The development of neuropsychological measures allows for the valid and reliable assessment of treatment efficacy. This is particularly important as ‘negative features’ (including cognitive impairment) have become increasingly recognized as key targets for pharmacological treatment in psychiatry. This chapter reviews the clinical presentation and common neuropsychological features of some of the major psychiatric disorders. These include anorexia nervosa, Asperger's syndrome, autism, bulimia nervosa, Capgras syndrome, conversion disorder (hysteria), Cotard syndrome, and De Clerambault's syndrome.

This chapter uses case histories to illustrate the reality of eating disorders and provides a detailed clinical description of the condition. It explains what eating disorders are, how they manifest, whom they affect, and what somatic effects they have. It discusses distortion of body image, which is thought to affect eating disorder sufferers. Family and social issues relating to eating disorders are introduced. The effects of abnormal eating on the endocrine system, the heart, and the gastrointestinal apparatus are reported in detail and in accessible language. This chapter also introduces ethical issues surrounding care and treatment of people with eating disorders.

Eating disorders are an important concern for school social workers and mental health personnel because these disorders often begin in adolescence. A number of school-based interventions aimed at prevention are described in the literature. In addition, professionals in the schools are in a position to notice eating disorders and assist with interventions, either through providing treatment or through supporting students who are participating in treatment in another setting. This chapter discusses two types of eating disorders that are diagnosed in youth — anorexia nervosa and bulimia nervosa — and strategies of effective intervention based on the small amount of existing empirical evidence.

This chapter examines the learned nature of binge eating disorder characterized by recurrent binge eating with marked stress regarding binge eating but without the characteristic compensatory features of bulimia nervosa. It describes two models of binge eating, the cognitive model and the model of learned anticipatory responses and discusses empirical data pertaining to each of the models. It also investigates how binge eating can be treated effectively.

This chapter also reviews the evidence concerning the preabsorptive sites, adequate stimuli, and neural and endocrine or paracrine components of small intestinal satiating mechanisms. The chapter states concern with the action of small intestinal stimuli and mechanisms that provide a negative feedback control of intake within a single test meal. However, it remains to be determined whether deficiencies in the satiating effect of nutrients in the small intestine contribute to the abnormally large meal size observed in conditions of bulimia nervosa and some forms of obesity.

Eating disorders (EDs) are thought to affect primarily Caucasian adolescent and young adult females. Study of men, older adults, and individuals from diverse racial/ethnic backgrounds has been inadequate. Nationally representative studies have indicated that the female:male ED ratio is smaller than previously estimated, and there are fewer racial differences in the prevalence of EDs than previously believed. Risk factor studies have identified weight concerns, negative body image, dieting, negative affectivity, and low self-esteem as variables which increase risk for EDs. These factors may also be relevant to older populations. More research is needed on risk factors and interactions among genes and psychosocial variables across developmental periods. A life course approach to the epidemiology of EDs would allow for developmental, gender, and cultural differences in clinical presentation. Results would further our understanding of ED aetiology and could inform developmental and cultural tailoring of treatment for individuals of all ages.

This chapter discusses anxiety disorders and eating disorders, specifically bulimia nervosa. It covers the effective therapeutic approaches to anxiety disorders, while simultaneously showing these therapies are effective when used in an autonomy-supportive way. This chapter presents a handful of clinical examples that illustrate the self-determination principles and the treatments which require attention to motivational issues, clinical-technical skill, warmth, and sensitivity.

This chapter discusses eating disorders in patients suffering from significant character pathology. It covers the diagnosis and treatment of anorexia nervosa and bulimia nervosa; and dominant dynamics in patients with severe eating disorders. It also describes the case of a woman with borderline personality organization, an infantile personality with hysterical features, characterological depression, bulimia, and moderate obesity.

