Identification and Treatment of Eating Disorders in the Primary Care Setting
2010; Elsevier BV; Volume: 85; Issue: 8 Linguagem: Inglês
10.4065/mcp.2010.0070
ISSN1942-5546
AutoresLeslie Sim, Donald E. McAlpine, Karen Grothe, Susan Himes, Richard G. Cockerill, Matthew M. Clark,
Tópico(s)Obesity, Physical Activity, Diet
ResumoEating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral member of the treatment team and is in a unique role to diagnose and treat eating disorders. This clinical review surveys the eating disorders literature, identified by searching MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. This review also focuses on practical issues faced by primary care physicians in the management of these conditions and other issues central to the care of these complex patients with medical and psychiatric comorbid conditions. Eating disorders, which are associated with a host of adverse medical morbidities, negative psychological sequelae, and considerable reductions in quality of life, should be diagnosed and treated promptly. However, primary care physicians may find it uniquely challenging to detect eating disorders in their early stages, before obvious physical problems arise and while psychological symptoms are subtle. Although psychological symptoms may dominate the presentation, the physician is an integral member of the treatment team and is in a unique role to diagnose and treat eating disorders. This clinical review surveys the eating disorders literature, identified by searching MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. This review also focuses on practical issues faced by primary care physicians in the management of these conditions and other issues central to the care of these complex patients with medical and psychiatric comorbid conditions. Health service utilization among adults with eating disorders is high, and hospitalization expenses are on the rise.1Mond JM Hay PJ Rodgers B Owen C Health service utilization for eating disorders: findings from a community-based study.Int J Eat Disord. 2007; 40: 399-408Crossref PubMed Scopus (141) Google Scholar Among adults with eating disorders, at least half had their disorder first diagnosed by their primary care physicians.2Hudson JI Hiripi E Pope Jr, HG Kessler RC The prevalence and correlates of eating disorders in the national comorbidity survey replication.Biol Psychiatry. 2007; 61: 348-358Abstract Full Text Full Text PDF PubMed Scopus (3345) Google Scholar, 3Walsh JM Wheat ME Freund K Detection, evaluation and treatment of eating disorders: the role of the primary care physician.J Gen Intern Med. 2000; 15: 577-590Crossref PubMed Scopus (117) Google Scholar Although primary care physicians are in a unique role to diagnose and treat eating disorders, reviews of medical education frequently show a lack of adequate training in their identification and treatment, and hence health care professionals may only detect an eating disorder once substantial medical and psychological consequences have developed.3Walsh JM Wheat ME Freund K Detection, evaluation and treatment of eating disorders: the role of the primary care physician.J Gen Intern Med. 2000; 15: 577-590Crossref PubMed Scopus (117) Google Scholar, 4Currin L Schmidt U Waller G Variables that influence diagnosis and treatment of the eating disorders within primary care settings: a vignette study.Int J Eat Disord. 2007; 40: 257-262Crossref PubMed Scopus (51) Google Scholar This review discusses the main eating disorders seen in primary care, including anorexia nervosa (AN), bulimia nervosa (BN), binge-eating disorder (BED), night-eating syndrome (NES), and eating disorder not otherwise specified (EDNOS), detailing the signs and symptoms of each of these eating disorders, screening tests to detect them, and pharmacological and psychosocial approaches to their treatment (Table 1). To identify eligible studies, we searched MEDLINE and PubMed for articles published from January 1, 1983, to September 30, 2009, using the following keywords: anorexia nervosa, bulimia nervosa, eating disorders, eating disorders NOS, binge eating, binge eating disorder, and night eating syndrome. We also reviewed the reference section of each of the eligible primary studies and of narrative and systematic reviews to identify additional candidate studies.TABLE 1Guide to Identification and Treatment of Patients With Eating Disorders in the Primary Care SettingEating disorderDemographic characteristics and diagnostic symptomsScreening tool optionsCommon physical symptoms to monitorPharmacological treatmentPsychological treatmentAnorexia nervosa (AN) Female13-25 yBMI BMI < 25Binge eatingVomiting, fasting, or other compensatory behaviorStrong drive for thinness SCOFF7Perry L Morgan J Reid F et al.Screening for symptoms of eating disorders: reliability of the SCOFF screening tool with written compared to oral delivery.Int J Eat Disord. 