The Eating Disorders Medical and Psychological Bases of Diagnosis and Treatment Edited by Barton J. Blinder, M.D., Ph.D. Department ofP.sychiatry and Human Behavior College ofMedicine, University of California, Irvine Director, Eating Disorders Program and Research Studies Barry F. Chaitin, M.D. Department of Psychiatry and Human Behavior College of Medicine, University of California, Irvine Clinical Director, University Service, Capistrano-by-the-Sea Hospital Renee S. Goldstein, Ph.D. Department of Psychiatry and Human Behavior College of Medicine, University of California, Irvine PMA PUBLISHING CORP. New York Copyright © 1988 by PMA Publishing Corp. All rights reserved. This book is protected by copyright. No part of it may be reproduced, stored in a retrieval system or transmitted in any form or by any manner or means: electronic. electrostatic, magnetic tape, mechanical, photocopying, recording or otherwise, without written permission from the publisher NOTICE: The editors, contributors, and publisher of this work have made every effort to ensure that the drug dosage schedules and/or procedures are accurate and in accord with the standards accepted at the time of publications. Readers are cautioned, however, to check the product information sheet included in the package of each drug they plan to administer. This is particularly important in regard to new or infrequently used drugs. The publisher is not responsible for any errors of fact or omissions in this book. . , Library of Congress Cataloging in Publication Data The Eating disorders. Includes bibliographies and index. 1. Eating disorders. I. Blinder, Barton J.. II. Chaitin, Barry F. III. Goldstein, Renee. [DNLM: 1. Appetite Disorders — diagnosis. 2. Appetite Disorders — therapy. WM 175 E1475] RC552.E18E285 1988 616.85'2 88-15251 ISBN 0-89335-300-0 Printed in the United States of America Dedication The editors dedicate this volume to Hilde Bruch, M.D., and Albert Stunkard, MD., whose scientific contributions and educational endeavors have enriched the field. . Contributors ELLIOTT M. BLASS, PH.D. KATHERINE DIXON, M.D. Department of Psychology, The Johns Hopkins Psychiatric Centers at San Diego University San Diego, California Baltimore, Maryland ADAM DREWNOWSKI, PH.D. BARTON J. BLINDER, M.D., PH.D Human Nutrition Program, School of Public Department of Psychiatry and Human Behavior, Health, The University of Michigan University of California Irvine Ann Arbor, Michigan University Service, Capistrano by the Sea Hospital Dana Point, California MICHAEL H. EBERT, M.D. Department of Psychiatry, Vanderbilt University JOHN E. BLUNDELL, PH.D., F.B.PS.S. Nashville, Tennessee Department of Psychology, The University of Leeds United Kingdom DANIEL M.A. FREEMAN, M.D. Private Practice BARRY F. CHAITIN, M.D. Jenkintown, Pennsylvania Department of Psychiatry and Human Behavior, University of California Irvine A. GERTLER, M.A. University Service, Capistrano by the Sea Hospital Rishon Le-Zion Mental Health Community Clinic Dana Point, California Israel ROWAN T. CHLEBOWSKI, M.D., PH.D. JAMES GIBBS, M.D. Department of Medicine, Division of Medical The Edward W. Bourne Behavioral Research Oncology, Harbor UCLA Medical Center Laboratory, Department of Psychiatry, The New UCLA School of Medicine York Hospital-Cornell Medical Center Torrance, California White Plains, New York JEAN DENSMORE-JOHN, M.D., R.D. I. LEE GISLASON, M.D. Nutritionist in Private Practice Department of Psychiatry and Human Behavior, Clinical Nutrition Consultants of Santa Barbara Child Study Center, University of California Irvine Santa Barbara, California UCI Medical Center Orange, California vii viii The Eating Disorders STANLEY GOODMAN, M.D. DOUGLAS G. KAHN, M.D. Private Practice Department of Psychiatry and Human