A practice guideline for treatment of eating disorders in children and adolescents

The integrated treatment of eating disorders, posttraumatic stress disorder, and psychiatric comorbidity: a commentary on the evolution of principles and guidelines

Psychiatric comorbidity is the norm in the assessment and treatment of eating disorders (EDs), and traumatic events and lifetime PTSD are often major drivers of these challenging complexities. Given that trauma, PTSD, and psychiatric comorbidity significantly influence ED outcomes, it is imperative that these problems be appropriately addressed in ED practice guidelines. The presence of associated psychiatric comorbidity is noted in some but not all sets of existing guidelines, but they mostly do little to address the problem other than referring to independent guidelines for other disorders. This disconnect perpetuates a "silo effect," in which each set of guidelines do not address the complexity of the other comorbidities. Although there are several published practice guidelines for the treatment of EDs, and likewise, there are several published practice guidelines for the treatment of PTSD, none of them specifically address ED + PTSD. The result is a lack of integration between ED and PTSD treatment providers, which often leads to fragmented, incomplete, uncoordinated and ineffective care of severely ill patients with ED + PTSD. This situation can inadvertently promote chronicity and multimorbidity and may be particularly relevant for patients treated in higher levels of care, where prevalence rates of concurrent PTSD reach as high as 50% with many more having subthreshold PTSD. Although there has been some progress in the recognition and treatment of ED + PTSD, recommendations for treating this common comorbidity remain undeveloped, particularly when there are other co-occurring psychiatric disorders, such as mood, anxiety, dissociative, substance use, impulse control, obsessive-compulsive, attention-deficit hyperactivity, and personality disorders, all of which may also be trauma-related. In this commentary, guidelines for assessing and treating patients with ED + PTSD and related comorbidity are critically reviewed. An integrated set of principles used in treatment planning of PTSD and trauma-related disorders is recommended in the context of intensive ED therapy. These principles and strategies are borrowed from several relevant evidence-based approaches. Evidence suggests that continuing with traditional single-disorder focused, sequential treatment models that do not prioritize integrated, trauma-focused treatment approaches are short-sighted and often inadvertently perpetuate this dangerous multimorbidity. Future ED practice guidelines would do well to address concurrent illness in more depth.

Implementation of Standardized Care for the Medical Stabilization of Patients With Anorexia Nervosa

Approaches to refeeding patients with anorexia nervosa for medical stabilization vary across institutions, and there is no established standard of care. This study assessed the impact of a refeeding pathway on hospital length of stay and transfer to the psychiatry unit.

Advantages and Disadvantages of Internet Use: The Perspective of Women with Eating Disorders Experience

Even though the internet is a common source of information and treatment for people with eating disorder (ED) experience, the motives for illness-related searches have rarely been investigated beyond the perceived negatives. This study explores how women with ED experience reflect upon the advantages and disadvantages of their ED-related internet use. We expand the framework of the Uses and Gratifications Theory (U&G) into the context of users with ED experience through 30 semi-structured interviews with women with ED experience, aged 16 to 28, who live in the Czech Republic. Thematic analysis revealed four themes related to the pros and cons of their internet usage: ED-related Information Content; Internet Features Important to Users; Body Image; and Social Interaction. The results challenge the binary view of ED-related internet use and question some presumptions of U&G Theory within the specific context of users with ED experience.

Mortality and risk assessment for anorexia nervosa in acute-care hospitals: a nationwide administrative database analysis

BACKGROUND

Anorexia nervosa (AN) is a common eating disorder with the highest mortality rate of all psychiatric diseases. However, few studies have examined inpatient characteristics and treatment for AN. This study aimed to characterise the association between mortality and risk factors in patients with AN in acute-care hospitals.

METHODS

We conducted a nationwide, retrospective analysis of the Japanese Diagnosis and Procedure Combination inpatient database. Data extraction occurred from April 2010 to March 2016. We estimated in-hospital mortality and identified independent risk factors, using multivariate logistic regression analysis to examine patient characteristics and physical and psychological comorbidities.