2002; 32: 466-472Crossref PubMed Scopus (70) Google ScholarEDDS8Stice E Telch C Rizvi S Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge eating disorder.Psychol Assess. 2000; 12: 123-131Crossref PubMed Scopus (581) Google Scholar HypokalemiaHypomagnesemiaRenal functionMetabolic alkalosisRussell signsDental cariesEnamel erosion Fluoxetine or other SSRI for BN symptomsSSRI for comorbid symptoms CBT has most evidence for BN and comorbid symptomsInterpersonal therapyDialectical behavior therapyBinge-eating disorder Male and female25-50 yBMI >25Binge-eating with absence of compensatory behavior EDDS8Stice E Telch C Rizvi S Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge eating disorder.Psychol Assess. 2000; 12: 123-131Crossref PubMed Scopus (581) Google ScholarEAT9Garner DM Olmstead MP Polivy J Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.Int J Eat Disord. 1983; 2: 15-34Crossref Scopus (3475) Google ScholarQEWP-R10Spitzer RL Yanovski SZ Marcus MD Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). New York State Psychiatric Institute, New York, NY1993Google Scholar Complications related to obesityLimited ability to lose weight Sibutramine for weight lossOrlistat for weight lossSSRI for comorbid depression or anxiety Group or individual CBT for binge-eating and comorbid symptomsBehavioral weight managementNight-eating syndrome Male and femaleBMI >2525%-50% of kilocalories consumed after evening mealInitial insomniaNot available Complications related to obesityLimited ability to lose weightSertraline or other SSRI Research evidence not availableBehavioral therapy for weight management or eating modificationBMI = body mass index; CBT = cognitive behavioral therapy; EAT = Eating Attitudes Test; ECG = electrocardiograpy; EDDS = Eating Disorder Diagnostic Scale; QEWP-R = Questionnaire on Eating and Weight Patterns-Revised; SSRI = selective serotonin reuptake inhibitor. Open table in a new tab BMI = body mass index; CBT = cognitive behavioral therapy; EAT = Eating Attitudes Test; ECG = electrocardiograpy; EDDS = Eating Disorder Diagnostic Scale; QEWP-R = Questionnaire on Eating and Weight Patterns-Revised; SSRI = selective serotonin reuptake inhibitor. The prevalence of AN is approximately 0.5% to 1% and is highest among adolescent girls and young women. Anorexia nervosa is characterized by an abnormally low body weight (at least 15% below what would be expected), a corresponding fear of weight gain, and an undue emphasis on weight and shape in self-evaluation.5American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC2000Google Scholar Although amenorrhea (ie, loss of 3 consecutive menstrual cycles) is currently required for the diagnosis, the importance of this symptom is unclear, and as such, the eating disorders workgroup of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Fifth Edition) has strongly considered removing it as a criterion for AN.6Attia E Roberto C Should amenorrhea be a criterion for AN.Int J Eat Disord. 2009; 42: 581-589Crossref PubMed Scopus (118) Google Scholar Anorexia nervosa can be classified into 2 subtypes: the restricting subtype and the binge-eating/purging subtype. Patients with AN who rarely binge-eat or purge but maintain a fairly regular pattern of caloric restriction may be classified as having the restricting subtype, whereas those who regularly engage in binge eating and/or compensatory behavior to prevent weight gain will be diagnosed as having the binge-eating/purging subtype.5American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC2000Google Scholar Many of those with the restricting subtype will eventually develop binge eating, with at least one-third of patients crossing over into BN.11Eddy KT Dorer DJ Franko DL Tahilani K Thompson-Brenner H Herzog DB Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V.Am J Psychiatry. 2008; 165: 245-250Crossref PubMed Scopus (334) Google Scholar Crossover to binge eating and BN typically occurs within the first 5 years of the illness.11Eddy KT Dorer DJ Franko DL Tahilani K Thompson-Brenner H Herzog DB Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V.Am J Psychiatry. 