The consequences and costs of the eating disorders.

Eating disorders are severe, relatively chronic conditions that are associated with comorbid psychopathology and adverse medical conditions. The death rate for patients with AN is the highest among psychiatric conditions, with high suicide rates and deaths from physiologic causes. In addition, the costs of therapy for AN are higher than those for schizophrenia. Although somewhat less chronic, BN and binge-eating disorder are costly conditions to treat, similar to or more expensive than the costs for the treatment of OCD. Although antidepressant medication seems to be the most cost-effective treatment in the short term, given the higher relapse rates with antidepressants, it seems that, in the end, CBT may be the most cost-effective approach to the treatment of BN. It is possible that similar figures would occur for binge-eating disorder. The issue of the comparative cost-effectiveness of various treatments for psychiatric disorders has been neglected in the research literature to date. It is important that large-scale RCTs add a sophisticated cost-effectiveness analysis to the design so that physicians can better choose the most effective and cost-effective sequence of therapies for their patients.