RESULTS

We identified 6937 patients with AN aged ≥12 years in 885 acute-care hospitals. Of these, 361 (5.2%) were male. Male and female participants' median ages at first admission were 34 (17-65) and 28 (17-41) years, respectively. In total, 195 in-hospital patient deaths, including 22 (6.1%) men and 173 (2.6%) women, it was observed that the unadjusted odds ratio of mortality for male patients was more than twice that for female patients (OR: 2.40, 95% CI: 1.45-3.81). Multivariate logistic regression analysis demonstrated an adjusted odds ratio of 2.19 (95% CI: 1.29-3.73). Age at first hospital admission, percentage of ideal body weight, comorbidities, and hypotension were significantly associated with increased mortality risk, but the frequency of hospitalization, bradycardia, and other psychiatric disorders were not. Treatment in a university hospital was associated with lower mortality risk (odds ratio: 0.45, 95% CI: 0.30-0.67).

CONCLUSION

The results highlighted sex differences in mortality rates. Potential risk factors could contribute to improved treatment and outcomes. These retrospective findings indicate a need for further longitudinal examination of these patients.

Comparison between enteral nutrition and intravenous hyperalimentation in patients with eating disorders: results from the Japanese diagnosis procedure combination database

OBJECTIVE

Eating disorders (EDs) are some of the most common chronic disorders in adolescent girls, and have some of the worst prognoses among psychiatric diseases. However, reported data on mortality and morbidity of ED patients are scarce, and no previous studies have compared the short-term outcomes of enteral nutrition (EN) and intravenous hyperalimentation (IVH) in patients with EDs.

METHOD

Using the Diagnostic Procedure Combination database, a national inpatient database in Japan, we searched for ED patients who received EN or IVH. We investigated the backgrounds, complications, and in-hospital mortality for all ED patients. We compared the length of stay between the EN and IVH groups using the Cox regression model. In-hospital mortality was compared between the groups using propensity score matching and inverse probability weighting.

RESULTS

We identified 3,611 patients with EDs from 540 hospitals. The mean body mass index was 13.1 ± 1.9 kg/m(2); 41 (1.1 %) patients died. The mean length of stay was 61.7 days. Compared with the EN-alone group (n = 634), the IVH-alone group (n = 278) showed significantly higher proportions of sepsis (0.5 vs. 5.8 %; p < 0.001) and disseminated intravascular coagulation (0.5 vs. 2.9 %; p = 0.005). The Cox regression showed no significant difference in hospital discharge between the two groups. Propensity-matched analysis evidenced lower in-hospital mortality in the EN group than the IVH group (0.4 vs. 3.0 %; p = 0.019).

DISCUSSION

ED patients treated with IVH were significantly more likely to have higher in-hospital mortality and morbidity than those receiving EN.

Nutrition therapy during initiation of refeeding in underweight children and adolescent inpatients with anorexia nervosa: a systematic review of the evidence

Restoration of weight and nutritional rehabilitation are recognized as fundamental steps in the therapeutic treatment of children and adolescent inpatients with anorexia nervosa (AN). However, current recommendations on initial energy requirements for this population are inconsistent, with a clear lack of empirical evidence. Thus, the aim of our study was to systematically review, assess, and summarize the available evidence on the effect of differing nutrition therapies prescribed during refeeding on weight restoration in hospitalized children and adolescents (aged 19 years and younger) with diagnosed AN. Searches were conducted in Scopus, Web of Science, Global Health (CABI), PubMed, and the Cochrane database for articles published in English up to May 2012, and complemented by a search of the reference lists of key publications. Seven observational studies investigating a total of 403 inpatients satisfied the inclusion criteria. The range of prescribed energy intakes varied from 1,000 kcal to >1,900 kcal/day with a progressive increase during the course of hospitalization. It appeared that additional tube feeding increased the maximum energy intake and led to greater interim or discharge weight; however, this was also associated with a higher incidence of adverse effects. Overall, the level of available evidence was poor, and therefore consensus on the most effective and safe treatment for weight restoration in inpatient children and adolescents with AN is not currently feasible. Further research on refeeding methods is crucial to establish the best practice approach to treatment of this population.

Introduction of DRG-based reimbursement in inpatient psychosomatics--an examination of cost homogeneity and cost predictors in the treatment of patients with eating disorders

OBJECTIVE

Various western countries are focusing on the introduction of reimbursement based on diagnosis-related groups (DRG) in inpatient mental health. The aim of this study was to analyze if psychosomatic inpatients treated for eating disorders could be reimbursed by a common per diem rate.

METHODS

Inclusion criteria for patient selection (n=256) were (1) a main diagnosis of anorexia nervosa (AN), bulimia nervosa (BN) or eating disorder-related obesity (OB), (2) minimum length of hospital stay of 2 days, (3) and treatment at Charité Universitaetsmedizin Berlin, Germany during the years 2006-2009. Cost calculation was executed from the hospital's perspective, mainly using micro-costing. Generalized linear models with Gamma error distribution and log link function were estimated with per diem costs as dependent variable, clinical and patient variables as well as treatment year as independent variables.

