Search tips
Search criteria 


Logo of westjmedLink to Publisher's site
West J Med. 1992 December; 157(6): 658–662.
PMCID: PMC1022101

Eating disorders. A review and update.


Anorexia nervosa and bulimia nervosa are prevalent illnesses affecting between 1% and 10% of adolescent and college age women. Developmental, family dynamic, and biologic factors are all important in the cause of this disorder. Anorexia nervosa is diagnosed when a person refuses to maintain his or her body weight over a minimal normal weight for age and height, such as 15% below that expected, has an intense fear of gaining weight, has a disturbed body image, and, in women, has primary or secondary amenorrhea. A diagnosis of bulimia nervosa is made when a person has recurrent episodes of binge eating, a feeling of lack of control over behavior during binges, regular use of self-induced vomiting, laxatives, diuretics, strict dieting, or vigorous exercise to prevent weight gain, a minimum of 2 binge episodes a week for at least 3 months, and persistent overconcern with body shape and weight. Patients with eating disorders are usually secretive and often come to the attention of physicians only at the insistence of others. Practitioners also should be alert for medical complications including hypothermia, edema, hypotension, bradycardia, infertility, and osteoporosis in patients with anorexia nervosa and fluid or electrolyte imbalance, hyperamylasemia, gastritis, esophagitis, gastric dilation, edema, dental erosion, swollen parotid glands, and gingivitis in patients with bulimia nervosa. Treatment involves combining individual, behavioral, group, and family therapy with, possibly, psychopharmaceuticals. Primary care professionals are frequently the first to evaluate these patients, and their encouragement and support may help patients accept treatment. The treatment proceeds most smoothly if the primary care physician and psychiatrist work collaboratively with clear and frequent communication.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.1M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Halmi KA, Casper RC, Eckert ED, Goldberg SC, Davis JM. Unique features associated with age of onset of anorexia nervosa. Psychiatry Res. 1979 Oct;1(2):209–215. [PubMed]
  • Yager J. The treatment of eating disorders. J Clin Psychiatry. 1988 Sep;49 (Suppl):18–25. [PubMed]
  • Drewnowski A, Yee DK, Krahn DD. Bulimia in college women: incidence and recovery rates. Am J Psychiatry. 1988 Jun;145(6):753–755. [PubMed]
  • Yates A. Current perspectives on the eating disorders: I. History, psychological and biological aspects. J Am Acad Child Adolesc Psychiatry. 1989 Nov;28(6):813–828. [PubMed]
  • Andersen AE, Mickalide AD. Anorexia nervosa in the male: an underdiagnosed disorder. Psychosomatics. 1983 Dec;24(12):1066–1075. [PubMed]
  • Yager J, Kurtzman F, Landsverk J, Wiesmeier E. Behaviors and attitudes related to eating disorders in homosexual male college students. Am J Psychiatry. 1988 Apr;145(4):495–497. [PubMed]
  • Carlat DJ, Camargo CA., Jr Review of bulimia nervosa in males. Am J Psychiatry. 1991 Jul;148(7):831–843. [PubMed]
  • Bruch H. Anorexia Nervosa: therapy and theory. Am J Psychiatry. 1982 Dec;139(12):1531–1538. [PubMed]
  • Garfinkel PE, Garner DM, Rose J, Darby PL, Brandes JS, O'Hanlon J, Walsh N. A comparison of characteristics in the families of patients with anorexia nervosa and normal controls. Psychol Med. 1983 Nov;13(4):821–828. [PubMed]
  • Johnson C, Lewis C, Hagman J. The syndrome of bulimia. Review and synthesis. Psychiatr Clin North Am. 1984 Jun;7(2):247–273. [PubMed]
  • Fava M, Copeland PM, Schweiger U, Herzog DB. Neurochemical abnormalities of anorexia nervosa and bulimia nervosa. Am J Psychiatry. 1989 Aug;146(8):963–971. [PubMed]
  • Walsh BT, Katz JL, Levin J, Kream J, Fukushima DK, Weiner H, Zumoff B. The production rate of cortisol declines during recovery from anorexia nervosa. J Clin Endocrinol Metab. 1981 Jul;53(1):203–205. [PubMed]
  • Halmi KA. Anorexia nervosa and bulimia. Annu Rev Med. 1987;38:373–380. [PubMed]
  • Kaye WH, Gwirtsman HE, George DT, Ebert MH, Jimerson DC, Tomai TP, Chrousos GP, Gold PW. Elevated cerebrospinal fluid levels of immunoreactive corticotropin-releasing hormone in anorexia nervosa: relation to state of nutrition, adrenal function, and intensity of depression. J Clin Endocrinol Metab. 1987 Feb;64(2):203–208. [PubMed]
  • Halmi KA. Anorexia nervosa: demographic and clinical features in 94 cases. Psychosom Med. 1974 Jan-Feb;36(1):18–26. [PubMed]
  • Kaye WH, Ballenger JC, Lydiard RB, Stuart GW, Laraia MT, O'Neil P, Fossey MD, Stevens V, Lesser S, Hsu G. CSF monoamine levels in normal-weight bulimia: evidence for abnormal noradrenergic activity. Am J Psychiatry. 1990 Feb;147(2):225–229. [PubMed]