Behavior, Irvine, California University of California Irvine College of Medicine RICHARD A. GORDON, PH.D. Newport Beach, California Department of Psychology, Bard College WALTER H. KAYE, M.D. Annandale-on-Hudson, New York Department of Psychiatry, University of Pittsburgh Pittsburgh, Pennsylvania HARVEY E. GWIRTSMAN, M.D. Neuropsychiatric Institute, University of California DEAN D. KRAHN, M.D. Los Angeles Department of Psychiatry, Veterans Administration Los Angeles, California Medical Center Minneapolis, Minnesota JENNIFER HAGMAN, M.D. Department of Psychiatry and Human Behavior, SHELDON L KRAMER, PH.D. University of California Irvine, UCI Medical Department of Psychology, Assistant Clinical Center Training Director of Clinical Psychology, U.S. Orange, California International University, San Diego Medical Consultant and Trainer of Family Therapy, ROBERT HAMPTON, III, M.D. Department of Psychiatry, U.S. Navy, San Diego Private Practice San Diego, California Balboa, California JAMES R. KUECHLER, M.D. PHYLLIS HENDERSON, M.D. Department of Psychiatry and Human Behavior, Department of Psychiatry University of California Irvine Loma Linda University Medical Center Muirlands Medical Center Loma Linda, California El Toro, California MARION HETHERINGTON, V. PHIL. C. RAYMOND LAKE, M.D., PH.D. Department of Psychiatry and Behavioral Sciences, Departments of Psychiatry and Pharmacology, The Johns Hopkins University School of Medicine Uniform Services, University of Health Sciences Baltimore, Maryland Bethesda, Maryland ANDREW J. HILL, PH.D. FELIX E.F. LAROCCA, M.D., F.A.P.A. Department of Psychology, The University of Leeds BASH Treatment and Research Center, Deaconess United Kingdom Hospital St. Louis, Missouri LEIGH-ANN HOHLSTEIN Laboratory of Clinical Science, Section of Clinical PIERRE LEICIINER, M.D. Studies, National Institute on Alcohol Abuse Director, Community Psychiatric Center, Douglas Bethesda, Maryland Hospital Verdun, Quebec, Canada L.K. GEORGE HSU, M.D. Department of Psychiatry, School of Medicine, ALLAN S. LEVINE, PH.D. Western Psychiatric Institute and Clinic, Neuroendocrine Research Laboratory, Veterans University of Pittsburgh Administration Medical Center Pittsburgh, Pennsylvania Minneapolis, Minnesota GLYNN ISAAC, PH.D. (DEC.) RONALD LIEBMAN, M.D. Department of Anthropology, Peabody Museum, Department of Psychiatry, Temple University Harvard University School of Medicine Cambridge, Massachusetts Philadelphia, Pennyslvania Contributors ix NADINE A. LEVINSON, D.D.S. TIMOTHY SCHALLERT, M.D. Department of Psychiatry and Human Behavior, Psychology Department, Institute for Neurological University of California Irvine Sciences, University of Texas at Austin Laguna Niguel, California Austin, Texas DAVID L MARGULES, PH.D. JEANNE SEPT, PH.D. Department of Psychology, Temple University Department of Anthropology, Indiana University Philadelphia, Pennsylvania Bloomington, Indiana ROLF MEERMAN, M.D., PH.D. JAMES C. SHEININ, M.D. Lecturer of Psychiatry at the University of Munster, Division of Endocrinology and Metabolism, School of Medicine and Medical Director, Department of Medicine, Michael Reese Psychosomatic Hospital Bad Pyrmont Hospital and Medical Center, University of Bad Pyrmont, West Germany Chicago, Pritzker School of Medicine Chicago, Illinois JAMES E. MITCHELL, M.D. Department of Psychiatry, University of Minnesota DAVID C. SIBLEY, M.D. Minneapolis, Minnesota Private Practice Brea, California JOHN E. MORLEY, M.D. Veterans Administration Medical Center LAWRENCE D. SPORTY, M.D. Sepulveda, California Department of Psychiatry and Human Behavior, University of California Irvine Medical Center CHRISTIANE NAPIERSKI, M.D. Orange, California Department of Psychiatry, University of Munster Munster, West Germany MARC H. STOLAR, M.D. Private Practice