RESULTS

Mean costs/case for AN amounted to 5,251€, 95% CI [4407-6095], for BN to 3,265€, 95% CI [2921-3610] and for OB to 3,722€, 95% CI [4407-6095]. Mean costs/day over all patients amounted to 208€, 95% CI [198-218]. The diagnosis AN predicted higher costs in comparison to OB (p=.0009). A co-morbid personality disorder (p=.0442), every one-unit increase in BMI in OB patients (p=.0256), every one-unit decrease in BMI in AN patients (p=.0002) and every additional life year in BN patients (p=.0455) predicted increased costs.

CONCLUSION

We see a need for refinements to take into account considerable variations in treatment costs between patients with eating disorders due to diagnosis, BMI, co-morbid personality disorder and age.

Hormonal profile heterogeneity and short-term physical risk in restrictive anorexia nervosa

CONTEXT

The relevance of hormonal assessment in anorexia nervosa (AN) management is still unclear. The short-term physical risk during undernutrition period of the disease is partially predicted by anthropometric and electrolytic parameters.

OBJECTIVE

The objective of the study was to evaluate hormonal profiles in a large cohort of AN and their relationship with critical states.

DESIGN AND SETTING

This was an observational monocentric cross-sectional study performed in the endocrinological unit.

PATIENTS AND OTHER PARTICIPANTS

Participants included 210 young female subjects with restrictive-type AN and 42 female controls of comparable age.

MAIN OUTCOME MEASURES

The following hormonal parameters were measured: thyroid hormones, GH, IGF-I, cortisol, oestradiol, FSH, LH, SHBG, dehydroepiandrosterone sulfate, plasma metanephrines, and bone markers. Their relation with registered short-term evolution of AN subjects after hormonal assessment was evaluated.

RESULTS

Except for metanephrines and dehydroepiandrosterone sulfate, most of the hormonal abnormalities previously reported in AN were confirmed. The manifestation of these hormonal abnormalities started below different body mass index (BMI) levels, ranging between 17 and 15 kg/m(2), even though an important percentage of normal values for every parameter was still noticed for very low BMIs. All patients who developed critical states during the 3 months after the hormonal assessment presented with BMI less than 15 kg/m(2) and a very increased level of cortisol, GH, and increased values of metanephrines.

CONCLUSIONS

The hormonal response to undernutrition is heterogeneous in a large population with restrictive AN. In clinical practice, metanephrines, GH, and/or cortisol data could be used as important predictors for severe short-term outcome.

Influence of the digestive enzymes trypsin and pepsin in vitro on the progression of erosion in dentine

OBJECTIVES

In patients with eating disorders, gastric and pancreatic enzymes could possibly reach the oral cavity during vomiting and could perhaps degrade the organic matrix of eroded dentine. This in vitro study sought to investigate whether pepsin, trypsin or the combination of both, have an influence on erosive mineral loss in dentine and whether they are able to degrade the organic matrix.

METHODS

Sixty-four human dentine specimens were prepared and randomly divided into four groups. Specimens were cyclically de- and remineralised for six days. Demineralisation was performed with an HCl-solution (6x 5min daily, pH 1.6) in groups 1 and 3; in groups 2 and 4 the demineralisation solution additionally contained pepsin (750 microg/ml). After demineralisation, specimens of groups 3 and 4 were treated with a trypsin solution (6x 10min daily, 2000 BAEE/ml). After each day, mineral content (mum) was determined microradiographically, and the matrix degradation was determined by hydroxyproline analysis.

RESULTS

After six days, treatment with pepsin (group 2) or trypsin (group 3) had no significant influence on mineral loss. The combined impact of pepsin and trypsin led to significantly higher mineral loss (group 4: 202.5+/-37.4) compared to all other groups (group 1: 139.1+/-29.5, p<or=0.001; group 2: 108.8+/-34.7, p<or=0.001; group 3: 157.8+/-37.2, p<or=0.05). Hydroxyproline was found in all pepsin-solutions but in no trypsin- or HCl-solutions.

CONCLUSION

The combined impact of pepsin and trypsin intensified dentine erosion progression in vitro. This could be one reason for the fast proceeding of dental erosion in patients with chronic vomiting.

