Eating Disorders

Preface Contents About the Editors Contributors Part I: General Aspects, Overviews, and Setting the Scene 1 Enhanced Cognitive Behavior Therapy for Eating Disorders Introduction The Origins of CBT-E Transdiagnostic Theory Overview of CBT-E Goals of CBT-E General Treatment Strategy Forms of CBT-E Versions of CBT-E Outpatient CBT-E for Adults Outpatient CBT-E for Adolescents Intensive Outpatient CBT-E Inpatient CBT-E Post-inpatient Outpatient CBT-E The Status of CBT-E Implications for Clinical Services Remaining Challenges Applications in Other Eating Disorders Mini-Dictionary of Terms Key Facts of Enhanced Cognitive Behavior Therapy for Eating Disorders Summary Points References 2 Eating Disorders During Pregnancy Introduction EDs and Fertility EDs in Pregnancy Gestational AN Gestational BN Binge Eating Disorder (BED) in Pregnancy Pica in Pregnancy Pregorexia Bottlenecks for the Management of EDs and OFSED Before Fertility Treatment and During Gestation Application to Other EDs Mini-dictionary of Terms Key Facts of EDs During Pregnancy Summary Points References 3 Eating Habits During Pregnancy Introduction Role of Maternal Anthropometrics and Nutrition on Short- and Long-Term Outcomes Current Maternal Nutrition Is Inadequate Even in Industrialized Countries Dietary Patterns and Feto-maternal Outcomes Conclusion Mini-Dictionary of Terms Summary Points References 4 Stress and Disordered Eating Patterns Introduction Stress Responses Physiology of Stress Role of the HPA Axis and Glucocorticoids in Eating Behaviors HPA Axis and Dopamine Reward Pathway Hedonics and Addictive Properties of Food Stress and Eating Patterns The Impact of Eating Patterns on Stress and Mood Individual Differences and Disordered Eating Stress and Undereating Stress and Overeating Coping Strategies Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Summary Points References 5 Gene Variants Involved in the Etiopathogenesis of Eating Disorders: Neuropeptides, Neurotransmitters, Hormones, and Their Re... Introduction Family Studies Candidate Gene Association Studies Genome-Wide Association Studies Gene Variants Serotonin Pathway Brain-Derived Neurotrophic Factor Gene Dopamine Receptor Family Opioids and Their Receptors Endocannabinoid Pathway Appetite Regulatory System Other Genes Rare Genetic Variants Conclusions Summary Points References 6 Genes and Eating Disorders Introduction Role of Serotonin in Eating Disorders Characteristics of the Serotonin Transporter (SERT) SLC6A4 Serotonin Transporter Gene Genetic Association Studies Studies of Association of the SLC6A4 Gene and Psychopathological Traits in Eating Disorders Gene x Environment Interaction Studies in Eating Disorder Studies of Sequence of SLC6A4 Conclusions Key Points Key Facts of Genes and Eating Disorders: A Focus on the Solute Carrier Family 6 (Neurotransmitter Transporter, Serotonin), Mem... Summary Points Applications to Other Areas Mini-Dictionary References 7 Eating Disorders in Athletes Introduction Prevalence of EDs in Athletes Risk Factors Which Sports Disciplines Are at Higher Risk for EDs? EDs in Male Athletes Special Considerations on Anorexia Nervosa in Athletes Special Considerations on Bulimia Nervosa and Binge Eating Disorder (BED) in Athletes Special Considerations on Orthorexia Nervosa in Athletes Relative Energy Deficiency in Sport (RED-S) Tools for Screening EDs Specifically in Athletes Application to Other EDs Mini-Dictionary Key Facts of EDs in Athletes Summary Points References 8 Eating Disorders in Children and Adolescents with Attention Deficit Hyperactivity Disorder Introduction ADHD: A Prevalent Neurodevelopmental Disorder in Children and Adolescents ADHD Diagnosis and Etiology ADHD Comorbidities Eating Patterns of Children with ADHD Loss of Control (LOC) Eating/Binge Eating Binge Eating Disorder (BED) Bulimia Nervosa (BN) Anorexia Nervosa (AN) and Avoidant/Restrictive Food Intake Disorder (ARFID) Prevalence of ED in Children and Adolescents with ADHD The Role of Gender in the Prevalence of ED Among Children and Adolescents with ADHD Risk Factors for ED in Children and Adolescents with ADHD Psychiatric Comorbidities and Emotional Regulation Difficulties (ERD) Sleep Disturbances: The Overlooked Factor for Disordered Eating Digital Media Use Influences on Body Satisfaction and Eating Behaviors Possible Mechanisms Underlying the Association Between ADHD and ED Clinical Implications/Clinical Management of ADHD and Eating Disorder Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Eating Disorders in Children and Adolescents with ADHD Key Facts of Reward Deficiency Syndrome (RDS) Key Facts of Stimulant Drugs for ADHD Summary Points References 9 Insomnia in Eating Disorders Insomnia in Eating Disorders Defining Insomnia Insomnia as Transdiagnostic Across Psychopathology Insomnia Disorder and Symptoms in Eating Disorders Hypotheses for Understanding the Underlying Mechanisms of Insomnia and Eating Disorders Hypothesized Psychological Factors Hypothesized Biological Factors Hypothesized Social Factors Treatment Implications Conclusion Applications to Other Eating Disorders Mini-dictionary of Terms Key Facts of Insomnia and Eating Disorders Summary Points References 10 Uric Acid Levels and Eating Disorders Introduction UA Physiological Roles and General Pathophysiological Aspects UA Measurement in Body Fluids Gender Effects on SUA UA in the Central Nervous System (CNS) UA in Neuropsychiatric Disorders UA in Eating Disorders (ED) Conclusion Applications to Other Areas Mini-Dictionary of Terms Key Facts Summary Points References 11 The Virtually Delivered Body Project (vBP): A Viable Option for Large-Scale Prevention of Eating Disorders Introduction Eating Disorders in Context Prevention The Main Prevention Strategies for EDs Cognitive Dissonance Theory and Its Implication for Prevention Dissonance-Based Intervention and Body Project The Efficacy and Effectiveness of the Body Project Influencing Public Health: Prevention on Broad Basis The Promise of Internet and Digital Techniques vBP Applications to Other EDs Mini-Dictionary of Terms Key Facts of the Virtually Delivered Body Project (vBP) and EDs Summary Points References 12 Time-Related Changes in Eating Disorders Introduction Changes in the Concept and Diagnosis of EDs Anorexia Nervosa (AN) Bulimia Nervosa (BN) Transition of Diagnostic Criteria for AN and BN Time Trend of Incidence and Prevalence Western Countries Anorexia Nervosa Bulimia Nervosa Non-Western Countries East Asia West Asia Latin America Africa Changes in Clinical Picture Middle-Aged Women Men Conclusion Applications to Other Eating Disorders Mini-dictionary of Terms Key Facts of Time-Related Changes in Eating Disorders Summary Points References 13 The Connection Between Eating Disorders and Substance Use Disorders Introduction Eating Disorders Substance Use Disorders Genetics The Role of Serotonin The Role of Dopamine Genetics and ED-SUD Neurobiology Neurobiology of SUD Neurobiology of ED Neurobiology of ED-SUD Neuroimaging Findings in SUD and ED Temperament Impulsivity in SUD and ED Executive Function Deficits Executive Function Deficits in SUD and ED Emotion Regulation Emotion Regulation in SUD and ED Additional Shared Risk Factors for SUD and ED Adverse Events, Trauma, and SUD Adverse Events, Trauma, and ED Adverse Events, Trauma, and ED-SUD Clinical Implications Conclusions