Handbook of Clinical Neurology, Vol.

175 (3rd series)

Sex Differences in Neurology and Psychiatry
R. Lanzenberger, G.S. Kranz and I. Savic, Editors
https://doi.org/10.1016/B978-0-444-64123-6.00026-6
Copyright © 2020 Elsevier B.V. All rights reserved

Chapter 24

Feeding and eating disorders

ANUSHUA BHATTACHARYA1, LEVI DEFILIPP2,3,4, AND C. ALIX TIMKO1*

1
Department of Child and Adolescent Psychiatry and Behavioral Health, Children’s Hospital of Philadelphia,
Philadelphia, PA, United States
2
Department of Pediatrics, Division of Child & Adolescent Psychiatry and Psychology,
University of Louisville School of Medicine, Louisville, KY, United States
3
Norton Children’s Hospital, Louisville, KY, United States
4
Department of Psychiatry, Dell Medical School, University of Texas at Austin, Austin, TX, United States

Abstract
Eating disorders (EDs) are a group of prevalent psychiatric illnesses with an onset in early to late
adolescence—a time of significant neural development, physical and psychologic growth, and self-
exploration. The etiology and neurobiology of EDs are not well understood, but EDs are recognized as
brain-based illnesses with serious acute and long-term consequences if undertreated or ignored. Two
EDs, anorexia nervosa (AN) and bulimia nervosa (BN), have historically been the primary EDs of focus.
The DSM-5 updated diagnostic criteria for these disorders added two more: binge-eating disorder (BED)
and avoidant/restrictive food intake disorder (ARFID). EDs severely impact males as well as females
across the weight spectrum. Comorbidity is high; mortality rates for AN and BN are the highest in
psychiatric conditions and higher than many medical conditions. Several treatment options are available
to treat an ED ranging from inpatient hospitalization to outpatient services and different psychotherapy
options. This chapter reviews the diagnostic criteria, clinical presentation, and treatment for these disor-
ders. Where available, sex differences and developmental considerations will be noted. For all EDs, early
recognition and swift treatment are necessary to avoid a chronic course.

Eating disorders (EDs) are severe, biologically based
psychiatric illnesses of unknown etiology. While the
age of onset varies somewhat between different EDs,
most have an onset during adolescence, a critical period
of increased neural and physical development. The inci-
dence rate of EDs in adolescents is on the rise (Hoek and
van Hoeken, 2003; Keski-Rahkonen et al., 2007; Rosen,
2010). EDs are highly comorbid with serious medical
conditions (e.g., diabetes, cardiac problems, gastrointes-
tinal disorders; Erdur et al., 2012) and with other psychi-
atric conditions (e.g., anxiety, depression, substance use;
Salbach-Andrae et al., 2008). If not recognized or swiftly
and appropriately treated, they can have a long course
and become chronic or severe and enduring (Robinson
et al., 2015). In fact, EDs have some of the highest rates
of morbidity and mortality among all psychiatric illnesses
(Arcelus et al., 2011; Jáuregui-Garrido and Jáuregui-
Lobera, 2012). Despite the significant morbidity associated
with certain EDs, they remain relatively understudied com-
pared to other psychiatric illnesses. Historically, EDs have
been categorized as a female disorder; however, recent
research suggests that a significant proportion of males also
suffer from EDs. The purpose of this chapter is to review
the diagnostic criteria, clinical presentation, and treatment
of EDs. Whenever available, potential sex differences and
developmental considerations will be noted.

*Correspondence to: C. Alix Timko, PhD; 2716 South St., Robert’s Center for Pediatric Research, 8-212, Philadelphia, PA 19146,
United States. Tel: +1-267-426-5467, E-mail: timkoc@email.chop.edu
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6
Sex Differences in Neurology and Psychiatry, 1, (2020) 387-403. doi:10.1016/B978-0-444-64123-6.00026-6