Variations in admission practices for adolescents with anorexia nervosa: a North American sample

PURPOSE

The purpose of this study was to assess the variability in admission practices and medical inpatient care for adolescent patients with anorexia nervosa (AN).

METHODS

Participants consisted of members of the 2001-2003 Eating Disorder Special Interest Group from the Society for Adolescent Medicine who completed a structured telephone interview about their admission practices and patterns of inpatient care for teens with AN. Questions focused on admission threshold for heart rate (HR), percentage of ideal body weight (% IBW), and refeeding protocols. Case vignettes were used.

RESULTS

Of 95 eligible practitioners, 51 (53%) agreed to participate. Participants represented 25 American states, one Canadian province, and 45 different adolescent programs. The majority of physicians reported they would hospitalize an AN patient with HR <40 beats/min. The most common response for when to hospitalize based on % IBW was 75% IBW. There were no differences in admission practices based on number of years in practice, gender of physician, or practice setting. Regional differences in admission practices were noted, with physicians in the western United States less likely to admit patients with HR >or=40 beats per minute (p = .018). Physicians described 28 different methods of advancing a diet during an admission. Only 37% of physicians were aware of a standardized refeeding protocol in their institution.

CONCLUSION

This study indicates variability in admission criteria and refeeding practices and shows evidence of geographic variations of admission standards. These data provide a baseline for outcome trials investigating medical admissions for adolescents with AN.

Review of the literature regarding early intervention for children and adolescents aged 0-15 experiencing a first-episode psychiatric disturbance

AIM

The purpose of this review is to report on existing literature regarding children and adolescents younger than 16 years of age experiencing a first-episode psychiatric disturbance. Rather than providing a comprehensive list of service implications, this paper identifies some of the gaps in knowledge and practice to encourage ongoing analysis regarding better practices for early intervention for children and adolescents experiencing a first-episode psychiatric disturbance.

METHODS

A search was conducted to identify key evidence-based literature published from 1985 to 2007 discussing various aspects of child and youth mental health in Canada, the USA, the UK, Australia and New Zealand. The review also included 'grey' literature. Categories of information include diagnoses, pharmacological and non-pharmacological treatment, prevalence, environmental and other risk factors, and demographic variables.

RESULTS

Understanding first-episode psychiatric disturbance for patients under the age of 16 years is limited because of a scarcity of controlled studies focusing on this population. Programme evaluations are sparse, perhaps because of the small number of specialized units servicing this population. It may be helpful to enlist early intervention psychosis programmes that have been successful in assisting young people aged 16-24 in the development of better practices and care outcomes for younger age groups.

CONCLUSIONS

The authors highlight information that has the potential to assist in optimizing care for those youth younger than 16 years experiencing or exhibiting signs of a first-episode psychiatric disturbance.

Clinical practice guidelines for treating restrictive eating disorder patients during medical hospitalization

PURPOSE OF REVIEW

Anorexia nervosa is a life-threatening complex psychiatric disorder that often requires patients to be medically hospitalized. In order to help provide consistent high-quality care to inpatients medically hospitalized for nutritional deficiency, a clinical practice guideline for these patients was created at Children's Hospital Boston. This paper reviews essential components of the clinical practice guideline for patients with restrictive eating disorders.

RECENT FINDINGS

There is considerable variability in admission practices, inpatient treatment and discharge criteria for patients with anorexia nervosa. Weight restoration is one critical factor in treatment, and research suggests that some medical complications are reversible with weight restoration. Weight gain during hospitalization is associated with better short-term outcomes, which indicate patients are continuing toward recovery. However, patients must be closely monitored during nutritional rehabilitation to avoid complications.

SUMMARY

The clinical practice guideline for patients with restrictive eating disorders outlines the care patients receive during the course of their hospitalization. The clinical practice guideline has been effective in helping patients to meet weight-gain goals. Clinical practice guideline outcome data could be used to compare protocols on a national level and help establish best practices for the inpatient medical treatment for these patients.

Pharmacological treatment of anorexia nervosa: a retrospective study in preadolescents and adolescents

To date, studies addressing the role of pharmacotherapy in the treatment of anorexia nervosa are limited, especially in childhood and adolescence. The aim of this retrospective naturalistic study was to evaluate the efficacy and safety of pharmacotherapy in 19 anorexic preadolescents and adolescents referred, for the first time, to a specialist psychiatry unit. Almost all the patients showed an improvement both in their eating behaviors, and in their mood and obsessive symptoms. No evidence was found of dangerous adverse events. Combined with a multidisciplinary approach that includes nutritional rehabilitation and psychotherapy, adjunctive pharmacotherapy may be useful in addressing both eating disorder psychopathology and comorbid psychiatric disorders.