Mini-dictionary of Terms Key Facts of Substance Use Disorders Summary Points References 14 Fluid Restriction in Eating Disorders Introduction Recognizing Intentional Fluid Restriction How Much Fluid Does a Patient Need? Who Restricts Fluids? Why Do Patients Restrict Fluids? Clinical Cases Case 1: Adele Case 2: Bianca Case 3: Celia Treatment of Fluid Restriction Fluid Replacement Behavioral Interventions Psychological Interventions Applicability to Other Eating Disorders Mini-dictionary of Terms Key Facts About Fluid Restriction Summary Points About Fluid Restriction References 15 Features of Medical Consultations Before the Onset of Eating Disorders Introduction Risk Factors and Prodromes as Predictors for Future Emergence of EDs Features of Medical Consultations Before the Onset of EDs Other Important Features of EDs Prevention of EDs, Intervention Programs, and Impact Applications to Other EDs Mini-Dictionary of Terms Key Facts of Features of Medical Consultations Before the Onset of EDs Summary Points References 16 The Role of Parents and Other Caregivers in the Early Detection of Eating Disorders Introduction The Early Intervention Continuum The Role of Parents in Early Detection Earliest Detectable Symptoms Barriers to Early Detection of Eating Disorders Parent-Led Early Intervention Programs Parent-Led Risk Factor Reduction Parent-Led Treatments for the Prodromal Phase Parent Support in the Early Eating Disorder Phase Conclusion Applications to Other Eating Disorders Mini Dictionary of Terms Key Facts of Parent-Led Early Detection Summary Points References 17 Alexithymia in Eating Disorders: A Narrative Review Introduction Types of Alexithymia Impact of Alexithymia Assessment on Research Findings Structure and Rationale of the Current Review Findings from Case-Control Studies Findings in Cohort Studies with Community Samples Showing ED Symptoms Findings from Clinical Samples: Alexithymia Differences According to AN and BN Diagnosis Longitudinal Findings and the Impact of Alexithymia on ED Treatment Outcomes The Longitudinal Variation of Alexithymia: Does It Have an Effect? Therapeutic Implications and Applications Limitations and Future Lines of Research Conclusions Mini-Dictionary of Terms Key Facts of Alexithymia Summary Points References 18 Eating Disorder and Quality of Life Introduction General Characteristics of EDs Comorbidities of ED Relationship Between QoL and ED Relationship Between System of Organs and EDs Dynamics of ED and QoL Considerations for Targeted Interventions for QoL in the Treatment of Patients with EDs Conclusion Mini Dictionary of Terms Key Facts of Eating Disorders and Quality of Life Summary Points References 19 The Role of Denial in Eating Disorder Development, Assessment, and Treatment Introduction Defining Denial of Disordered Eating Etiology of the Denial of Disordered Eating Consequences of Denial of Disordered Eating Assessment Treatment Future Directions Summary Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Denial of Disordered Eating Summary Points References 20 The Role of the Dietitian Overview of Dietetic Treatment for Eating Disorders Nutrition Assessment Nutritional Issues in Individuals with Eating Disorders Nutrition Assessment for Eating Disorders Nutrition Intervention, Monitoring, and Evaluation Nutrition Education and Counselling Outpatient Dietetic Treatment for Eating Disorders Calcium Foods Protein Carbohydrates Fruits and Vegetables Fluids Nuts, Oils, and Fats Diet Foods and Fillers Inpatient Dietetic Treatment for Eating Disorders, Including Considerations for Individuals with Anorexia Nervosa Refeeding Syndrome Nutrition Support for Inpatients Considerations for Individuals with Bulimia Nervosa Treatment Considerations for Individuals with Bulimia Nervosa Considerations for Individuals with Binge Eating Disorder Considerations for Individuals with Co-occurring Binge Eating Disorder and Obesity Application to Other Eating Disorders Mini-Dictionary of Terms Key Facts Key Facts Regarding the Role of Dietitians in Eating Disorder Treatment Summary Points References Part II: Anorexia Nervosa 21 A Research Approach to Self-Report and Objective Measurements of Physical Activity in Eating Disorders Introduction Assessment Tools for Measuring Objective and Psychological Components of PA in EDs Self-Report Measurement of PA in EDs Self-Report Measures of Objective Components of PA Self-Report Measures of General PA Motivations Self-Report Measures of Maladaptive PA Strengths and Weaknesses of Self-Report Measures of PA Ecological Momentary Assessment of PA in EDs EMA of Objective Components of PA EMA of General PA Motivations EMA Maladaptive PA Strengths and Weaknesses of EMA Measures of PA Semi-structured Interviews of PA in EDs Semi-structured Interviews of Maladaptive PA Strengths and Weaknesses of Semi-structured Interviews of PA Assessment Tools for Measuring Objective Components of PA in EDs Objective Measurement: Types of Sensor Technology Objective Measurement Outcome Variables Strengths and Weaknesses of Objective PA Measurement Future Directions of Assessment of Psychological and Objective Components of PA in EDs Mini-Dictionary of Terms Key Facts Summary Points References 22 Body Mass Index and Body Fat in Anorexia Nervosa Introduction Definitions of BMI and BF BMI BF Methods of Assessment in AN Clinical Settings Weight, Height, and Standard for BMI Determination BF Estimation and Measurement Skinfold Thickness (ST) BIA DXA Changes in BMI and BF Before and After Weight Gain and Normalization Relationship Between BMI, BF, and Clinical Outcomes Remission, Recovery, and Risk of Relapse Resumption of Menses and Reproductive Functions Osteoporosis and Restoration of BMD Summary References 23 Modeling Anorexia Nervosa Introduction AA-Derived eiCs Pathways eiCs Receptors eiCs and Neuroinflammation Animal Models of AN Neuroinflammation in Animal Models of AN eiCs in the ABA Model Conclusion Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Anorexia Nervosa Summary Points References 24 Anorexia Nervosa and Impact After Three Decades Introduction Sten Theander´s Study in the Southern Part of Sweden The Gothenburg Anorexia Nervosa Study Background and Methods Neurofilament Light Chain Protein in Serum Facial Emotion Recognition Task Definition of Full Eating Disorder Recovery Results General Outcome Eating Disorder Outcome Psychiatric Morbidity Neurodegenerative Findings Facial Emotion Recognition Task Comparisons Between Theander´s Study and the Gothenburg AN Study Discussion Conclusions Key Facts Summary Points References 25 Linking Anorexia Nervosa with the Gut Microbiota Introduction The Microbiota-Gut-Brain Axis Gut Microbiota Link to AN Intestinal Microbial Metabolites in AN Gut Microbiota Adaptation to Diet Manipulating the Gut Microbiota Antibiotics Probiotics, Prebiotics, and Psychobiotics Fermented Food Fecal Microbiota Transplantation Immunity Involvement Potential Mechanisms in AN Development Applications to Other Eating Disorders Mini-dictionary of Terms Key Facts of Human Microbiota Key Facts of Microbiota in Patients with AN Key Facts of Gut Microbiota Modifications Summary Points References 26 Gender Aspects of Anorexia Nervosa: the Male Introduction Prevalence Risk Factors, Symptom Onset, and Age of Presentation Symptoms and Comorbidities Medical Complications Course and Prognosis Treatment Role of