ABSTRACT
In the western industrial culture, where food is plentiful, it is ironic that self-starvation and a pattern of bingeing and purging are major problems affecting teenage girls. An example of a typical eating disorder case is presented in Box 17.1. Thorough reviews of the outcome for eating disorders show that the prognosis for these conditions is poor (American Psychiatric Association, 1993; Bryant-Waugh and Lask, 1995a, 1995b) and treatment studies highlight the importance of early intervention (Szmukler and Dare, 1991). For anorexia nervosa about half of all cases have a good outcome, a quarter have a moderate outcome and a quarter have a poor outcome. At 20 years follow-up, the mortality rate is about 20 per cent. Poor prognosis is associated with lower weight, a more chronic condition, bulimic symptoms and problematic family relationships. For bulimia nervosa about a quarter of cases have a good outcome, a third have a poor outcome and the remainder (about two-fifths) have a moderate outcome (Szmukler et al., 1995). In this chapter, after considering the classification, epidemiology and clinical features of eating disorders, a variety of theoretical explanations concerning their aetiology will be considered along with relevant empirical evidence. The assessment of eating disorders and a family-therapy-based approach to their treatment will then be given. The chapter will conclude with some ideas on how to prevent eating disorders in populations at risk.
