Table Of Contentfacts
Eating disorders
% also available in facts series
ADHD (2nd ed.) | 9780199565030 Insomnia and Other Adult Sleep Problems
Alcoholism (4th ed.) | 9780199231393 9780199560837
Alzheimer’s and Other Dementias Living with a Long-term Illness
9780199596553 9780198528821
Angina and Heart Attack | 9780199599288 Lung Cancer (3rd ed.) | 9780199569335
Ankylosing Spondylitis | 9780192632821 Lupus (2nd ed.) | 9780199213870
Asthma | 9780199211265 Motor Neuron Disease | 9780199206919
Autism and Asperger Syndrome Multiple Sclerosis | 9780199652570
9780198504900 Muscular Dystrophy (3rd ed.)
Back Pain | 9780199561070 9780199542161
Borderline Personality Disorder Myotonic Dystrophy (2nd ed.)
9780199202966 9780199571970
Breast Cancer | 9780199558698 Obsessive–Compulsive Disorder (4th ed.)
9780199561773
Chronic Fatigue Syndrome (2nd ed.)
9780199233168 Osteoarthritis | 9780199211388
COPD | 9780199563685 Osteoporosis | 9780199215898
Cosmetic Surgery | 9780199218820 Panic Disorder (3rd ed.) | 9780199574698
Cystic Fibrosis (4th ed.) | 9780199295807 Polycystic Ovary Syndrome
9780199213689
Depression (2nd ed.) | 9780199602933
Post-traumatic Stress | 9780199566587
Diabetes | 9780199232666
Prenatal Tests and Ultrasound
Down Syndrome (3rd ed.) | 9780199232772
9780199599301
Dyslexia and Other Learning Difficulties
Prostate Cancer (2nd ed.) | 9780199573936
(3rd ed.) | 9780199691777
Psoriatic Arthritis | 9780199231225
Eating Disorders (6th ed.) | 9780199551019
Pulmonary Arterial Hypertension
Epilepsy (3rd ed.) | 9780199233687
9780199582921
Epilepsy in Women | 9780199548835
Schizophrenia (3rd ed.) | 9780199600915
Essential Tremor | 9780199211272
Sexually Transmitted Infections (3rd ed.)
Facts and Practice for A-level: Biology 9780199595655
9780199147663
Sleep Problems in Children and
Falls | 9780199541287 Adolescents | 9780199296149
Head Injury | 9780199218226 Stroke | 9780199212729
Heart Disease | 9780199582815 The Pill and Other Forms of Hormonal
Huntington’s Disease (2nd ed.) Contraception (7th ed.) | 9780199565764
9780199212019 Thyroid Disease (4th ed.) | 9780199205714
Infertility | 9780199217694 Tourette Syndrome (2nd ed.)
Inflammatory Bowel Disease | 9780199230716 9780199298198
facts
Eating disorders
SEVENTH EDITION
SUZANNE ABRAHAM
Professor, The Faculty of Medicine,
The University of Sydney, Australia
1
1
Great Clarendon Street, Oxford, OX2 6DP,
United Kingdom
Oxford University Press is a department of the University of Oxford.
It furthers the University’s objective of excellence in research, scholarship,
and education by publishing worldwide. Oxford is a registered trade mark of
Oxford University Press in the UK and in certain other countries
© Oxford University Press 2016
The moral rights of the author have been asserted
First Edition published in 1984
Seventh Edition published in 2016
Impression: 1
All rights reserved. No part of this publication may be reproduced, stored in
a retrieval system, or transmitted, in any form or by any means, without the
prior permission in writing of Oxford University Press, or as expressly permitted
by law, by licence or under terms agreed with the appropriate reprographics
rights organization. Enquiries concerning reproduction outside the scope of the
above should be sent to the Rights Department, Oxford University Press, at the
address above
You must not circulate this work in any other form
and you must impose this same condition on any acquirer
Published in the United States of America by Oxford University Press
198 Madison Avenue, New York, NY 10016, United States of America
British Library Cataloguing in Publication Data
Data available
Library of Congress Control Number: 2015944826
ISBN 978–0–19–871560–3
Printed and bound by
Ashford Colour Press Ltd, Gosport, Hampshire
Oxford University Press makes no representation, express or implied, that the
drug dosages in this book are correct. Readers must therefore always check
the product information and clinical procedures with the most up-to-date
published product information and data sheets provided by the manufacturers
and the most recent codes of conduct and safety regulations. The authors and
the publishers do not accept responsibility or legal liability for any errors in the
text or for the misuse or misapplication of material in this work. Except where
otherwise stated, drug dosages and recommendations are for the non-pregnant
adult who is not breast-feeding
Links to third party websites are provided by Oxford in good faith and
for information only. Oxford disclaims any responsibility for the materials
contained in any third party website referenced in this work.
Preface and
acknowledgements
This book is written for patients, their families, and health professionals, par-
ticularly family doctors. The previous edition of this book (the sixth edition)
was highly commended at the 2009 British Medical Association Medical Book
Awards in the category of popular medicine. This edition has retained the pre-
vious successful format and updates the information in the light of recent and
proposed changes to the diagnostic criteria for eating disorders and scientific
thinking, including the field of epigenetics.
With globalization, eating disorders can no longer be considered as culture
or class bound. To allow more women to receive help for their disordered
eating there has been a softening of the diagnostic criteria for anorexia and
bulimia nervosa, the acceptance of binge-eating disorder as a formal diagno-
sis, and the introduction by the American Psychiatric Association of avoidant/
restrictive food intake disorder. This latter diagnosis resembles our eating dis-
order ‘anorexia not for weight and shape’ that we had previously described in
the fifth edition. These recent changes make the diagnosis a clinical decision
based on the mental and physical health and quality of life of the person rather
than specific measures, for example body mass index.