2008; 165: 245-250Crossref PubMed Scopus (334) Google Scholar Women with AN who develop BN are likely to relapse back into AN.11Eddy KT Dorer DJ Franko DL Tahilani K Thompson-Brenner H Herzog DB Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V.Am J Psychiatry. 2008; 165: 245-250Crossref PubMed Scopus (334) Google Scholar The outcomes associated with AN are poor, with only a 35% to 85% recovery rate and a protracted recovery, ranging from 57 to 79 months.12Strober M Freeman R Morrell W The long-term course of severe anorexia nervosa in adolescents: survival analysis of recovery, relapse, and outcome predictors over 10-15 years in a prospective study.Int J Eat Disord. 1997; 22: 339-360Crossref PubMed Scopus (764) Google Scholar Not only can AN evolve into a chronic condition, it is one of the most medically serious psychiatric disorders.13Katzman DK Medical complications in adolescents with anorexia nervosa: a review of the literature.Int J Eat Disord. 2005; 37: S52-S59Crossref PubMed Scopus (288) Google Scholar, 14Sullivan PF Mortality in anorexia nervosa.Am J Psychiatry. 1995; 152: 1073-1074PubMed Google Scholar People with AN are affected by the physical consequences of the severe weight loss, alongwith psychological comorbid conditions that contribute to mortality,15Herzog DB Keller MB Sacks NR Yeh CJ Lavori PW Psychiatric comorbidity in treatment-seeking anorexics and bulimics.J Am Acad Child Adolesc Psychiatry. 1992; 31: 810-818Abstract Full Text PDF PubMed Scopus (293) Google Scholar with suicides representing a large portion of the deaths from AN.14Sullivan PF Mortality in anorexia nervosa.Am J Psychiatry. 1995; 152: 1073-1074PubMed Google Scholar Depression, a consequence of poor caloric intake and low weight, is frequently comorbid with AN and often resolves with refeeding.16Fairburn CG Harrison PJ Eating disorders.Lancet. 2003; 361: 407-416Abstract Full Text Full Text PDF PubMed Scopus (1322) Google Scholar Anxiety symptoms are common and often precede the development of the illness.17Godart N Berthoz S Rein Z et al.Does the frequency of anxiety and depressive disorders differ between diagnostic subtypes of anorexia nervosa and bulimia?.Int J Eat Disord. 2006; 39: 772-778Crossref PubMed Scopus (49) Google Scholar The emaciated patient requires urgent medical attention, with close monitoring for dehydration, electrolyte disturbances, renal problems, cardiac compromise with a variety of arrhythmias, and refeeding syndrome. Hypomagnesemia may underlie hypokalemia that persists despite replacement. Metabolic alkalosis is the most common acid-base disturbance in patients with eating disorders, particularly those who purge by vomiting. Rapid development of hypophosphatemia during refeeding may herald refeeding syndrome, characterized by rapid shifts in fluids and electrolytes, including hypomagnesemia, hypokalemia, gastric dilation, and severe edema. Although relatively rare, this syndrome may even result in delirium, cardiac arrhythmia, coma, and death.18Mehanna HM Moledina J Travis J Refeeding syndrome: what it is, and how to prevent and treat it.BMJ. 2008; 336: 1495-1498Crossref PubMed Scopus (402) Google Scholar Gradual initial refeeding of the severely underweight patient can help prevent refeeding syndrome. Phosphorus supplementation should be initiated early, and phosphorus levels should be sustained above 3.0 mg/dL (to convert to mmol/L, multiply by 0.323). Patients should be monitored daily for hypophosphatemia, hypomagnesemia, hypokalemia, and other electrolyte disturbances, with treatment as needed. Accordingly, inpatient treatment may be indicated in patients who are less than 70% of ideal body weight or when low weight is accompanied by bradycardia, hypotension, hypoglycemia, hypokalemia, or hypophosphatemia. The negative effect of AN on patients' long-term physical health is well established. Given that AN most commonly affects women during the period of development of peak bone mass, the effects on bone can be severe and debilitating.13Katzman DK Medical complications in adolescents with anorexia nervosa: a review of the literature.Int J Eat Disord. 2005; 37: S52-S59Crossref PubMed Scopus (288) Google Scholar, 19Rome ES Ammerman S Medical complications of eating disorders: an update.J Adolesc Health. 2003; 33: 418-426PubMed Scopus (89) Google Scholar Although estrogen preparations, mostly oral contraceptives, are widely prescribed to women with AN for the purpose of ameliorating bone loss, little evidence supports its use.20Golden NH Lanzkowsky L Schebendach J Palestro CJ Jacobson MS Shenker IR The effect of estrogen-progestin treatment on bone mineral density in anorexia nervosa.J Pediatr Adolesc Gynecol. 