Eating Disorder Nutrition Counseling: Strategies and Education Needs of English-Speaking Dietitians in Canada

The purpose of this study was to profile nutrition counseling strategies for eating disorders that English-speaking Canadian registered dietitians (RDs) use and to explore their educational needs in this area. A cross-sectional survey consisting of open- and closed-ended questions on nutrition counseling strategies was developed and administered via mail. Types of strategies included assessment, rapport-building, educational, and behavior-change strategies. Sixty-five of the 116 eligible RDs who were members of the Dietitians of Canada Eating Disorder Network responded to the survey. Descriptive statistics, chi(2), and Spearman correlation statistics were used. P values less than 0.05 were considered significant. Canadian RDs used strategies that were familiar and strategies they considered useful. Content-oriented or "doing" strategies were used more often than strategies that involved some process-oriented or "thinking" strategies. Reading and intuition were the most frequently reported learning routes. Seventy-one percent of respondents were dissatisfied with the educational opportunities available to RDs in this area in Canada. In Canada, both generalist RDs and specialist eating disorders RDs work with clients with eating disorders. In the absence of a formal nutrition counseling education program, there seems to be a reliance on informal learning routes such as reading or intuition, which may be suboptimal. To optimize eating disorders nutrition practice in Canada, formal coordinated programming that accounts for the educational needs of specialist RDs as well as generalist RDs is needed.

Emotional, developmental, and behavioral health of American children and their families: a report from the 2003 National Survey of Children's Health

BACKGROUND

Recent children's health surveys have documented a high prevalence of emotional, developmental, and behavioral problems among children. Data from the 2003 National Survey of Children's Health provide new insights into these problems and their association with family function and community participation. These issues have become a current focus of the World Health Organization.

METHODS

Answers to questions of interest from the 2003 National Survey of Children's Health were reported using estimates and SEs of rates. Statistical comparisons of rates with chi2 tests at the 0.05 level were made when relevant.

RESULTS

The most commonly diagnosed problems among children 6-17 years of age were learning disabilities (11.5%), attention-deficit/hyperactivity disorder (8.8%), and behavioral problems (6.3%); among preschoolers, speech problems (5.8%) and developmental delay (3.2%) were most common. One in 200 children was diagnosed with autism. In contrast, rates of parental concerns about emotional, developmental, or behavioral problems were much higher; for example, 41% of parents had concerns about learning difficulties and 36% about depression or anxiety. Children with developmental problems had lower self-esteem, more depression and anxiety, more problems with learning, missed more school, and were less involved in sports and other community activities. Their families experienced more difficulty in the areas of childcare, employment, parent-child relationships, and caregiver burden.

CONCLUSIONS

The most recent National Survey of Children's Health mirrored results of previous surveys regarding rates of diagnosed emotional, developmental, and behavioral problems, including an escalating diagnosis of autism among children. Reported rates of parental concerns about these problems were much higher, suggesting possible underdiagnosis of children's problems. Children with chronic problems had diminished family functioning, more school absences, and less participation in community activities compared with other children. Their parents experienced more difficulty with childcare, employment, and parenting skills. A change in treatment emphasis is needed, away from an exclusive focus on a child's developmental and behavioral problems to one that addresses the impacts of these problems on the family and community participation. A new approach to the way these issues are addressed and managed has the potential to enhance the quality of life for a child, as well as the parents, and to produce more meaningful and tangible solutions to these complex and increasingly evident problems.

Eating disorders across the life span

Clearly, eating disorders appear in both men and women across the entire life span. Nurses must be aware of eating disorder issues in populations such as children and adolescents, adult men, middle-aged women, and older adults so that proper screening and treatment can occur to reduce the consequences of these potentially life-threatening illnesses.

Recent Developments in Anorexia Nervosa

  This review summarises recent clinical developments, topics of debate, and research findings in relation to anorexia nervosa in children and adolescents. Following an update of diagnostic and prevalence issues, recent developments in treatment approaches are discussed. These cover recommendations for the medical management of anorexia nervosa in young people, as well as psychological interventions for children, adolescents and their families. The question of which type of service setting is most appropriate for the treatment of young people with anorexia nervosa remains a subject of discussion, and recent guidance and work in this area is presented. Finally, the ongoing relatively poor prognosis in terms of general mental health associated with anorexia nervosa is highlighted and the implications for CAMHS practitioners discussed.

