CPG for Eating Disorders

Aspects not included in the CPGThe CPG does not include the following diagnoses related with eating disorders for severalreasons:• Orthorexia. A poorly defined and insufficiently studied syndromic spectrum that consists ofextreme focus on eating healthy and contaminant-free foods. This disorder can be related toobsessive concerns about health, hypochondriac fears of diseases, and, in a certain way, tocultural attitudes linked to diet and food. Though it is true that people with orthorexia maypresent restrictive anomalies in their diets and ponderal losses, they cannot be consideredatypical or incomplete cases of AN.• Vigorexia (muscle dysmorphia). This disorder is characterized by excessive concern aboutobtaining body perfection by performing specific exercises. This extreme preoccupationentails significant dissatisfaction with one’s own body image, excessive exercise, special dietsand foods, to the point of generating dependence, as well as substance abuse 35 . At the momentit remains a vaguely defined disorder related with obsessiveness, perfectionism anddysmorphophobia 36-40 .• Night eating syndrome (nocturnal eaters). People with this disorder experience recurrentepisodes of binge-eating during sleep. It is not defined whether these clinical pictures are dueto an eating disorder or to a primary sleep disorder 41-44 .The CPG does not include patients under the age of 8 and, thus, diagnoses relating to eatingdisorders most common during those ages, such as swallowing phobia, selective eating andrefusal to eat are not included. However, these disorders are not included either when they areobserved in patients aged 8 and older for the following reasons:• Food phobia (simple phobias). In some cases it may be an anxiety-related disorder, while inothers it may be linked to hypochondria (fear of choking, swallowing phobia and death).Therefore, it does not seem to belong to the spectrum of eating disorders.• Selective eating and refusal to eat. Both are eating disorders but lack the complete andcharacteristic symptomatology associated with AN and BN (cognitive disturbances, distortedbody image, purging behaviours, etc).This does not mean that when deciding on primary prevention policies no interventions shouldbe carried out to address these behaviours, which could indeed be precursors of an eatingdisorder.The CPG does not include exclusive interventions for comorbid conditions that may occurwith eating disorders.CLINICAL PRACTICE GUIDELINE FOR EATING DISORDERS41