2002; 15: 135-143Abstract Full Text Full Text PDF PubMed Scopus (199) Google Scholar, 21Sim LA McGovern L Elamin MB Swiglo BA Erwin PJ Montori VM Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa: a systematic review and meta-analyses.Int J Eat Disord. 2010; 43: 218-225PubMed Google Scholar, 22Strokosch GR Friedman AJ Wu SC Kamin M Effects of an oral contraceptive (norgestimate/ethinyl estradiol) on bone mineral density in adolescent females with anorexia nervosa: double blind, placebo-controlled study.J Adolesc Health. 2006; 39: 819-827Abstract Full Text Full Text PDF PubMed Scopus (137) Google Scholar Not only do estrogen preparations provide questionable benefit, they also present some disadvantages to women with AN.21Sim LA McGovern L Elamin MB Swiglo BA Erwin PJ Montori VM Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa: a systematic review and meta-analyses.Int J Eat Disord. 2010; 43: 218-225PubMed Google Scholar Once oral contraceptives reestablish menses, the clinician's ability to discern when a healthy weight has been reached, signaled by resumption of menses, becomes disrupted, and an important source of motivation for weight restoration is lost to the patient.21Sim LA McGovern L Elamin MB Swiglo BA Erwin PJ Montori VM Effect on bone health of estrogen preparations in premenopausal women with anorexia nervosa: a systematic review and meta-analyses.Int J Eat Disord. 2010; 43: 218-225PubMed Google Scholar Although the format has not been systematically investigated, practice guidelines for the treatment of AN recommend a multidisciplinary approach involving medical management, nutritional intervention, and psychotherapy.23American Psychiatric Association Practice guideline for the treatment of patients with eating disorders (revision).Am J Psychiatry. 2000; 157: 1-39Google Scholar The research literature is limited by small trials and lack of randomized trials. A recent meta-analysis of psychotherapies found that no specific psychotherapy was consistently superior to any other approach. However, for children and adolescents, a family-based approach for the treatment of eating disorders has demonstrated positive outcomes for adolescents with early onset and relatively short histories of AN.24Dare C Eisler I Russell G Szmukler G The clinical and theoretical impact of a controlled trial of family therapy in anorexia nervosa.J Marital Fam Ther. 1990; 16: 39-57Crossref Scopus (114) Google Scholar, 25Eisler I Dare C Hodges M Russell G Dodge E Le Grange D Family therapy for adolescent anorexia nervosa: the results of controlled comparison of two family interventions.J Child Psychol Psychiatry. 2000; 41: 727-736Crossref PubMed Google Scholar, 26Eisler I Dare C Russell G Szmukler G Le Grange D Dodge E A five-year follow-up of a controlled trial of family therapy in severe eating disorders.Arch Gen Psychiatry. 1997; 54: 1025-1030Crossref PubMed Scopus (437) Google Scholar, 27Le Grange D Family therapy for adolescent anorexia nervosa.J Clin Psychiatry. 1994; 55: 727-739Google Scholar This approach entails a specific form of family therapy in which the family is enlisted as a resource in the treatment of the patient.27Le Grange D Family therapy for adolescent anorexia nervosa.J Clin Psychiatry. 1994; 55: 727-739Google Scholar Although selective serotonin reuptake inhibitors are frequently prescribed for AN, most placebo-controlled trials have not found evidence that these medications improve weight gain, eating disorders, or associated psychopathology. Moreover, a recent study found no differences in the time to relapse between weight-restored patients with AN who were randomized to fluoxetine and those receiving placebo.28Walsh BT Kaplan AS Attia E et al.Fluoxetine after weight restoration in anorexia nervosa: a randomized controlled trial.JAMA. 2006; 295: 2605-2612Crossref PubMed Scopus (316) Google Scholar The clinician will encounter patients with BN more often than those with AN, because BN has a higher prevalence among women (1.0%-1.5%). However, often secretive and lacking obvious physical stigmata such as emaciation, patients with BN may avoid detection, with only a minority seeking treatment.2Hudson JI Hiripi E Pope Jr, HG Kessler RC The prevalence and correlates of eating disorders in the national comorbidity survey replication.Biol Psychiatry. 