Antidepressant drug therapy is the cornerstone of treatment for major depression and is usually successful (Rosenbaum et al., 2005). Fifty percent of patients respond to the first antidepressant used, and 75% respond to one of the first three agents chosen if these agents represent different antidepressant classes. Insufficient dosage and duration of therapy are the most common causes of treatment failure. The required duration for a full therapeutic trial of any antidepressant is 6 to 8 weeks, but some patients require 10 to 12 weeks to achieve maximum benefit. Every patient being treated pharmacologically for depression should be educated about the course of recovery. Even if an antidepressant is ultimately successful, improvement in the first week or two may be minimal and involve primarily improved sleep or diminished anxiety. When more substantial improvements begin later, they may vary greatly on a day-to-day basis, and patients should be forewarned that the early course of recovery may be punctuated by unexpected brief dips in mood. Patients may also find that their energy, appetite, activity level, and social engagement improve before they notice a positive change in their moods. Thus, they look much improved to their friends and families before they feel better. Eventually, however, the full range of depressive symptoms resolves, and this improvement is sustained. During the course of antidepressant treatment, all patients must be asked about new or recurrent suicidal ideas, and their families should be told to report any evidence of self-harming actions or thoughts. Suicidal ideas, perhaps held in check by lack of energy to carry them out, may potentially develop into suicidal impulses or actions if a patient’s energy improves while severely depressed mood or hopelessness persist. Five classes of antidepressants will be described below: selective serotonin reuptake inhibitors (SSRIs), the serotonin norepinephrine reuptake inhibitor (SNRI) venlafaxine, the alpha2-adrenergic antagonist mirtazapine, the norepinephrinedopamine reuptake inhibitor (NDRI) bupropion, and tricyclic antidepressants (TCAs). There is little evidence that any individual antidepressant (or antidepressant class) is generally superior to another, so the sequence of drug selection is determined primarily by tolerability and safety considerations. The SSRIs are commonly used in the initial treatment of major depression.

This chapter deals specifically with food and eating in contemporary women's texts. Some of these texts celebrate the inclusiveness of eating (and of writing) while others deal with the fear of eating. This fear or disgust can be seen as a warning against what the complacent “gourmet boom” of the 1980s and 1990s concealed: the dangers of the market economy, environmental destruction, and continuing gender biases. Intertextual criticism frequently appears in these texts: just as eating can distort or destroy the body, the discourse on food in the canonical literature and media can be manipulative and unreliable. Bulimia and anorexia not only appear as the afflictions of some of the female protagonists but also symbolically indicate their craving for, or rejection of, knowledge and information as food.

Eating disorders among school-age children have become an increasingly serious mental health concern over the past decade. Children and adolescents from 5 to 18 years old are being diagnosed with eating disorders, and the latest edition of the Diagnostic and Statistical of Mental Disorders, Fifth Edition (DSM-5) has expanded the eating disorders section to allow for more precise diagnoses of these disorders. Children and adolescents with eating disorders can suffer from anxiety, depression, and other mental disorders underlying the eating disorder. Youth often hide their eating disorder from adults, making it difficult for school professionals to assist them. This chapter includes evidence-based information on the assessment and diagnosis of and interventions for school-age children with eating disorders.

Eating disorders are one of the most common problems that school social workers encounter with their students. This chapter begins with an overview of eating disorders, including definitional and descriptive information, causative factors, and student impacts. The chapter focuses on the three most common types of eating disorders, which are anorexia nervosa, bulimia nervosa, and binge eating disorder. Next, rationale for using a Solution-Focused Brief Therapy approach will be presented and a discussion for why it is a good fit for working with students who have eating disorders. Following the rationale, a case study will demonstrate the use of SFBT techniques by a school social worker in a therapy session with a student experiencing an eating disorder.

This chapter discusses anorexia nervosa, bulimia nervosa, and eating disorders, including biochemical and clinical abnormalities, complications, factors to be considered in nutritional evaluation (e.g., behavior, laboratory values, anthropometric measures, physical signs), dietary management, nutrition, hospital treatment, medications, behavior modification, and follow-up care.