the Dietitian Future Directions and Need for Awareness Application to Other Eating Disorders Mini-dictionary of Terms Key Facts Key Facts of DSM (Diagnostic and Statistical Manual of Mental Disorders) Key Facts of BMI Summary Points References 27 The Biology of Anorexia Nervosa Introduction Clinical Presentation of Anorexia Nervosa Neurohormonal Regulation of Appetite and Metabolism Brain Centers of Energy Homeostasis Hypoleptinemia in Anorexia Nervosa: A Chicken or an Egg? Interaction of Metabolic State and Gonadal Function Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Anorexia Nervosa Summary Points References 28 The Hippocampus in Anorexia Nervosa Introduction Hippocampus in Animal Model of AN Structural Studies Functional Studies Hippocampus in Other Eating Disorders Applications to Other Areas Mini-Dictionary of Terms Key Facts of Hippocampus in Anorexia Nervosa Summary Points References 29 Endocrine Disturbances in Anorexia Nervosa Introduction Physiological Functions of Ghrelin Ghrelin and Reward Signaling in AN Clinical Evidence of Ghrelin Resistance Ghrelin Resistance: Antagonism by Other Ghrelin-Derived Peptides? Physical Activity: The Patients´ Option to Induce Ghrelin Resistance? Genetic Factors Involved in Ghrelin Resistance Chronicity and Ghrelin Levels in AN Application to Other Eating Disorders Summary Points Mini-Dictionary References 30 Anorexia Nervosa and Eye Movements Introduction Neurobiology of Saccadic Eye Movements Saccade Characteristics Saccade Tasks Fixation Task Prosaccade Task Antisaccade Task Go/No-Go Saccade Task Memory-Guided Saccade Task Self-Paced Saccade Task Visual Scan Path Tasks Attentional Bias Tasks Conclusions and Implications Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Eye Movements in AN Summary Points References 31 Anorexia Nervosa: Reproduction and Consequences for Mother and Child Introduction Anorexia Nervosa and Fertility Functional Hypothalamic Amenorrhea Management and Treatment of Functional Hypothalamic Amenorrhea Long-Term Effect on Fertility The Prevalence of Anorexia Nervosa in Pregnancy Disease Course in Pregnancy Anorexia Nervosa and Pregnancy Complications Anorexia Nervosa and Adverse Perinatal Outcomes The Postpartum Period Children to Mothers with Eating Disorders Management of Pregnant Women with Anorexia Nervosa Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Key Facts of Amenorrhea in Anorexia Nervosa Key Facts of Pregnancy and Perinatal Outcomes in Women with Anorexia Nervosa Key Facts of Management of Pregnant Women with Anorexia Nervosa Summary Points References 32 Anorexia Nervosa in the Acute Hospitalization Setting Introduction Hospitalization Criteria Integrated Treatment Nutritional Rehabilitation Refeeding Process Caloric Prescription Nutrient Quality and Nutrient Supplementation Nasogastric Feeding and Parenteral Nutrition Psychological Treatment Psychopharmacological Treatment Behavioral Management Motivation to Treatment Treatment Outcomes Renutrition Psychopathology Quality of Life Rehospitalization Discharge and Follow-up Applications to Other Eating Disorders Mini Dictionary of Terms Summary Points References 33 Anorexia Nervosa and Comorbidities Introduction Feeding and Eating Disorders Anorexia Nervosa Mental Health Comorbidities in Individuals with AN Autism Spectrum Disorder AN and ASD General Considerations Epidemiology Psychodiagnostics Clinical Traits and Theories Treatments and Outcomes Conclusions Applications to Other Eating Disorders Mini Dictionary of Terms Key Facts of Anorexia Nervosa and Comorbidities: Linking Autism Summary Points References 34 The Electrocardiogram in Anorexia Nervosa Introduction Background Heart Rate and Heart Rhythm The Electrocardiogram The Electrocardiogram in Anorexia Nervosa The ECG in Anorexia Nervosa Bradycardia Heart Rate Variability QTc Interval T-Wave Changes Special Circumstances Impact of Refeeding The Electrocardiogram during Exercise Psychopharmacotherapy and the Electrocardiogram Sudden Unexpected Death Clinical Use of the ECG in AN Conclusion Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of the Electrocardiogram in Anorexia Nervosa Summary Points References 35 Anorexia Nervosa and Concurrent Psychiatric Comorbidity Introduction Psychiatric Comorbidity in Anorexia Nervosa Population-Based Studies Clinical-Based Studies Theoretical Implications Clinical Implications Anorexia Nervosa and Depressive Disorders Anorexia and Bipolar Disorders Anorexia Nervosa and Anxiety Disorders Anorexia and Obsessive-Compulsive Disorder Anorexia Nervosa and Psychosis Anorexia Nervosa and Other Disorders Application to Other Eating Disorders Mini-Dictionary of Terms Key Facts Key Facts of Depressive Disorders Key Facts of Bipolar Disorders Key Facts of Anxiety Disorders Key Facts of Obsessive-Compulsive Disorders Key Facts of Psychosis Summary Points References Part III: Bulimia Nervosa 36 The Growth Hormone-IGF-1 Axis in Anorexia Nervosa Introduction GH and IGF-1 Levels in Anorexia Nervosa Potential Causes and Mechanisms of GH Resistance in Anorexia Nervosa Protein Deficiency Ghrelin Sirtuin 1 CREBH Fibroblast Growth Factor (FGF)-21 Insulin Triiodothyronine Leptin Estradiol Testosterone Effects of GH Resistance on Bone Mineral Density Effects of GH and IGF-1 Replacement in Anorexia Nervosa (Table 1) Recombinant Human GH Recombinant Human IGF-1 Applications to Other Eating Disorders Conclusions Mini-Dictionary of Terms Key Facts of the GH/IGF-1 Axis Summary Points Conflict of Interest References 37 Relationship Between Bulimia Nervosa and Psychological Problems in Period of Adolescence Introduction Adolescence: A Risky Period for the Development of Bulimia Nervosa Psychodynamics of Bulimia Nervosa Bulimia Nervosa, Adolescence, and Psychological Profile of the Person Psychological Problems in Adolescence and Bulimia Nervosa The Image of One´s Own Body as a Predictor for the Development of Bulimia Nervosa in the Period of Adolescence Self-Esteem and Bulimia Nervosa Perfectionism and Bulimia Nervosa Anxiety, Depression, and Bulimia Nervosa Other Psychological Problems in Adolescence and Bulimia Nervosa Our Experience What Questionnaires Did We Use for Evaluation? What Do the Obtained Results Show Us? Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Bulimia Nervosa Summary Points References 38 Visuospatial Abilities in Eating Disorders Introduction Visuospatial Abilities and Mental Rotation Central Coherence Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Tasks Description Clinical Implications Treatment Implications Conclusion Application to Other Areas Mini-dictionary of Terms Key facts of Visuospatial Abilities in Eating Disorders Summary Points References 39 Androgens and Their Role in Bulimia Nervosa and Eating Disorder Not Otherwise Specified of Purging Type (EDNOS-P) Introduction Androgens and Their Mechanism of Action The Action of Sex Steroid Hormones in the Pathophysiology of Bulimia Nervosa Binging and Purging: Hormonal Changes Polycystic Ovarian Syndrome: A Hyperandrogenic Condition with Associations with Bulimia Nervosa Antiandrogenic Treatment in Bulimia Nervosa Androgen´s Role in Relation to Psychiatric Disorders and Bulimia Nervosa Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Summary Points References 40 Bulimic Symptomatology Introduction Understanding the Dental Implications: An Outlook for Erosive Tooth Wear