Eating disorders The prevalence of eating disorders in the total population is low, with lifetime estimates of around 1% to 2%; however, the rates among adolescents and young adults are considerably higher (twoto threefold). Despite the low prevalence, the considerable health-related shortand long term consequences and the substantial risk for comorbidity and premature mortality make the GP an important route to specialist care.49 The evidence Inhibitors,research,lifescience,medical for increasing rates of bulimia nervosa50 adds further to this need and requires greater

attention in the future. Few systematic studies are available to describe the frequency, recognition, and specific forms of intervention applied in eating disorders in primary care. On the basis of primary

care registries with administrative diagnoses for the UK, Protein Tyrosine Kinase inhibitor Schmidt49 Inhibitors,research,lifescience,medical estimated that the average GP has about 2 patients with anorexia nervosa and about 18 patients with bulimia nervosa on their list of registered patients. Despite the fact that eating-disordered patients consult their GPs more frequently than control subjects,51 GPs were unaware of the diagnosis in up to 50% of cases discovered by research interview.52,53 Inhibitors,research,lifescience,medical These patients presented to their GP with a variety of symptoms, including psychological, gastrointestinal, Inhibitors,research,lifescience,medical and gynecological complaints. In many cases, the earlier consultations to the GP had been prompted by complications of the eating disorders, but the diagnosis was missed. Many reasons have been evoked to account for these problems,

including the patients’ tendency to hide the problem verbally as well as by Inhibitors,research,lifescience,medical wearing baggy clothes, social factors (lower socioeconomic status, ethnic minority), and gender (males are not expected to have eating disorders). Some indications were also found for specific communication barriers: female patients do not expect their mostly male doctors to understand their problem or to be sympathetic about it. A survey by the Eating Disorder Association (cited in reference 50) revealed that 43% of 1638 respondents with eating disorders found that their initial consultation with the GP was unhelpful. Other important for barriers specifically relate to the problem of the compulsory treatment of severe anorexia nervosa. The few systematic primary care studies available do not lead to any conclusions about how to improve recognition or treatment rates, which seem to be at least as deficient as those for anxiety and depression. There is some evidence that at least early recognition and short motivational interviewing techniques for subsequent specialist treatment are high priority topics for improved primary care in this subgroup of disorders.