RICHARD L PYLE, M.D. Tustin, California Department of Psychiatry, University of Minnesota Minneapolis, Minnesota CARL L THOMPSON, PH.D. Department of Psychology, Wabash College BARBARA J. ROLLS, PH.D. Crawfordsville, Indiana Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine WALTER VANDEREYCKEN, M.D. Baltimore, Maryland University Psychiatric Center Kortenberg, Belgium PETER ROY-BYRNE, M.D. Biological Psychiatry Branch, National Institute of TIMOTHY WALSH, M.D. Mental Health Department of Psychiatry, College of Physicians & Bethesda, Maryland Surgeons, Columbia University New York, New York S. MARK SACHER, D.O. Department of Psychiatry and Human Behavior, PHILIP WILSON, M.D. University of California Irvine Private Practice UCI Medical Center New York, New York Orange, California JOSEPH L WOOLSTON, M.D. JOHN SARGENT, M.D. Child Study Center, Yale University Center for Psychosomatic and Eating Disorders, New Haven, Connecticut Philadelphia Guild Guidance Clinic Philadelphia, Pennsylvania Contents Preface xv Acknowledgement xvii Section I: Neurobiologic Foundations of Appetite and Eating: Basic and Applied Studies John E. Morley Basic Studies 1 The Development of Feeding Behavior 3 Elliott M. Blass 2 Neurotransmitter Regulation of Appetite and Eating 11 John E. Morley, Allan S. Levine, and Dean D. Krahn 3 Energy Balance and Opioid Receptors: Epsilons in the Periphery Promote Conservation; Kappa and Delta in the CNS Permit Expenditures 21 David L. Maigules 4 Long-Term History of Human Diet 29 Glynn LI. Isaac, and Jeanne M. Sept 5 Animal Models of Eating Disorders: Hypothalamic Function 39 Timothy Schallert 6 Adjusting Food Intake to Meet Homeostatic Demands: Implications for Anorexia Nervosa 49 Carl I. Thompson 7 Gastrointestinal Peptides and the Limitation of Meal Size 57 James Gibbs Applied Studies 8 Descriptive and Operational Study of Eating in Humans 65 John E. Blundell and Andrew J. Hill 9 The Effect of Psychopharmacological Agents on Appetite and Eating 87 Marc H. Stolar xi xii The Eating Disorders 10 Palatability and Preference: Basic Studies 101 Barbara J. Rolls and Marion Hetherington 11 Physiological Basis of Food Preferences in Eating Disorders 121 Adam Drewnowski Section II: Clinical Entities Barton J. Blinder, Bany F. Chaitin, and Renee Goldstein Psychobiologic and Psychosocial Bases 12 Prevalence and Incidence Studies of Anorexia Nervosa 131 Pierre Leichner and A. Genler 13 A Sociocultural Interpretation of the Current Epidemic of Eating Disorders 151 Richard A. Gordon s,' 14 ; Family Structure of Interpersonal Relationships in the Eating Disorders 165 Sheldon Z. Kramer 15 Experimental Body Image Research in Anorexia Nervosa Patients 177 Rolf Meermann, Christiane Napierski, and Walter Vandereycken 16 Transcultural Perspectives on Eating Disorders 195 Daniel M.A. Freeman 17 New Neuroendocrine Findings in Anorexia Nervosa and Bulimia 205 Hairy E. Gwirtsman, Leigh Anne Hohlstein, and Peter Roy-Byrne 18 Disturbances in Brain Neurotransmitter Systems in Anorexia Nervosa: A Review of CSF Studies 215 Walter H. Kaye, Michael H. Ebert, and C. Raymond Lake 19 Pathophysiologic and Clinical Aspects of Medical, Endocrine, and Nutritional Abnormalities and Adaptations in Eating Disorders 227 James C. Sheinin Clinical Disorders 20 Classification and Diagnosis of the Eating Disorders 235 L.K. George Hsu 21 The Etiology of Anorexia Nervosa 239 L.K. George Hsu 22 Anorexia Nervosa 247 David C Sibley and Barton J. Blinder 23 The Epidemiology of Bulimia 259 Richard L Pyle and James E. Mitchell 24 The Diagnosis and Clinical Characteristics of Bulimia 267 James E. Mitchell and Richard L. Pyle 25 Eating Disorders in Infancy and Early Childhood 275 Joseph L. Woolston 26 Eating Disorders in Child ood (Ages 4 Through 11 Years) 285 I. Lee Gislason