The consequences and costs of the eating disorders

Reviewed here are data on the consequences and costs of eating disorders. All three of the eating disorders, anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder are associated with high levels of comorbid psychopathology, and AN has the highest mortality rate of any psychiatric disorder. These consequences are reflected in the high costs associated with treatment of these disorders. AN is as costly to treat as schizophrenia, whereas BN and binge-eating disorder are as costly to treat as obsessive-compulsive disorder (OCD). The relative costs of cognitive-behavioral therapy (CBT) and antidepressant medication for BN are outlined, as are potential methods to reduce treatment costs. Although BN was first described only 20 years ago,(22) it is now considered, together with AN, as a severe mental illness. The California legislature, recognizing the burden borne by patients with eating disorders, listed AN and BN among the nine diagnoses, including schizophrenia, bipolar personality disorder, and OCD, that were to be given parity for health care with severe medical conditions by health maintenance organizations and third-party payers. Now, the outlines of the consequences and costs of AN and BN for patients, their families, and society are becoming apparent. Although fewer data are available for the newly designated diagnosis of binge-eating disorder, a condition that, according to the DSM-IV, requires further research, at least some of the costs are apparent.