Female puberty: clinical implications for the use of prolactin-modulating psychotropics

During puberty, girls may present with psychiatric illness necessitating treatment with psychotropic medications. Pubertal girls are especially vulnerable to medication-associated adverse events. Atypical antipsychotics and antidepressants have the potential to elevate prolactin levels, altering pubertal progression. Selection of prolactin-sparing atypical antipsychotics is recommended, as is treatment with the lowest effective dose of selective serotonin reuptake inhibitors. Monitoring of serum prolactin levels may be necessary.

Psychotropic medication use at a private eating disorders treatment facility: A retrospective chart review and descriptive data analysis

BACKGROUND

The extent of psychotropic medication use in patients with eating disorders worldwide is unknown.

OBJECTIVES

THE PURPOSES OF THIS STUDY WERE TO: (1) describe the extent and pattern of psychotropic medication use at a private treatment facility for patients with eating disorders and (2) describe patient characteristics and treatment outcomes at the facility.

METHODS

This retrospective chart review included data from a private treatment facility (inpatient or outpatient) for patients with eating disorders in the greater Los Angeles area. Data from all patients of any age who attended the facility between January 1, 2004, and January 1, 2005, and who met the criteria for anorexia nervosa (AN), bulimia nervosa (BN), or eating disorder not otherwise specified (ED NOS) defined in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision were included. Two investigators used a consistent chart-review method for recording clinical status, including treatment-related adverse effects and discharge status (improved, no change, or decompensated from admission). Improved was defined as meeting 1 or more of the following criteria: achieved ideal body weight, stabilized mood, decreased eating disorder symptoms (binge-purge, restrictive, or ritualistic behavior), eating disorder remission, or decreased suicidal ideation plus another improvement in this list.

RESULTS

Data from 60 patients were included (31 with AN, 28 with 13N, and I with ED NOS). Ages ranged from 12 to 47 years, and the mean duration of treatment was 35 days. Fifty-eight (96.7%) patients received a psychotropic agent; 35 (58.3%) patients were prescribed 2 or more agents concomitantly. Selective serotonin reuptake inhibitors (SSRls) were the most commonly prescribed class of psychotropic medication (86.7%), followed by antipsychotics (38.3%). Fluoxetine, escitalopram, and aripiprazole were the most commonly prescribed agents (41.7%, 28.3%, and 23.3%, respectively). A total of 63.3% of patients had a comorbid diagnosis of major depressive disorder, with 96.7% of these patients prescribed an antidepressant. At discharge, 51.6% of the inpatients and 37.9% of the outpatients had improved (AN, 52.6% and 33.3%, respectively; BN, 54.5% and 41.2%, respectively). Of the patients prescribed an SSRI, 40.4% had improved. In the inpatient setting, 35.5% of patients receiving an antipsychotic had improved, versus 6.9% in the outpatient setting.

CONCLUSIONS

The results of this retrospective chart review and descriptive analysis of data from patients at a private eating disorders treatment facility in the United States suggest that psychotropics, particularly antidepressants and antipsychotics, were highly utilized, largely to treat comorbid symptoms. Fluoxetine, escitalopram, and aripiprazole were the most commonly prescribed agents. We observed that psychotropic medication selection was based on patient comorbidities and symptom expression and severity.

Repetitive transcranial magnetic stimulation: A possible novel therapeutic approach to eating disorders

The two most common eating disorders, anorexia nervosa and bulimia nervosa, are characterized by aberrant eating patterns and disturbances in body image. Treatment involves combining individual, behavioural, group, and family therapies, possibly with medications. Studies have found that medication, chiefly antidepressants, could be of help in bulimia nervosa but the evidence is weaker for use in anorexia nervosa. Repetitive transcranial magnetic stimulation (rTMS) is a non-invasive technique that briefly stimulates or depresses cortical areas within the brain. It has been used in the treatment of various psychiatric disorders, especially major depression, which is a condition that patients with eating disorders often experience as a significant comorbidity. Given that both disorders may share a common pathogenesis, this report proposes that rTMS may represent an alternative strategy for the treatment of eating disorders. Other evidence that supports this notion comes from animal studies that show that rTMS can change feeding behaviours and central neurotransmitters related to the regulation of eating behaviours. Further investigation into the dose, duration and type of rTMS stimulus is needed to verify the efficacy of this intervention in eating disorders.