When therapeutic goals are established for patients with active mood and eating disorder symptoms, the selection of a treatment setting should be guided by a careful assessment of acute medical and psychiatric risks. Persons with a BMI of less than 16.0 kg/m2 or frequent purging that leads to electrolyte abnormalities may require inpatient hospitalization for medical stabilization and early nutritional rehabilitation, even if they do not meet criteria for hospitalization on the basis of the severity of their mood symptoms alone. In the outpatient setting, routine monitoring of weight, vital signs, and (especially in those who purge) serum electrolytes should be incorporated into the treatment of patients with comorbid mood and eating disorders.
Treatment modalities for eating disorders and mood disorders often overlap. Cognitive-behavioral therapy (CBT), which addresses dysfunctional beliefs and maladaptive behaviors that perpetuate symptomatology, is a well-established evidence-based treatment for both disorders.11 In addition to its efficacy for MDD, CBT monotherapy has been shown to achieve remission rates in nearly 50% of patients with bulimia nervosa.12 Remission rates of about 50% to 60% were seen when individuals with binge eating disorder received CBT.13,14 Unfortunately, while the evidence supporting the use of CBT for both binge eating disorder and bulimia nervosa is strong, CBT has not shown similar rates of efficacy with anorexia nervosa.
Initially developed for the treatment of depression, interpersonal psychotherapy is a time-limited intervention that has also shown efficacy for the treatment of bulimia nervosa and binge eating disorder.15
Dr Uniacke is an upcoming Chief Resident in the department of psychiatry at the Columbia University Medical Center in New York City. Dr Broft is Assistant Professor of Psychiatry at the Columbia University Medical Center; she is also a psychiatrist in private practice in New York City. The authors report no conflicts of interest concerning the subject matter of this article.
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