A Reassessment of the Classification and Management of Eating Disorders: Should the Relative Importance of Symptoms and Aetiology Be Re-Balanced?
Eating disorder (ED) pathology is an important cause of psychosocial and physical morbidity across multiple age groups, and is becoming increasingly prevalent1,2. This paper provides an up-to-date assessment of current knowledge about EDs, addressing the roles of potential causes (aetiology) as well as symptoms. How well this information is reflected by current diagnostic and treatment strategies is considered, with a view to proposing novel ways in which the clinical management of EDs may be optimised to align with the latest research findings about which factors may truly be driving these diseases. The retrieval of data for this project was based on a comprehensive literature search: this method was used to access data pertaining to: (a) current knowledge about ED aetiology, and symptoms; (b) ED classification and management strategies. Once the data were collected and their credibility established, they were used to generate an up-to-date, evidence-based response to the research question. The findings support that aetiological risk factors, including neurobiological, developmental and sociocultural processes, generate psychopathological features that are key to the establishment and maintenance of EDs. There is evidence that these factors are more important for diagnosis and treatment than current classification and management strategies suggest. On the basis of these results, this paper proposes a new model for ED classification, where the diagnosis is based not on specific presenting symptoms, but on the existence of characteristic psychopathological traits, many of which are conserved across ED presentations. The principal implication of this model is that the focus of ED treatment should shift from symptom management to correcting the underlying psychopathology, and its causes. Long-term psychological intervention is likely to be key to achieving this goal, and the particular therapeutic strategies that could be used are considered.