  • Geracioti TD, Jr, Liddle RA. Impaired cholecystokinin secretion in bulimia nervosa. N Engl J Med. 1988 Sep 15;319(11):683–688. [PubMed]
  • Schwartz DM, Thompson MG. Do anorectics get well? Current research and future needs. Am J Psychiatry. 1981 Mar;138(3):319–323. [PubMed]
  • Yates A. Current perspectives on the eating disorders: II. Treatment, outcome, and research directions. J Am Acad Child Adolesc Psychiatry. 1990 Jan;29(1):1–9. [PubMed]
  • Mitchell JE, Seim HC, Colon E, Pomeroy C. Medical complications and medical management of bulimia. Ann Intern Med. 1987 Jul;107(1):71–77. [PubMed]
  • Hsu LK. Outcome of anorexia nervosa. A review of the literature (1954 to 1978). Arch Gen Psychiatry. 1980 Sep;37(9):1041–1046. [PubMed]
  • Hsu LK. The treatment of anorexia nervosa. Am J Psychiatry. 1986 May;143(5):573–581. [PubMed]
  • Halmi KA, Goldberg SC, Casper RC, Eckert ED, Davis JM. Pretreatment predictors of outcome in anorexia nervosa. Br J Psychiatry. 1979 Jan;134:71–78. [PubMed]
  • Swift WJ, Ritholz M, Kalin NH, Kaslow N. A follow-up study of thirty hospitalized bulimics. Psychosom Med. 1987 Jan-Feb;49(1):45–55. [PubMed]
  • Fairburn CG, Kirk J, O'Connor M, Anastasiades P, Cooper PJ. Prognostic factors in bulimia nervosa. Br J Clin Psychol. 1987 Sep;26(Pt 3):223–224. [PubMed]
  • Hatsukami DK, Mitchell JE, Eckert ED. Eating disorders: a variant of mood disorders? Psychiatr Clin North Am. 1984 Jun;7(2):349–365. [PubMed]
  • Eckert ED, Mitchell JE. An overview of the treatment of anorexia nervosa. Psychiatr Med. 1989;7(4):293–315. [PubMed]
  • Brotman AW, Rigotti N, Herzog DB. Medical complications of eating disorders: outpatient evaluation and management. Compr Psychiatry. 1985 May-Jun;26(3):258–272. [PubMed]
  • Garfinkel PE, Kline SA, Stancer HC. Treatment of anorexia nervosa using operant conditioning techniques. J Nerv Ment Dis. 1973 Dec;157(6):428–433. [PubMed]
  • Halmi KA, Powers P, Cunningham S. Treatment of anorexia nervosa with behavior modification. Effectiveness of formula feeding and isolation. Arch Gen Psychiatry. 1975 Jan;32(1):93–96. [PubMed]
  • Touyz SW, Beumont PJ, Glaun D, Phillips T, Cowie I. A comparison of lenient and strict operant conditioning programmes in refeeding patients with anorexia nervosa. Br J Psychiatry. 1984 May;144:517–520. [PubMed]
  • Herzog DB. Antidepressant use in eating disorders. Psychosomatics. 1986 Nov;27(11 Suppl):17–23. [PubMed]
  • Wells LA, Logan KM. Pharmacologic treatment of eating disorders. Review of selected literature and recommendations. Psychosomatics. 1987 Sep;28(9):470–479. [PubMed]
  • Stein GS, Hartshorn S, Jones J, Steinberg D. Lithium in a case of severe anorexia nervosa. Br J Psychiatry. 1982 May;140:526–528. [PubMed]
  • Fairburn C. A cognitive behavioural approach to the treatment of bulimia. Psychol Med. 1981 Nov;11(4):707–711. [PubMed]
  • Garner DM, Olmsted MP, Polivy J, Garfinkel PE. Comparison between weight-preoccupied women and anorexia nervosa. Psychosom Med. 1984 May-Jun;46(3):255–266. [PubMed]
  • Bond WS, Crabbe S, Sanders MC. Pharmacotherapy of eating disorders: a critical review. Drug Intell Clin Pharm. 1986 Sep;20(9):659–665. [PubMed]
  • Mitchell JE, Hoberman H, Pyle RL. An overview of the treatment of bulimia nervosa. Psychiatr Med. 1989;7(4):317–332. [PubMed]
  • Mitchell JE, Groat R. A placebo-controlled, double-blind trial of amitriptyline in bulimia. J Clin Psychopharmacol. 1984 Aug;4(4):186–193. [PubMed]
  • Sabine EJ, Yonace A, Farrington AJ, Barratt KH, Wakeling A. Bulimia nervosa: a placebo controlled double-blind therapeutic trial of mianserin. Br J Clin Pharmacol. 1983;15 (Suppl 2):195S–202S. [PubMed]
  • Pope HG, Jr, Hudson JI, Jonas JM, Yurgelun-Todd D. Bulimia treated with imipramine: a placebo-controlled, double-blind study. Am J Psychiatry. 1983 May;140(5):554–558. [PubMed]
  • Hughes PL, Wells LA, Cunningham CJ, Ilstrup DM. Treating bulimia with desipramine. A double-blind, placebo-controlled study. Arch Gen Psychiatry. 1986 Feb;43(2):182–186. [PubMed]
  • Walsh BT, Gladis M, Roose SP, Stewart JW, Stetner F, Glassman AH. Phenelzine vs placebo in 50 patients with bulimia. Arch Gen Psychiatry. 1988 May;45(5):471–475. [PubMed]
  • McCann UD, Agras WS. Successful treatment of nonpurging bulimia nervosa with desipramine: a double-blind, placebo-controlled study. Am J Psychiatry. 1990 Nov;147(11):1509–1513. [PubMed]
  • Walsh BT. Fluoxetine treatment of bulimia nervosa. J Psychosom Res. 1991;35 (Suppl 1):33–40. [PubMed]
  • Edelstein CK, Yager J, Gitlin M, Landsverk J. A clinical study of anti-depressant medications in the treatment of bulimia. Psychiatr Med. 1989;7(3):111–121. [PubMed]

Articles from The Western Journal of Medicine are provided here courtesy of BMJ Publishing Group