The importance of interoception for adaptive and maladaptive behavior, as well as for psychopathology, has gained growing interest, and dysfunctional interoception has been recognized as representing a core impairment across psychosomatic and psychiatric disorders. Eating is intrinsically guided by interoceptive signals and is directly associated with homeostatic psychophysiological needs, well-being, and survival. This chapter provides conceptually and empirically drawn conclusions focusing on the relevance of distinguishable dimensions of interoception for shaping eating behavior and body weight, and for eating disorders. Going beyond eating behavior per se, anorexia and bulimia nervosa are conceptualized as characterized by profound impairment of the self, with dysfunctional interoception at its core. Predictive coding models are addressed to integrate conclusions and empirical findings tentatively.

The term ‘eating disorder’ describes a range of conditions characterized by abnormal eating habits and methods of weight control which lead to a significant impairment of psychological, social, and physical functioning. Eating disorders are serious, complex conditions; they are not simply a problem of eating too much or too little, or an attempt to achieve the perfect physique. Anorexia nervosa has the highest mortality of any psychiatric disorder, and it is notoriously difficult both to engage eating- disordered patients, and to treat them success­fully. There is a positive association between early diag­nosis and prognosis, so the skills to recognize an eating disorder— whether they present with psychological or physical symptoms— are essential for all clinicians. At the time of writing, the description of eating dis­orders within diagnostic classification systems has been undergoing considerable change. Under the ICD- 10 and DSM- IV classification systems, three main eating disorders were recognized (Fig. 27.1): … 1 anorexia nervosa; 2 bulimia nervosa; 3 eating disorder not otherwise specified (EDNOS). … However, this classification has been shown to have various difficulties: … ● The majority of cases were attracting an ‘EDNOS’ label, whereas it was supposed to be a residual category (Fig. 27.1). ● EDNOS contained within it the subdiagnosis ‘binge eating disorder’ (BED). Recent research has demonstrated BED accounts for approximately 10 per cent of eating disorders in clinical cohorts. ● The categorical nature of the system does not allow for the fact that most eating disorders change over time, and frequently move back and forth along the spectrum of presentations. ● The DSM- 5 classification system (see ‘Further reading’) has tried to tackle the first two of these difficulties, and the upcoming ICD- 11 will echo these changes (Table 27.1) There is now a separate category for BED, and three other defined conditions. This is a positive change, but has only reduced the ‘NOS/ unspecified’ percentage to some extent, and has not considered the changeable nature of eating disorder symptomatology. Hopefully in the future a solution to the difficulty of turning a spectrum of pathology into a categorical system will emerge.

Listening for narratives of strength and meaning that have not yet been told but are implicit in the patient’s experience is key to the art of narrative psychiatry. In any conversation, there are many openings for finding exceptions to the activities and effects of problems. Each exception to the problem is a seed that can be cultivated into a narrative by fleshing it out with detail, linking it to other exceptions over time, and articulating the meanings that these exceptions have for the person. This new narrative offers fertile ground for freshly imagining what might be possible in the future. It sustains valued aspects of identity and points the way toward freedom from the problem. At the same time that we are nurturing nascent stories of skill and resilience, we are also listening for narratives that fuel problems, so that they may be examined, dismantled, and replaced with narratives that support well-being. Stories that fuel problems come from many sources. For example, someone who is dealing with depression may be influenced by a family story of being the “problem child,” a local story that derides those who seek mental health treatment, and a wider cultural story that narrowly defines a successful life in terms of money. These narratives can be named and closely examined in light of the patient’s own values, allowing the patient more choice over which narratives are taken up and which are set aside. Narrative psychiatry continuously attends to the patient’s social context. Often, the people who consult with us are living under the influence of cultural discourses that make negative claims about their worthiness, seek to limit their prospects, and engage them in processes of self-scrutiny that lead to anxiety or despair. By discourses I mean narratives and practices that share a common value. These discourses include those that privilege or denigrate people on the basis of their race, gender, gender preference, sexual preference, body type, financial status, education, health, or ability. Narrative psychiatry attends to issues of power—of privilege and oppression—and deconstructs the operations of power as they influence someone’s life.