Concepts and Epidemiology Biological and Clinical Aspects Etiology Understanding the Dental Implications: An Outlook for Dental Caries Concepts and Epidemiology Biological and Clinical Aspects Etiology Time to Link Bulimic Symptomatology with Oral Health and Food Choices Food Choices and Erosive Tooth Wear vs. Bulimic Symptomatology Scientific Evidence Hypotheses Food Choices and Dental Caries vs. Bulimic Symptomatology Hypotheses The Role of Professionals Toward Oral Health Preventive Approach Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Bulimic Symptomatology, Food Choices, and Oral Health Summary Points References 41 Emotion Regulation in Bulimia Nervosa and Purging Disorder Introduction Conceptual and Theoretical Underpinnings Clinical Observation and Comorbidity Theoretical Models of Bulimia Nervosa as a Disorder of Emotion Regulation Affect Regulation Model Escape Theory Mood Intolerance and the Transdiagnostic Cognitive Behavioral Model of Eating Disorder Maintenance Manifestations of Emotion Regulation Difficulties in Bulimia Nervosa and Purging Disorder Relationship Between State Negative Affect and Binge Eating/Purging Behaviors: Ecological Momentary Assessment Research Interventions Targeting Emotion Regulation Difficulties for Bulimia Nervosa and Purging Disorder Cognitive Behavioral Therapy (CBT) and CBT-Based Intensive Treatments Dialectical Behavior Therapy Integrative Cognitive-Affective Therapy for Bulimia Nervosa Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Emotion Regulation in Bulimia Nervosa and Purging Disorder Summary Points References 42 Pharmacology Options for Bulimia Nervosa Introduction Antidepressants Antiepileptics Stimulants Other Medications Hormonal Other Medications with Mixed/Negative Findings Pharmacology Youth with BN Psychotherapy and Pharmacology Combination in BN Conclusions Mini-Dictionary of Terms Key Facts of Pharmacology Options for Bulimia Nervosa Summary Points References 43 Linking Embodiment Disorder and Bulimia Nervosa Introduction The Lived Body, The Embodied Being Bulimia Nervosa as a Disorder of Embodiment Visceral Interoception Neural Correlates Attachment Style Tempo-spatial Dynamics Embodiment and the Definition of the Self Embodiment and Sexuality Embodiment, Clinical Perspectives Applications to Other Areas Mini-Dictionary of Terms Key Facts References 44 Treating Adolescent Bulimia Nervosa Introduction BN Diagnostic Criteria Prevalence, Onset, and Demographics Transdiagnostic View of BN Comorbidity BN Treatment Other Promising Avenues for Psychotherapy Treatments in Youth Pharmacotherapy for BN Treatment Moderators Research and Clinical Future Directions Summary/Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Treatment for Bulimia Nervosa Summary Points References 45 A Narrative Review on the Dual Pathway Model of Bulimic Pathology Introduction The Risk Factors Included in the DPM for BN Body Mass Index Sociocultural Pressures to Be Thin Thin-Ideal Internalization Body Dissatisfaction Dietary Restraint Negative Affect Dietary Restraint and Negative Affect Empirical Studies Assessing the Dual Pathway Model Cross-Sectional Studies Longitudinal Studies A Note on the Predictive Utility of the DPM for BN Limitations of Previous Studies and Future Directions Clinical and Prevention Implications Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Summary Points References 46 Bulimia Nervosa: Reproduction and Consequences for Mother and Child Introduction Bulimia Nervosa and Fertility Polycystic Ovary Syndrome Polycystic Ovary Syndrome in Bulimia Nervosa Management and Treatment of Amenorrhea in Bulimia Nervosa Long-Term Effect on Fertility The Prevalence of Bulimia Nervosa in Pregnancy Disease Course in Pregnancy and Pregnancy and Perinatal Outcomes in BN The Postpartum Period Children to Mothers with Eating Disorders Management of Pregnant Women with Bulimia Nervosa Applications to Other Eating Disorders Key Facts Key Facts of Amenorrhea in Bulimia Nervosa Key Facts of Pregnancy and Perinatal Outcomes in Women with Bulimia Nervosa Key Facts of Management of Pregnant Women with Bulimia Nervosa Summary Points References Part IV: Binge Eating Disorder 47 Long-Term Outcome of Inpatients and Outpatients with Bulimia Nervosa Introduction The Studies Remission from Bulimia Nervosa Persistence of Bulimia Nervosa at Follow-Up Cross-Over to Other Eating Disorders at Follow-Up Chronicity of Eating Disorders Aspects of Social Functioning at Follow-Up Mortality Outcome of Bulimia Nervosa in Males Application to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Bulimia Nervosa Key Facts of Follow-Up Key Facts of Mortality Summary Points References 48 Parental Care and Binge-Eating Disorder Introduction Psychopathological Aspects Epidemiology Attachment Liability in the Pathogenesis of BED Parenting Style as a Measure of Early Attachment in Psychiatric Disorders Parenting Correlates in Eating Disorders, BED, and Obesity Parenting Influence on Personality Traits of Obese Participants With and Without BED Evidences About Combined Maternal and Paternal Parenting Styles No Specific Parental Style for BED Expression Clinical Implications Preventions Issues Conclusion Implications for Other Eating Disorders Mini-Dictionary of Terms Key Facts of Parental Care and Binge-Eating Disorder Summary Points References 49 DeltaFosB and Preclinical Binge Eating Introduction ΔFosB and BE ΔFosB: What, When, and How? What Is the Effect of ΔFosB Expression on Behavior? What Is the Effect of ΔFosB on Neuronal Activity? BE: What, When, and How? What Do We Know from Human Studies? What Do We Know from Animal Studies? Animal Models of BE Overview of the Reward System Similarities Between Human and Animal Studies Implications for Clinical Contextual Applications Application to Other EDs Mini-Dictionary of Terms Key Facts of ΔFosB Summary Points References 50 Characterization of Binge Eating Days in Daily Life Introduction Binge Eating in Eating Disorders Measuring Binge Eating: State of the Art and Its Limitations Example of Studying Binge Eating through EMA Affect General and Specific Negative and Positive Affect in Daily Life Stress Affective Lability, Emotion Dysregulation, and Dissociation Dietary Restraint and Weight Loss Dieting Food Craving/Hunger and Urge to Binge Physical Appearance and Body Dissatisfaction Cognitive States: Expectancy and Executive Functioning External Context The Aftermath: Consequences of Binge Eating Future Directions in EMA Research on Binge Eating Prediction Methodological Considerations in the Affect-Binge Eating Relationship Moderators in the Relationship Between Antecedents and Binge Eating Including Objective Assessment Measures Individualized Approaches (``N of One Studies´´) Interventions/Clinical Implications Application to Other Eating Disorders Mini Dictionary of Terms Key Facts of Emotional Eating Key Facts of Ecological Momentary Assessment Summary Points References 51 Cancer and Binge Eating Introduction Behavioral Risk Factors for Cancer Associations with Binge Eating and Related Disorders Mental and Emotional Health, Binge Eating, and Cancer Conclusions and Future Directions Application to other Areas Mini-dictionary of Terms Key Facts Summary of Points References 52 Fat Mass and Obesity-Related Gene (FTO) and Binge Eating Disorder in Adults and Adolescents Introduction FTO a Preface Contents