At present, there is no easy way of classifying the eating disorders. It is prob-
ably easier during assessment and treatment to think of a single eating dis-
order with different characteristics that must be taken into account.
In this book I have chosen to classify the eating disorders as: (1) anorexia
nervosa and anorexia nervosa-like disorders; (2) bulimia nervosa and bulimia
nervosa-like disorders; and (3) binge-eating disorder and binge-eating-like
disorders. I hope this will allow readers to select the features from the dif-
ferent sections that are relevant for them at the time. I have included ano-
rexia nervosa not for weight or shape with anorexia nervosa-like disorders and
v
Eating disorders · facts
purging disorder and regurgitation disorder with bulimia nervosa and bulimia
nervosa-like disorders. Obesity is considered a disorder by physicians but not
by psychiatrists. Obesity and eating disorders related to overeating are includ-
ed with binge-eating and binge-eating-like disorders.
I wanted this seventh edition to remain faithful to my original aims, which
were: first, to provide accurate information that will allow people who suffer
from eating and weight problems to obtain information that improves their
quality of life; and secondly, to provide a balanced approach that is useful for
the general practitioner, as they will be consulted by people with transitory,
easily resolved problems as well as the chronic cases frequently portrayed in
books or found on the internet. The following questions are typical of those
asked by carers of patients with eating disorders:
◆ What causes the illness?
◆ What do you do to make her better?
◆ How can we help her?
◆ Should we comment on her eating and weight?
◆ Should you say anything when her behaviour is unacceptable?
◆ Why can’t she eat?
◆ Why can’t she stop eating?
◆ Will she ever get better or will she always have an eating disorder?
◆ How long will she need treatment?
◆ Will her bones recover?
◆ Will her heart and kidneys be permanently damaged?
◆ Has the family caused the eating disorder?
◆ Is it genetic?
◆ Will she be able to have children?
◆ Is it because her grandmother suffered depression?
◆ Will she ever be her old self again?
vi
Preface and acknowledgements
◆ Do you ever really recover from an eating disorder?
◆ Why does she keep saying we do not understand?
I have attempted to answer these questions as fully as possible in this book.
Nowadays most people with eating disorders recover and maintain a good
quality of life. They frequently form relationships and desire children; and if
they are not achieving pregnancy they will seek assisted conception. Not a lot
is known about disordered eating and pregnancy. The chapter on pregnancy
and the post-partum period addresses many issues including the challenge of
pregnancy and the possible outcomes for both mothers and their babies.
Eating Disorders: the Facts could never have been written without discussions
and help from our colleagues and friends. They include: Tarek Ali, Catherine
Boyd, Janet Conti, Susan Hart, John Kellow, Astrid von Lojewski, Maala Lal,
Michael Mira, Sarah Maguire, Sian Ong, Amanda McBride, Janice Russell,
Jim Telfer, Kathryn Velickovic, and Jeremy Wang. For this edition I am very
grateful to my colleagues Jessica Anderson, Elise Coker, Hannah Kluckow,
Victor Lam, and Georgina Luscombe.
Most of all I would like to thank our patients. Without them there would be no
book. I would particularly like to thank those patients who permitted us to use
their emails and diaries (appropriately modified for reason of privacy) for the
case histories and quotations.
This book is not intended to glamorize or sensationalize eating disorders. I
have presented the facts in the key points at the beginning of each chapter
and highlighted others throughout the book. Some suggestions have also been
added that will allow people to help themselves in conjunction with their usual
treatment.
Note
Because of problems of gender in the English language, and because we treat
more women than men with eating disorders, we have chosen to use ‘she’
rather than ‘he’ in most cases. We believe that an increasing interest in appear-
ance among men and easy access to online information is resulting in a greater
number of men seeking treatment.
The generally accepted measure of body thinness and fatness is the body mass
index (BMI, kg/m2) (see Appendix A). Conversion for height and weight units
is given in Appendices A and B.
vii
Eating disorders · facts
We have been very careful to use the word obesity to mean a BMI of 30 kg/m 2
or greater (depending on ethnic variations in fat distribution) and not to con-
fuse with overweight BMI (25–29 kg/m2).The formal diagnostic criteria for
the eating disorders are available online:
1. World Health Organization. ICD-10 Classification of Mental and
Behavioural Disorders. http://www.who.int/classifications/icd/en/blue-
book.pdf
2. American Psychiatric Association. Diagnostic and Statistical Manual of
Mental Disorders, fifth edition (DSM-5). http://dsm.psychiatryonline.org/
doi/book/10.1176/appi.books.9780890425596
viii
Contents
1 Adolescent eating behaviour 1
2 Eating disorders—an overview 19
3 Why do eating disorders occur? 39
4 Infertility, pregnancy, and the post-partum period 53
5 Investigation of eating disorders 75
6 General management of eating disorders 89
7 Anorexia nervosa and anorexia nervosa-like disorders 103
8 Treatment and outcome of anorexia nervosa and anorexia
nervosa-like disorders 129
9 Bulimia nervosa and bulimia nervosa-like disorders 153
10 Treatment and outcome of bulimia and bulimia
nervosa-like disorders 173
11 Investigation and treatment of binge-eating
and binge-eating-like disorders 199
Appendix A: Body mass index (BMI) charts
and height conversion 225
Appendix B: Pounds to kilograms chart 231
Appendix C: Quality of Life for Eating Disorders (QOL ED)
questionnaire 237
Glossary 249
Index 255
ix