2007; 61: 348-358Abstract Full Text Full Text PDF PubMed Scopus (3345) Google Scholar, 29Fairburn CG Beglin SJ Studies of the epidemiology of bulimia nervosa.Am J Psychiatry. 1990; 147: 401-408PubMed Google Scholar The modal patient is a woman aged 16 to 22 years; however, the physician may encounter BN in older patients. Bulimia nervosa can be classified into 2 subtypes: the purging type, which is characterized by episodes of binge-eating (an inordinately large amount of food, in a short period of time, in an out-of-control fashion), followed by compensatory behavior, such as self-induced vomiting, laxative abuse, and diuretic abuse; and the nonpurging type, which is characterized by excessive exercise, fasting, or strict diets.5American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC2000Google Scholar As with AN, patients with BN may place undue emphasis on their body shape and live in fear of gaining weight.5American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC2000Google Scholar Currently, if binge eating and purging occur in the context of low weight and amenorrhea, AN is diagnosed. Although crossover from AN to BN is common, crossover from BN to AN is relatively rare unless the patient was originally diagnosed as having AN.11Eddy KT Dorer DJ Franko DL Tahilani K Thompson-Brenner H Herzog DB Diagnostic crossover in anorexia nervosa and bulimia nervosa: implications for DSM-V.Am J Psychiatry. 2008; 165: 245-250Crossref PubMed Scopus (334) Google Scholar In terms of screening measures for the primary care physician, the SCOFF is a brief instrument (5 questions, <2 minutes to complete) that assesses the core psychopathology of AN and BN in early stages of the disorders.7Perry L Morgan J Reid F et al.Screening for symptoms of eating disorders: reliability of the SCOFF screening tool with written compared to oral delivery.Int J Eat Disord. 2002; 32: 466-472Crossref PubMed Scopus (70) Google Scholar, 30Morgan JF Reid F Lacey JH The SCOFF questionnaire: assessment of a new screening tool for eating disorders.BMJ. 1999; 319: 1467-1468Crossref PubMed Scopus (778) Google Scholar The SCOFF has been found to have high sensitivity and specificity for AN and BN.30Morgan JF Reid F Lacey JH The SCOFF questionnaire: assessment of a new screening tool for eating disorders.BMJ. 1999; 319: 1467-1468Crossref PubMed Scopus (778) Google Scholar, 31Luck AJ Morgan JF Reid F et al.The SCOFF questionnaire and clinical interview for eating disorders in general practice: comparative study.BMJ. 2002; 325: 755-756Crossref PubMed Scopus (163) Google Scholar It includes the following questions: (1) Do you make yourself Sick because you feel uncomfortably full? (2) Do you worry you have lost Control over how much you eat? (3) Do you believe yourself to be fat when Others say you are too thin? (4) Have you recently lost more then Fourteen pounds in a 3-month period? and (5) Would you say that Food dominates your life? Although it has been suggested that 2 or more affirmative answers warrant further investigation for an eating disorder, it is wise to gather more information about eating disorder symptoms if any of these items are endorsed, particularly because substantial weight loss or self-induced vomiting alone should be sufficient to prompt further inquiry.30Morgan JF Reid F Lacey JH The SCOFF questionnaire: assessment of a new screening tool for eating disorders.BMJ. 1999; 319: 1467-1468Crossref PubMed Scopus (778) Google Scholar, 32Parker SC Lyons J Bonner J Eating disorders in graduate students: exploring the SCOFF questionnaire as a simple screening tool.J Am Coll Health. 2005; 45: 103-107Crossref Scopus (65) Google Scholar All clinicians should be appropriately suspicious of substantial weight loss, particularly in a patient of previously normal weight. Findings on physical examination may not establish the presence of BN. Most patients with BN will be of normal weight. Russell sign, calluses, or abrasions on the dorsum of the hand overlying the metacarpophalangeal and interphalangeal joints, caused by repeated contact with the incisors during self-induced vomiting, can tip off the observant clinician. Unexpected frequency of dental caries and enamel erosion from repeated vomiting are other physical signs. Laboratory findings of hypokalemia, metabolic alkalosis, and/or hypochloremia in an otherwise healthy, young woman should also prompt inquiry. As is the case for the patient with the AN binge/purge subtype, hypomagnesemia may underlie hypokalemia that persists despite replacement. Electrolyte disturbance of these types and intestinal dysfunction (eg, bloating, sluggish bowel function) are common medical complications of BN. The most effective treatments emerging for patients with BN include a specific type of psychotherapy, cognitive behavioral therapy (CBT), that focuses on modifying the specific behaviors and ways of thinking that maintain the binge-eating and purging behaviors. Fluoxetine, an antidepressant of the selective serotonin reuptake inhibitor category, is the only agent approved by the Food and Drug Administration for the treatment of BN. Most other classes of antidepressant medications have shown some benefit, regardless of whether the patient is depressed; however, it should be noted that bupropion is contraindicated because of increased seizure risk in eating disorders. Overall, medication plays a legitimate role in reducing the symptoms of BN and associated comorbid conditions; however, it is viewed as an adjunctive treatment to psychotherapy.33Mitchell JE Agras S Wonderlich S Treatment of bulimia nervosa: where are we and where are we going?.Int J Eat Disord. 2007; 40: 95-101Crossref PubMed Scopus (71) Google Scholar Binge-eating disorder is characterized by the consumption of large amounts of food in a 2-hour time period, accompanied by a perceived loss of control.5American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC2000Google Scholar Additional symptoms include feeling uncomfortably full, eating rapidly, eating alone, eating when not hungry, and feeling disgusted afterward.34Cremonini F Camilleri M Clark MM et al.Associations among binge-eating behavior patterns and gastrointestinal symptoms: a population based study.Int J Obes. 2009; 33: 342-353Crossref Scopus (57) Google Scholar Unlike BN, compensatory behavior (eg, vomiting, laxative abuse) does not accompany these binge episodes.5American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revision (DSM-IV-TR). American Psychiatric Association, Washington, DC2000Google Scholar When diagnosing BED, the clinician should take care to differentiate it from overeating. Overeating episodes often occur at social functions, where abundant food is readily available, the mood is relaxed or positive, and other people are also overeating, whereas binge episodes typically are secretive and occur in the context of negative mood and all-or-nothing thinking. Primary care physicians may elect to screen for BED using the Eating Attitudes Test, the most widely used eating disorder screening tool.9Garner DM Olmstead MP Polivy J Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia.Int J Eat Disord. 1983; 2: 15-34Crossref Scopus (3475) Google Scholar Alternatively, the Eating Disorder Diagnostic Scale is a 22-item, self-report inventory created to diagnose AN, BN, and BED in accordance with DSM-IV criteria.8Stice E Telch C Rizvi S Development and validation of the Eating Disorder Diagnostic Scale: a brief self-report measure of anorexia, bulimia, and binge eating disorder.Psychol Assess. 2000; 12: 123-131Crossref PubMed Scopus (581) Google Scholar However, the Questionnaire on Eating and Weight Patterns-Revised, which generates diagnostic information regarding BED, in addition to information regarding dieting and weight history, has been widely used with diverse community and clinical samples, including severely obese candidates for bariatric surgery.10Spitzer RL Yanovski SZ Marcus MD Questionnaire on Eating and Weight Patterns-Revised (QEWP-R). New York State Psychiatric Institute, New York, NY1993Google Scholar, 35Grilo CM Masheb RM Wilson GT Subtyping binge eating disorder.J Consult Clin Psychol. 2001; 69: 1066-1072Crossref PubMed Scopus (159) Google Scholar, 36Elder KA Grilo CM Masheb RM Rothschild BS Burke-Martindale CH Brody ML Comparison of two self-report instruments for assessing binge eating in bariatric surgery candidates.Behav Res Ther. 2006; 44: 545-560Crossref PubMed Scopus (66) Google Scholar The prevalence of BED in community samples is 2% to 3% of the general population2Hudson JI Hiripi E Pope Jr, HG Kessler RC The prevalence and correlates of eating disorders in the national comorbidity survey replication.Biol Psychiatry. 2007; 61: 348-358Abstract Full Text Full Text PDF PubMed Scopus (3345) Google Scholar but is much higher in weight management settings (30%) and among those who are severely obese (50%).37Walsh BT Wilfley DE Hudson JI Binge Eating Disorder: Progress in Understanding and Treatment. Health Learning Systems, Wayne, NJ2003Google Scholar Binge-eating disorder occurs in both men and women and affects man
Referência(s)