About the Editors Contributors Part I: General Aspects, Overviews, and Setting the Scene 1 Enhanced Cognitive Behavior Therapy for Eating Disorders Introduction The Origins of CBT-E Transdiagnostic Theory Overview of CBT-E Goals of CBT-E General Treatment Strategy Forms of CBT-E Versions of CBT-E Outpatient CBT-E for Adults Outpatient CBT-E for Adolescents Intensive Outpatient CBT-E Inpatient CBT-E Post-inpatient Outpatient CBT-E The Status of CBT-E Implications for Clinical Services Remaining Challenges Applications in Other Eating Disorders Mini-Dictionary of Terms Key Facts of Enhanced Cognitive Behavior Therapy for Eating Disorders Summary Points References 2 Eating Disorders During Pregnancy Introduction EDs and Fertility EDs in Pregnancy Gestational AN Gestational BN Binge Eating Disorder (BED) in Pregnancy Pica in Pregnancy Pregorexia Bottlenecks for the Management of EDs and OFSED Before Fertility Treatment and During Gestation Application to Other EDs Mini-dictionary of Terms Key Facts of EDs During Pregnancy Summary Points References 3 Eating Habits During Pregnancy Introduction Role of Maternal Anthropometrics and Nutrition on Short- and Long-Term Outcomes Current Maternal Nutrition Is Inadequate Even in Industrialized Countries Dietary Patterns and Feto-maternal Outcomes Conclusion Mini-Dictionary of Terms Summary Points References 4 Stress and Disordered Eating Patterns Introduction Stress Responses Physiology of Stress Role of the HPA Axis and Glucocorticoids in Eating Behaviors HPA Axis and Dopamine Reward Pathway Hedonics and Addictive Properties of Food Stress and Eating Patterns The Impact of Eating Patterns on Stress and Mood Individual Differences and Disordered Eating Stress and Undereating Stress and Overeating Coping Strategies Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Summary Points References 5 Gene Variants Involved in the Etiopathogenesis of Eating Disorders: Neuropeptides, Neurotransmitters, Hormones, and Their Re... Introduction Family Studies Candidate Gene Association Studies Genome-Wide Association Studies Gene Variants Serotonin Pathway Brain-Derived Neurotrophic Factor Gene Dopamine Receptor Family Opioids and Their Receptors Endocannabinoid Pathway Appetite Regulatory System Other Genes Rare Genetic Variants Conclusions Summary Points References 6 Genes and Eating Disorders Introduction Role of Serotonin in Eating Disorders Characteristics of the Serotonin Transporter (SERT) SLC6A4 Serotonin Transporter Gene Genetic Association Studies Studies of Association of the SLC6A4 Gene and Psychopathological Traits in Eating Disorders Gene x Environment Interaction Studies in Eating Disorder Studies of Sequence of SLC6A4 Conclusions Key Points Key Facts of Genes and Eating Disorders: A Focus on the Solute Carrier Family 6 (Neurotransmitter Transporter, Serotonin), Mem... Summary Points Applications to Other Areas Mini-Dictionary References 7 Eating Disorders in Athletes Introduction Prevalence of EDs in Athletes Risk Factors Which Sports Disciplines Are at Higher Risk for EDs? EDs in Male Athletes Special Considerations on Anorexia Nervosa in Athletes Special Considerations on Bulimia Nervosa and Binge Eating Disorder (BED) in Athletes Special Considerations on Orthorexia Nervosa in Athletes Relative Energy Deficiency in Sport (RED-S) Tools for Screening EDs Specifically in Athletes Application to Other EDs Mini-Dictionary Key Facts of EDs in Athletes Summary Points References 8 Eating Disorders in Children and Adolescents with Attention Deficit Hyperactivity Disorder Introduction ADHD: A Prevalent Neurodevelopmental Disorder in Children and Adolescents ADHD Diagnosis and Etiology ADHD Comorbidities Eating Patterns of Children with ADHD Loss of Control (LOC) Eating/Binge Eating Binge Eating Disorder (BED) Bulimia Nervosa (BN) Anorexia Nervosa (AN) and Avoidant/Restrictive Food Intake Disorder (ARFID) Prevalence of ED in Children and Adolescents with ADHD The Role of Gender in the Prevalence of ED Among Children and Adolescents with ADHD Risk Factors for ED in Children and Adolescents with ADHD Psychiatric Comorbidities and Emotional Regulation Difficulties (ERD) Sleep Disturbances: The Overlooked Factor for Disordered Eating Digital Media Use Influences on Body Satisfaction and Eating Behaviors Possible Mechanisms Underlying the Association Between ADHD and ED Clinical Implications/Clinical Management of ADHD and Eating Disorder Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Eating Disorders in Children and Adolescents with ADHD Key Facts of Reward Deficiency Syndrome (RDS) Key Facts of Stimulant Drugs for ADHD Summary Points References 9 Insomnia in Eating Disorders Insomnia in Eating Disorders Defining Insomnia Insomnia as Transdiagnostic Across Psychopathology Insomnia Disorder and Symptoms in Eating Disorders Hypotheses for Understanding the Underlying Mechanisms of Insomnia and Eating Disorders Hypothesized Psychological Factors Hypothesized Biological Factors Hypothesized Social Factors Treatment Implications Conclusion Applications to Other Eating Disorders Mini-dictionary of Terms Key Facts of Insomnia and Eating Disorders Summary Points References 10 Uric Acid Levels and Eating Disorders Introduction UA Physiological Roles and General Pathophysiological Aspects UA Measurement in Body Fluids Gender Effects on SUA UA in the Central Nervous System (CNS) UA in Neuropsychiatric Disorders UA in Eating Disorders (ED) Conclusion Applications to Other Areas Mini-Dictionary of Terms Key Facts Summary Points References 11 The Virtually Delivered Body Project (vBP): A Viable Option for Large-Scale Prevention of Eating Disorders Introduction Eating Disorders in Context Prevention The Main Prevention Strategies for EDs Cognitive Dissonance Theory and Its Implication for Prevention Dissonance-Based Intervention and Body Project The Efficacy and Effectiveness of the Body Project Influencing Public Health: Prevention on Broad Basis The Promise of Internet and Digital Techniques vBP Applications to Other EDs Mini-Dictionary of Terms Key Facts of the Virtually Delivered Body Project (vBP) and EDs Summary Points References 12 Time-Related Changes in Eating Disorders Introduction Changes in the Concept and Diagnosis of EDs Anorexia Nervosa (AN) Bulimia Nervosa (BN) Transition of Diagnostic Criteria for AN and BN Time Trend of Incidence and Prevalence Western Countries Anorexia Nervosa Bulimia Nervosa Non-Western Countries East Asia West Asia Latin America Africa Changes in Clinical Picture Middle-Aged Women Men Conclusion Applications to Other Eating Disorders Mini-dictionary of Terms Key Facts of Time-Related Changes in Eating Disorders Summary Points References 13 The Connection Between Eating Disorders and Substance Use Disorders Introduction Eating Disorders Substance Use Disorders Genetics The Role of Serotonin The Role of Dopamine Genetics and ED-SUD Neurobiology Neurobiology of SUD Neurobiology of ED Neurobiology of ED-SUD Neuroimaging Findings in SUD and ED Temperament Impulsivity in SUD and ED Executive Function Deficits Executive Function Deficits in SUD and ED Emotion Regulation Emotion Regulation in SUD and ED Additional Shared Risk Factors for SUD and ED Adverse Events, Trauma, and SUD Adverse Events, Trauma, and ED Adverse Events, Trauma, and ED-SUD Clinical Implications Conclusions Mini-dictionary of Terms Key Facts of