Eating disorders

Eating disorders are common, affecting 5–10% of young people, with >50% of these having an illness that persists for >5 years. The main eating disorders are anorexia nervosa, bulimia nervosa and binge-eating disorder. Eating disorders with binge eating now dominate. New diagnostic categories have been introduced (avoidant/restrictive food intake disorder, pica, rumination disorder). Genetic factors interacting with environmental stress (some shared with other psychiatric disorders, others relating to metabolism and eating) increase the risk. Self-management strategies, including a focus on social emotional functioning and behavioural change skills to manage fears and habits, are moderately effective. Olanzapine shows some evidence in anorexia nervosa but cannot be generally recommended, fluoxetine is approved in bulimia nervosa, and lisdexamfetamine has been approved for binge-eating disorder in some countries, although not the UK. Inpatient care and family involvement are important in the management of anorexia nervosa.