Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (EDNOS)

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Nutrition Intervention in the Treatment of Anorexia Nervosa, Bulimia Nervosa, and Eating Disorder Not Otherwise Specified (EDNOS)
Dec 03, 2008
Last Updated ( Mar 11, 2009 )
reviewed by: Harry Croft, MD
HealthyPlace.com

Abstract
More than 5 million Americans suffer from eating disorders. Five percent of females and 1% of males have anorexia nervosa, bulimia nervosa, or binge eating disorder. It is estimated that 85% of eating disorders have their onset during the adolescent age period. Although Eating Disorders fall under the category of psychiatric diagnoses, there are a number of nutritional and medical problems and issues that require the expertise of a registered dietitian. Because of the complex biopsychosocial aspects of eating disorders, the optimal assessment and ongoing management of these conditions appears to be with an interdisciplinary team consisting of professionals from medical, nursing, nutritional, and mental health disciplines (1). Medical Nutrition Therapy provided by a registered dietitian trained in the area of eating disorders plays a significant role in the treatment and management of eating disorders. The registered dietitian, however, must understand the complexities of eating disorders such as comorbid illness, medical and psychological complications, and boundary issues. The registered dietitian needs to be aware of the specific populations at risk for eating disorders and the special considerations when dealing with these individuals.

POSITION STATEMENT

It is the position of the American Dietetic Association (ADA) that nutrition education and nutrition intervention, by a registered dietitian, is an essential component of the team treatment of patients with anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS) during assessment and treatment across the continuum of care.

INTRODUCTION

Eating Disorders are considered to be psychiatric disorders, but unfortunately they are remarkable for their nutrition and medical-related problems, some of which can be life- threatening. As a general rule, eating disorders are characterized by abnormal eating patterns and cognitive distortions related to food and weight, which in turn result in adverse effects on nutrition status, medical complications, and impaired health status and function (2,3,4,5,6).

Many authors (7,8,9) have noted that anorexia nervosa is detectable in all social classes, suggesting that higher socioeconomic status is not a major factor in the prevalence of anorexia and bulimia nervosa. A wide range of demographics is seen in eating disorder patients. The major characteristic of eating disorders are the disturbed body image in which one's body is perceived as being fat (even at normal or low weight), an intense fear of weight gain and becoming fat, and a relentless obsession to become thinner (8).

Diagnostic criteria for anorexia nervosa, bulimia nervosa, and eating disorders not otherwise specified (EDNOS) are identified in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (10) (See the Figure). These clinical diagnoses are based on psychological, behavioral, and physiological characteristics.

It is important to note that patients cannot be diagnosed with both anorexia nervosa (AN) and bulimia nervosa (BN) at the same time. Patients with EDNOS do not fall into the diagnostic criterion for either AN or BN, but account for about 50% of the population with eating disorders. If left untreated and behaviors continue, the diagnosis may change to BN or AN. Binge eating disorder is currently classified within the EDNOS grouping.

Over a lifetime, an individual may meet diagnostic criteria for more than one of these conditions, suggesting a continuum of disordered eating. Attitudes and behaviors relating to food and weight overlap substantially. Nevertheless, despite attitudinal and behavioral similarities, distinctive patterns of comorbidity and risk factors have been identified for each of these disorders. Therefore, the nutritional and medical complications and therapy can differ significantly (2,3,11).

Because of the complex biopsychosocial aspects of eating disorders, the optimal assessment and ongoing management of these conditions appear to be under the direction of an interdisciplinary team consisting of professionals from medical, nursing, nutritional and mental health disciplines (1). Medical Nutrition Therapy (MNT) provided by a registered dietitian trained in the area of eating disorders is an integral component of treatment and management of eating disorders.

COMORBID ILLNESS AND EATING DISORDERS#

Patients with eating disorders may suffer from other psychiatric disorders as well as their eating disorder, which increases the complexity of treatment. Registered dietitians must understand the characteristics of these psychiatric disorders and the impact of these disorders on the course of treatment. The experienced dietitian knows to be in frequent contact with the mental health team member in order to have an adequate understanding of the patient's current status. Psychiatric disorders that are frequently seen in the eating disorder population include mood and anxiety disorders (eg, depression, obsessive compulsive disorder), personality disorders, and substance abuse disorders (12).

Abuse and trauma may precede the eating disorder in some patients (13). The registered dietitian must consult with the primary therapist on how to best handle the patient's recall of abuse or dissociative episodes that may occur during nutrition counseling sessions.


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