Page 11 - The efficacy and effectiveness of psychological treatments for eating disorders - Elske van den Berg

Chapter 1 11
patients (Royal Australian and New Zealand College of Psychiatrists, 2014). The physical consequences of eating disorder behaviors can be very serious and may lead, besides risks to physical health, to cognitive and psychological dysfunctions which in turn contribute to maintaining eating disorder pathology. Consequently, when treating eating disorder patients, being fully aware of all possible associated physical risks and their subsequent effects on cognitive and psychological functioning is crucial. This is of particular relevance in underweight eating disorder patients and / or in eating disorder patients who under-eat while having a normal weight.
At the other end of the spectrum, when treating eating disorder patients who are (morbidly) obese, it is as essential to understand physical risks associated with obesity.
Therapists also need to be aware that people with eating disorders may be vulner- able to stigma and shame (National Institute for Health and Care Excellence, 2017).
Prevalence eating disorders
Among young European females, anorexia nervosa is reported by <1–4%, bulimia nervosa by <1–2%, binge eating disorder by <1–4%, and subthreshold eating disorders by 2–3%. Among European men, 0.3–0.7% report an eating disorder (Keski-Rahkonen & Mustelin, 2016). Although anorexia nervosa is a relatively rare disorder in many non-western countries, bulimia nervosa and binge eating disorder are common disorders around the world (Hoek, 2016). Literature suggests that the incidence of anorexia nervosa appears stable and that of bulimia appears be declin- ing (Keski-Rahkonen & Mustelin, 2016), although a recent study suggests that the weighted means of point prevalence for eating disorders increased from 3.5% in the 2000–2006 period to 7.8% in the 2013–2018 period (Galmiche, Déchelotte, Lambert, & Tavolacci, 2019). The findings may be conflicting, partly because DSM-5 includes a considerably revised eating disorder section compared with earlier editions (Smink, van Hoeken, Oldehinkel, & Hoek, 2014).
Although the numbers of individuals receiving treatment have increased, only about one-third is detected by healthcare (Keski-Rahkonen & Mustelin, 2016).
Treating anorexia nervosa
There is a growing body of evidence supporting the efficacy of family treatment for adolescents and children with anorexia nervosa (Royal Australian and New Zealand College of Psychiatrists, 2014; National Institute for Health and Care Excellence,