Substance Use Disorders Summary Points References 14 Fluid Restriction in Eating Disorders Introduction Recognizing Intentional Fluid Restriction How Much Fluid Does a Patient Need? Who Restricts Fluids? Why Do Patients Restrict Fluids? Clinical Cases Case 1: Adele Case 2: Bianca Case 3: Celia Treatment of Fluid Restriction Fluid Replacement Behavioral Interventions Psychological Interventions Applicability to Other Eating Disorders Mini-dictionary of Terms Key Facts About Fluid Restriction Summary Points About Fluid Restriction References 15 Features of Medical Consultations Before the Onset of Eating Disorders Introduction Risk Factors and Prodromes as Predictors for Future Emergence of EDs Features of Medical Consultations Before the Onset of EDs Other Important Features of EDs Prevention of EDs, Intervention Programs, and Impact Applications to Other EDs Mini-Dictionary of Terms Key Facts of Features of Medical Consultations Before the Onset of EDs Summary Points References 16 The Role of Parents and Other Caregivers in the Early Detection of Eating Disorders Introduction The Early Intervention Continuum The Role of Parents in Early Detection Earliest Detectable Symptoms Barriers to Early Detection of Eating Disorders Parent-Led Early Intervention Programs Parent-Led Risk Factor Reduction Parent-Led Treatments for the Prodromal Phase Parent Support in the Early Eating Disorder Phase Conclusion Applications to Other Eating Disorders Mini Dictionary of Terms Key Facts of Parent-Led Early Detection Summary Points References 17 Alexithymia in Eating Disorders: A Narrative Review Introduction Types of Alexithymia Impact of Alexithymia Assessment on Research Findings Structure and Rationale of the Current Review Findings from Case-Control Studies Findings in Cohort Studies with Community Samples Showing ED Symptoms Findings from Clinical Samples: Alexithymia Differences According to AN and BN Diagnosis Longitudinal Findings and the Impact of Alexithymia on ED Treatment Outcomes The Longitudinal Variation of Alexithymia: Does It Have an Effect? Therapeutic Implications and Applications Limitations and Future Lines of Research Conclusions Mini-Dictionary of Terms Key Facts of Alexithymia Summary Points References 18 Eating Disorder and Quality of Life Introduction General Characteristics of EDs Comorbidities of ED Relationship Between QoL and ED Relationship Between System of Organs and EDs Dynamics of ED and QoL Considerations for Targeted Interventions for QoL in the Treatment of Patients with EDs Conclusion Mini Dictionary of Terms Key Facts of Eating Disorders and Quality of Life Summary Points References 19 The Role of Denial in Eating Disorder Development, Assessment, and Treatment Introduction Defining Denial of Disordered Eating Etiology of the Denial of Disordered Eating Consequences of Denial of Disordered Eating Assessment Treatment Future Directions Summary Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Denial of Disordered Eating Summary Points References 20 The Role of the Dietitian Overview of Dietetic Treatment for Eating Disorders Nutrition Assessment Nutritional Issues in Individuals with Eating Disorders Nutrition Assessment for Eating Disorders Nutrition Intervention, Monitoring, and Evaluation Nutrition Education and Counselling Outpatient Dietetic Treatment for Eating Disorders Calcium Foods Protein Carbohydrates Fruits and Vegetables Fluids Nuts, Oils, and Fats Diet Foods and Fillers Inpatient Dietetic Treatment for Eating Disorders, Including Considerations for Individuals with Anorexia Nervosa Refeeding Syndrome Nutrition Support for Inpatients Considerations for Individuals with Bulimia Nervosa Treatment Considerations for Individuals with Bulimia Nervosa Considerations for Individuals with Binge Eating Disorder Considerations for Individuals with Co-occurring Binge Eating Disorder and Obesity Application to Other Eating Disorders Mini-Dictionary of Terms Key Facts Key Facts Regarding the Role of Dietitians in Eating Disorder Treatment Summary Points References Part II: Anorexia Nervosa 21 A Research Approach to Self-Report and Objective Measurements of Physical Activity in Eating Disorders Introduction Assessment Tools for Measuring Objective and Psychological Components of PA in EDs Self-Report Measurement of PA in EDs Self-Report Measures of Objective Components of PA Self-Report Measures of General PA Motivations Self-Report Measures of Maladaptive PA Strengths and Weaknesses of Self-Report Measures of PA Ecological Momentary Assessment of PA in EDs EMA of Objective Components of PA EMA of General PA Motivations EMA Maladaptive PA Strengths and Weaknesses of EMA Measures of PA Semi-structured Interviews of PA in EDs Semi-structured Interviews of Maladaptive PA Strengths and Weaknesses of Semi-structured Interviews of PA Assessment Tools for Measuring Objective Components of PA in EDs Objective Measurement: Types of Sensor Technology Objective Measurement Outcome Variables Strengths and Weaknesses of Objective PA Measurement Future Directions of Assessment of Psychological and Objective Components of PA in EDs Mini-Dictionary of Terms Key Facts Summary Points References 22 Body Mass Index and Body Fat in Anorexia Nervosa Introduction Definitions of BMI and BF BMI BF Methods of Assessment in AN Clinical Settings Weight, Height, and Standard for BMI Determination BF Estimation and Measurement Skinfold Thickness (ST) BIA DXA Changes in BMI and BF Before and After Weight Gain and Normalization Relationship Between BMI, BF, and Clinical Outcomes Remission, Recovery, and Risk of Relapse Resumption of Menses and Reproductive Functions Osteoporosis and Restoration of BMD Summary References 23 Modeling Anorexia Nervosa Introduction AA-Derived eiCs Pathways eiCs Receptors eiCs and Neuroinflammation Animal Models of AN Neuroinflammation in Animal Models of AN eiCs in the ABA Model Conclusion Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Anorexia Nervosa Summary Points References 24 Anorexia Nervosa and Impact After Three Decades Introduction Sten Theander ́s Study in the Southern Part of Sweden The Gothenburg Anorexia Nervosa Study Background and Methods Neurofilament Light Chain Protein in Serum Facial Emotion Recognition Task Definition of Full Eating Disorder Recovery Results General Outcome Eating Disorder Outcome Psychiatric Morbidity Neurodegenerative Findings Facial Emotion Recognition Task Comparisons Between Theander ́s Study and the Gothenburg AN Study Discussion Conclusions Key Facts Summary Points References 25 Linking Anorexia Nervosa with the Gut Microbiota Introduction The Microbiota-Gut-Brain Axis Gut Microbiota Link to AN Intestinal Microbial Metabolites in AN Gut Microbiota Adaptation to Diet Manipulating the Gut Microbiota Antibiotics Probiotics, Prebiotics, and Psychobiotics Fermented Food Fecal Microbiota Transplantation Immunity Involvement Potential Mechanisms in AN Development Applications to Other Eating Disorders Mini-dictionary of Terms Key Facts of Human Microbiota Key Facts of Microbiota in Patients with AN Key Facts of Gut Microbiota Modifications Summary Points References 26 Gender Aspects of Anorexia Nervosa: the Male Introduction Prevalence Risk Factors, Symptom Onset, and Age of Presentation Symptoms and Comorbidities Medical Complications Course and Prognosis Treatment Role of the Dietitian Future Directions