Eating disorders in females: genetics, pathophysiology, and treatment.

The eating disorders anorexia nervosa and bulimia nervosa are best conceptualized as syndromes and are classified on the basis of the clusters of symptoms they present. According to the multidimensional model, eating disorders begin with dieting, which is propelled into a full-blown disorder by antecedent conditions of biological vulnerability and genetics, premorbid psychological characteristics, family interactions, and social climate. The medical abnormalities present in individuals with eating disorders are due to starvation conditions and purging behaviors and will resolve with nutritional rehabilitation and the cessation of purging. Comorbid psychiatric conditions such as affective disorders, anxiety disorders, substance abuse, and personality disorders are frequently present. For anorexia nervosa, the most effective strategy is multidimensional treatment, consisting of nutritional rehabilitation, medical attention, individual cognitive psychotherapy, and family counseling or therapy if the patient is younger than age 18 years. For bulimia nervosa, the treatment of choice is cognitive-behavioral therapy with directions in a manual for therapists. A second choice for treatment is an antidepressant, beginning with fluoxetine.