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Concern Over Misclassification And Inappropriate Treatment Of People With Eating Disorders (p 407)

January 29, 2003

Authors of a seminar in this week's issue of THE LANCET provide an insight into our knowledge and treatment of eating disorders. They note how the current way of classifying eating disorders neglects the majority of people with eating disorders with the result that these cases have barely been studied and almost nothing is known about their treatment.

Eating disorders are an important cause of physical and psychosocial illness in adolescent girls and young adult women and are much less frequent in men.They are divided into three diagnostic categories: anorexia nervosa (characterised by severe self-induced weight loss), bulimia nervosa (characterised by alternating dieting and binge eating), and the atypical eating disorders (the neglected group of patients).

The authors, Christopher G Fairburn and Paul J Harrison from the University of Oxford, UK, discuss how the cause of eating disorders is complex and badly understood. There is evidence that genetic factors predispose some people to higher risk; as do environmental factors such as childhood adversity and childhood/parental obesity and the presence of the personality traits of low self-esteem and perfectionism.

Also discussed is research into treatment which has focused mainly on bulimia nervosa-treatment with a specific form of cognitive behaviour therapy is often effective, yet few patients receive it. The authors comment how treatment of anorexia nervosa and atypical eating disorders has received remarkably little research attention.

The authors conclude: "Several research themes and priorities emerge: first, the existing scheme for classifying eating disorders is unsatisfactory and anomalous, in that about half the cases seen in clinical practice are relegated to an atypical or not otherwise specified group. This system is a historical accident that needs to be rectified, since far more unites the three categories of eating disorder than separates them. Second, to clarify the pathogenesis of eating disorders requires larger and more sophisticated twin studies than those used to date, as well as continuing genome-wide linkage and association studiesMost importantly, the research must be targeted on the interaction of genetic and environmental processes. Third, there is a pressing need for more treatment research, both in terms of developing more effective treatments and focusing on the full range of eating disorders. Finally, the gulf between research evidence and service provision needs to be investigated and bridged; too few patients receive evidence-based treatment and too many receive suboptimal or inappropriate therapy."

Lancet