and Need for Awareness Application to Other Eating Disorders Mini-dictionary of Terms Key Facts Key Facts of DSM (Diagnostic and Statistical Manual of Mental Disorders) Key Facts of BMI Summary Points References 27 The Biology of Anorexia Nervosa Introduction Clinical Presentation of Anorexia Nervosa Neurohormonal Regulation of Appetite and Metabolism Brain Centers of Energy Homeostasis Hypoleptinemia in Anorexia Nervosa: A Chicken or an Egg? Interaction of Metabolic State and Gonadal Function Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Anorexia Nervosa Summary Points References 28 The Hippocampus in Anorexia Nervosa Introduction Hippocampus in Animal Model of AN Structural Studies Functional Studies Hippocampus in Other Eating Disorders Applications to Other Areas Mini-Dictionary of Terms Key Facts of Hippocampus in Anorexia Nervosa Summary Points References 29 Endocrine Disturbances in Anorexia Nervosa Introduction Physiological Functions of Ghrelin Ghrelin and Reward Signaling in AN Clinical Evidence of Ghrelin Resistance Ghrelin Resistance: Antagonism by Other Ghrelin-Derived Peptides? Physical Activity: The Patients ́ Option to Induce Ghrelin Resistance? Genetic Factors Involved in Ghrelin Resistance Chronicity and Ghrelin Levels in AN Application to Other Eating Disorders Summary Points Mini-Dictionary References 30 Anorexia Nervosa and Eye Movements Introduction Neurobiology of Saccadic Eye Movements Saccade Characteristics Saccade Tasks Fixation Task Prosaccade Task Antisaccade Task Go/No-Go Saccade Task Memory-Guided Saccade Task Self-Paced Saccade Task Visual Scan Path Tasks Attentional Bias Tasks Conclusions and Implications Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Eye Movements in AN Summary Points References 31 Anorexia Nervosa: Reproduction and Consequences for Mother and Child Introduction Anorexia Nervosa and Fertility Functional Hypothalamic Amenorrhea Management and Treatment of Functional Hypothalamic Amenorrhea Long-Term Effect on Fertility The Prevalence of Anorexia Nervosa in Pregnancy Disease Course in Pregnancy Anorexia Nervosa and Pregnancy Complications Anorexia Nervosa and Adverse Perinatal Outcomes The Postpartum Period Children to Mothers with Eating Disorders Management of Pregnant Women with Anorexia Nervosa Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Key Facts of Amenorrhea in Anorexia Nervosa Key Facts of Pregnancy and Perinatal Outcomes in Women with Anorexia Nervosa Key Facts of Management of Pregnant Women with Anorexia Nervosa Summary Points References 32 Anorexia Nervosa in the Acute Hospitalization Setting Introduction Hospitalization Criteria Integrated Treatment Nutritional Rehabilitation Refeeding Process Caloric Prescription Nutrient Quality and Nutrient Supplementation Nasogastric Feeding and Parenteral Nutrition Psychological Treatment Psychopharmacological Treatment Behavioral Management Motivation to Treatment Treatment Outcomes Renutrition Psychopathology Quality of Life Rehospitalization Discharge and Follow-up Applications to Other Eating Disorders Mini Dictionary of Terms Summary Points References 33 Anorexia Nervosa and Comorbidities Introduction Feeding and Eating Disorders Anorexia Nervosa Mental Health Comorbidities in Individuals with AN Autism Spectrum Disorder AN and ASD General Considerations Epidemiology Psychodiagnostics Clinical Traits and Theories Treatments and Outcomes Conclusions Applications to Other Eating Disorders Mini Dictionary of Terms Key Facts of Anorexia Nervosa and Comorbidities: Linking Autism Summary Points References 34 The Electrocardiogram in Anorexia Nervosa Introduction Background Heart Rate and Heart Rhythm The Electrocardiogram The Electrocardiogram in Anorexia Nervosa The ECG in Anorexia Nervosa Bradycardia Heart Rate Variability QTc Interval T-Wave Changes Special Circumstances Impact of Refeeding The Electrocardiogram during Exercise Psychopharmacotherapy and the Electrocardiogram Sudden Unexpected Death Clinical Use of the ECG in AN Conclusion Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of the Electrocardiogram in Anorexia Nervosa Summary Points References 35 Anorexia Nervosa and Concurrent Psychiatric Comorbidity Introduction Psychiatric Comorbidity in Anorexia Nervosa Population-Based Studies Clinical-Based Studies Theoretical Implications Clinical Implications Anorexia Nervosa and Depressive Disorders Anorexia and Bipolar Disorders Anorexia Nervosa and Anxiety Disorders Anorexia and Obsessive-Compulsive Disorder Anorexia Nervosa and Psychosis Anorexia Nervosa and Other Disorders Application to Other Eating Disorders Mini-Dictionary of Terms Key Facts Key Facts of Depressive Disorders Key Facts of Bipolar Disorders Key Facts of Anxiety Disorders Key Facts of Obsessive-Compulsive Disorders Key Facts of Psychosis Summary Points References Part III: Bulimia Nervosa 36 The Growth Hormone-IGF-1 Axis in Anorexia Nervosa Introduction GH and IGF-1 Levels in Anorexia Nervosa Potential Causes and Mechanisms of GH Resistance in Anorexia Nervosa Protein Deficiency Ghrelin Sirtuin 1 CREBH Fibroblast Growth Factor (FGF)-21 Insulin Triiodothyronine Leptin Estradiol Testosterone Effects of GH Resistance on Bone Mineral Density Effects of GH and IGF-1 Replacement in Anorexia Nervosa (Table 1) Recombinant Human GH Recombinant Human IGF-1 Applications to Other Eating Disorders Conclusions Mini-Dictionary of Terms Key Facts of the GH/IGF-1 Axis Summary Points Conflict of Interest References 37 Relationship Between Bulimia Nervosa and Psychological Problems in Period of Adolescence Introduction Adolescence: A Risky Period for the Development of Bulimia Nervosa Psychodynamics of Bulimia Nervosa Bulimia Nervosa, Adolescence, and Psychological Profile of the Person Psychological Problems in Adolescence and Bulimia Nervosa The Image of One ́s Own Body as a Predictor for the Development of Bulimia Nervosa in the Period of Adolescence Self-Esteem and Bulimia Nervosa Perfectionism and Bulimia Nervosa Anxiety, Depression, and Bulimia Nervosa Other Psychological Problems in Adolescence and Bulimia Nervosa Our Experience What Questionnaires Did We Use for Evaluation? What Do the Obtained Results Show Us? Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Bulimia Nervosa Summary Points References 38 Visuospatial Abilities in Eating Disorders Introduction Visuospatial Abilities and Mental Rotation Central Coherence Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder Tasks Description Clinical Implications Treatment Implications Conclusion Application to Other Areas Mini-dictionary of Terms Key facts of Visuospatial Abilities in Eating Disorders Summary Points References 39 Androgens and Their Role in Bulimia Nervosa and Eating Disorder Not Otherwise Specified of Purging Type (EDNOS-P) Introduction Androgens and Their Mechanism of Action The Action of Sex Steroid Hormones in the Pathophysiology of Bulimia Nervosa Binging and Purging: Hormonal Changes Polycystic Ovarian Syndrome: A Hyperandrogenic Condition with Associations with Bulimia Nervosa Antiandrogenic Treatment in Bulimia Nervosa Androgen ́s Role in Relation to Psychiatric Disorders and Bulimia Nervosa Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Summary Points References 40 Bulimic Symptomatology Introduction Understanding the Dental Implications: An Outlook for Erosive Tooth Wear Concepts and Epidemiology