Update on Eating Disorders: Anorexia, Bulimia, and Binge Eating

 

“Increasing data links impulsivity, [attention deficit/hyperactivity disorder], and binge eating in both bulimia and binge eating disorder. Some open label and small RCTs [randomized controlled trials] suggest that stimulants may be helpful, but there is no definitive support for these agents yet,” Guarda notes. “Importantly, stimulant abuse in the service of weight loss can be a concern. Naltrexone may have some efficacy based on a few small open label and RCT studies, however the data is limited.”

Anorexia is the most challenging eating disorder to treat. Inpatient therapy is usually needed to treat eating behavior as well as weight loss, and this treatment can be lifesaving. “Family therapy is often effective in adolescent patients with a short duration of illness,” says Guarda. “Outpatient psychotherapeutic interventions for adult or chronic anorexia have less support, and no one outpatient therapy has consistently been found effective.”

As of now, no medications have been found to be useful. “Some open label and a couple of smaller RCTs have suggested that olanzapine may improve weight gain and obsessional symptoms. A current NIH-funded, multicenter trial is under way exploring this possibility,”  Guarda says.

Bottom Line for Clinicians

A 2014 study published in The Lancet found that outpatient psychotherapy might be effective for patients with mild anorexia. The study, done in Germany, followed 242 adult women during 10 months of therapy and another 12 months after therapy. Various types of psychotherapy were used, and patients gained weight with each type, but one year after therapy, 25% of the patients had the full syndrome of anorexia.⁷

Because anorexia is a devastating disease with few well-supported treatments, new treatment modalities are being studied. Repetitive transcranial magnetic stimulation (TMS), a type of deep brain stimulation, is one possible treatment.⁸ “Some very preliminary evidence suggests that …TMS may be helpful. However, it is still far too early to say if any of these will prove fruitful avenues for development,” says Guarda.

“It is important for providers to screen for eating disorders and to refer for ongoing care to clinicians or behavioral specialty programs competent in the treatment of eating disorders,” she adds.

“Behavioral eating disorders program often employ group therapy as a primary psychotherapeutic modality. This can be an especially effective intervention in providing peer support and encouraging behavior change critical for recovery.”

Chris Iliades, MD, is a full-time freelance writer based in Cape Cod, Massachusetts.

This article was medically reviewed by Pat F. Bass III, MD, MS, MPH.

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