Pathophysiologic and Clinical Aspects of Medical, Endocrine, and Nutritional Abnormalities and Adaptations in Eating Disorders

Am norexia nervosa, bulimia, and related eating disorders are a heterogeneous group of priary psychiatric disorders whose incidence has approached epidemic proportions in recent years [1,2]. Patients with eating disorders may have numerous secondary medical, hypothalamic, endocrine, metabolic, and nutritional abnormalities [2-38,58-60], some of which may be or become severe enough to be lifethreatening. Further, it has been suggested that some of the psychologic abnormalities in patients with anorexia nervosa may be secondary to starvation and undernutrition rather than intrinsic to the syndrome of anorexia nervosa [39]. Response of the primary disorder to psychotherapy is associated with restoration of near-normal weight and reversal of the secondary medical, hypothalamic, endocrine, metabolic, and nutritional abnormalities. However, patients with bulimia may sustain irreversible damage to the gastrointestinal tract and the oral cavity as a result of emesis or laxative abuse. This review will provide some general perspectives regarding the pathogenesis, incidence, severity,and evolution of the abnormalities in patients with anorexia nervosa, bulimia, and related eating disorders, and the adaptation to starvation, undernutrition, emesis, or laxative or diuretic abuse. Subsequently, those specific abnormalities that are most significant for the diagnosis, evaluation, and management of these patients will be emphasized.