Biological and Clinical Aspects Etiology Understanding the Dental Implications: An Outlook for Dental Caries Concepts and Epidemiology Biological and Clinical Aspects Etiology Time to Link Bulimic Symptomatology with Oral Health and Food Choices Food Choices and Erosive Tooth Wear vs. Bulimic Symptomatology Scientific Evidence Hypotheses Food Choices and Dental Caries vs. Bulimic Symptomatology Hypotheses The Role of Professionals Toward Oral Health Preventive Approach Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Bulimic Symptomatology, Food Choices, and Oral Health Summary Points References 41 Emotion Regulation in Bulimia Nervosa and Purging Disorder Introduction Conceptual and Theoretical Underpinnings Clinical Observation and Comorbidity Theoretical Models of Bulimia Nervosa as a Disorder of Emotion Regulation Affect Regulation Model Escape Theory Mood Intolerance and the Transdiagnostic Cognitive Behavioral Model of Eating Disorder Maintenance Manifestations of Emotion Regulation Difficulties in Bulimia Nervosa and Purging Disorder Relationship Between State Negative Affect and Binge Eating/Purging Behaviors: Ecological Momentary Assessment Research Interventions Targeting Emotion Regulation Difficulties for Bulimia Nervosa and Purging Disorder Cognitive Behavioral Therapy (CBT) and CBT-Based Intensive Treatments Dialectical Behavior Therapy Integrative Cognitive-Affective Therapy for Bulimia Nervosa Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Emotion Regulation in Bulimia Nervosa and Purging Disorder Summary Points References 42 Pharmacology Options for Bulimia Nervosa Introduction Antidepressants Antiepileptics Stimulants Other Medications Hormonal Other Medications with Mixed/Negative Findings Pharmacology Youth with BN Psychotherapy and Pharmacology Combination in BN Conclusions Mini-Dictionary of Terms Key Facts of Pharmacology Options for Bulimia Nervosa Summary Points References 43 Linking Embodiment Disorder and Bulimia Nervosa Introduction The Lived Body, The Embodied Being Bulimia Nervosa as a Disorder of Embodiment Visceral Interoception Neural Correlates Attachment Style Tempo-spatial Dynamics Embodiment and the Definition of the Self Embodiment and Sexuality Embodiment, Clinical Perspectives Applications to Other Areas Mini-Dictionary of Terms Key Facts References 44 Treating Adolescent Bulimia Nervosa Introduction BN Diagnostic Criteria Prevalence, Onset, and Demographics Transdiagnostic View of BN Comorbidity BN Treatment Other Promising Avenues for Psychotherapy Treatments in Youth Pharmacotherapy for BN Treatment Moderators Research and Clinical Future Directions Summary/Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Treatment for Bulimia Nervosa Summary Points References 45 A Narrative Review on the Dual Pathway Model of Bulimic Pathology Introduction The Risk Factors Included in the DPM for BN Body Mass Index Sociocultural Pressures to Be Thin Thin-Ideal Internalization Body Dissatisfaction Dietary Restraint Negative Affect Dietary Restraint and Negative Affect Empirical Studies Assessing the Dual Pathway Model Cross-Sectional Studies Longitudinal Studies A Note on the Predictive Utility of the DPM for BN Limitations of Previous Studies and Future Directions Clinical and Prevention Implications Conclusions Applications to Other Eating Disorders Mini-Dictionary of Terms Key Facts Summary Points References 46 Bulimia Nervosa: Reproduction and Consequences for Mother and Child Introduction Bulimia Nervosa and Fertility Polycystic Ovary Syndrome Polycystic Ovary Syndrome in Bulimia Nervosa Management and Treatment of Amenorrhea in Bulimia Nervosa Long-Term Effect on Fertility The Prevalence of Bulimia Nervosa in Pregnancy Disease Course in Pregnancy and Pregnancy and Perinatal Outcomes in BN The Postpartum Period Children to Mothers with Eating Disorders Management of Pregnant Women with Bulimia Nervosa Applications to Other Eating Disorders Key Facts Key Facts of Amenorrhea in Bulimia Nervosa Key Facts of Pregnancy and Perinatal Outcomes in Women with Bulimia Nervosa Key Facts of Management of Pregnant Women with Bulimia Nervosa Summary Points References Part IV: Binge Eating Disorder 47 Long-Term Outcome of Inpatients and Outpatients with Bulimia Nervosa Introduction The Studies Remission from Bulimia Nervosa Persistence of Bulimia Nervosa at Follow-Up Cross-Over to Other Eating Disorders at Follow-Up Chronicity of Eating Disorders Aspects of Social Functioning at Follow-Up Mortality Outcome of Bulimia Nervosa in Males Application to Other Eating Disorders Mini-Dictionary of Terms Key Facts of Bulimia Nervosa Key Facts of Follow-Up Key Facts of Mortality Summary Points References 48 Parental Care and Binge-Eating Disorder Introduction Psychopathological Aspects Epidemiology Attachment Liability in the Pathogenesis of BED Parenting Style as a Measure of Early Attachment in Psychiatric Disorders Parenting Correlates in Eating Disorders, BED, and Obesity Parenting Influence on Personality Traits of Obese Participants With and Without BED Evidences About Combined Maternal and Paternal Parenting Styles No Specific Parental Style for BED Expression Clinical Implications Preventions Issues Conclusion Implications for Other Eating Disorders Mini-Dictionary of Terms Key Facts of Parental Care and Binge-Eating Disorder Summary Points References 49 DeltaFosB and Preclinical Binge Eating Introduction ΔFosB and BE ΔFosB: What, When, and How? What Is the Effect of ΔFosB Expression on Behavior? What Is the Effect of ΔFosB on Neuronal Activity? BE: What, When, and How? What Do We Know from Human Studies? What Do We Know from Animal Studies? Animal Models of BE Overview of the Reward System Similarities Between Human and Animal Studies Implications for Clinical Contextual Applications Application to Other EDs Mini-Dictionary of Terms Key Facts of ΔFosB Summary Points References 50 Characterization of Binge Eating Days in Daily Life Introduction Binge Eating in Eating Disorders Measuring Binge Eating: State of the Art and Its Limitations Example of Studying Binge Eating through EMA Affect General and Specific Negative and Positive Affect in Daily Life Stress Affective Lability, Emotion Dysregulation, and Dissociation Dietary Restraint and Weight Loss Dieting Food Craving/Hunger and Urge to Binge Physical Appearance and Body Dissatisfaction Cognitive States: Expectancy and Executive Functioning External Context The Aftermath: Consequences of Binge Eating Future Directions in EMA Research on Binge Eating Prediction Methodological Considerations in the Affect-Binge Eating Relationship Moderators in the Relationship Between Antecedents and Binge Eating Including Objective Assessment Measures Individualized Approaches (``N of One Studies ́ ́) Interventions/Clinical Implications Application to Other Eating Disorders Mini Dictionary of Terms Key Facts of Emotional Eating Key Facts of Ecological Momentary Assessment Summary Points References 51 Cancer and Binge Eating Introduction Behavioral Risk Factors for Cancer Associations with Binge Eating and Related Disorders Mental and Emotional Health, Binge Eating, and Cancer Conclusions and Future Directions Application to other Areas Mini-dictionary of Terms Key Facts Summary of Points References 52 Fat Mass and Obesity-Related Gene (FTO) and Binge Eating Disorder in Adults and Adolescents Introductio