Eating disorders: A clinical psychiatric approach
VARSOU E.

Eating Disorders (E.D.) are behavioural syndromes with important physical and psychosocial morbidity and unfortunately significant mortality, affecting primarily adolescent girls and young adult women, while they are very uncommon in males. During last few decades Eating Disorders have attracted great interest from both the scientific community and the general public, the later being influenced by mass-media as they give great coverage in fatal cases or celebrities affected. Another reason for growing interest on Eating Disorders, lies in the fact that they seem to become more frequent under some demographic conditions, especially in westernized societies, where the ideal of thinness has become prevailing, forcing females to practice dieting.

The classification of Eating Disorders and the criteria for diagnosis have being subject to considerable revisions. There are still present discrepancies among different classificatory systems and discussions between groups of clinicians and researchers.

Currently, Eating Disorders are classified into three main diagnostic categories: Anorexia Nervosa (AN), Bulimia Nervosa (BN), Atypical Eating Disorders or Eating Disorders Not Otherwise Classified. Within this last broad category -according the American system DSM-IV- it is proposed to separate Binge Eating Disorder (BED) as a distinct syndrome, setting diagnostic criteria for further research.

Anorexia Nervosa and Bulimia Nervosa are characterized by a common psychopathological feature. Patients overevaluate their body-shape and weight, considering them as the main measures to judge self-worth and therefore the need to control them becomes of paramount importance. In Anorexia Nervosa this leads to sustained and determined pursuit of weight loss by food selection and restriction resulting to self-starvation, frequently accompanied by over-exercising or other extreme weight-control behaviour. These patients tend to view their low weight as an accomplishment and consequently they have little or not at all motivation to change and they deny treatment. Many other features of the disorder's clinical presentation seem secondary to self-starvation. In Bulimia Nervosa the attempts to control shape and weight by food restriction are undermined by frequent and recurrent episodes of uncontrolled overeating, followed by self-induced purging or other extreme weight-control behaviour (misuse of diuretics, laxatives and other drugs, or extreme over-exercising). Patients with Bulimia Nervosa are very distressed by the loss of control over eating and ashamed, therefore they are easier to engage in treatment.

The prevalence of Eating Disorders seems to become growing over recent decades: for Anorexia Nervosa has been calculated to reach 0,5% of teenage girls and for Bulimia Nervosa 1-2% of females 16-35 year old.

The etiology of Eating Disorders is complex, not well understood, and is considered multifactorial. There is undoubtedly a genetic predisposition and a range of environmental risk factors, including familial, developmental and sociocultural, have been implicated in the pathogenesis.

Key words: Eating disorders, anorexia nervosa, bulimia nervosa.