Anorexia nervosa, bulimia nervosa, and binge-eating disorder have been increasing in prevalence over the last 30 years . At least 10 million people are afflicted with eating disorders in the United States and another 5-10 million are affected by atypical or subsyndromal eating disorders (Pyle et al., 1983; Lachenmeyer & Muni-Brander, 1988). The morbidity and mortality associated with eating disorders is high. Untreated anorexia nervosa has a premature mortality rate of 10-20% and as many as one-half to two-thirds of patients develop a chronic eating disorder (Ratnasuriya, Eisler, Szmukler, & Russell, 1991;; this is one of the highest mortality rates for any psychiatric disorder. The mortality rate of untreated bulimia nervosa is lower, probably in the range of 5%, but this condition also often becomes chronic (Herzog, Keller, & Lavori, 1988; Keller, Herzog, Lavori, Bradburn, & Mahoney, 1992). The physiological complications of anorexia nervosa and bulimia nervosa are significant and include osteoporosis, infertility, abnormalities in body composition, cardiac changes, and brain abnormalities. Binge-eating disorder ) is frequently associated with moderate obesity which contributes to a number of chronic illnesses including hypertension and diabetes mellitus. The long-term suffering experienced by eating disorder patients is significant and may account for the fact that half the deaths due to anorexia nervosa are a consequence of suicide (Tolstrup et al., 1985; Morgan & Russell, 1975).
There is evidence that early intervention and modern treatment reduces the duration of these disorders (Crisp et al., 1991; Crisp, Callender, Halek, & Hsu, 1992; Steinhausen, Rauss-Mason, & Seidel, 1991). However, with the advent of managed care and other pernicious cultural influences, many patients cannot access appropriate treatment. Although it is still true that the majority of patients are from the upper to middle socioeconomic classes and ostensibly may be able to access health care, insurance companies may arbitrarily delete coverage for eating disorder patients or so limit coverage that suitable treatment cannot be provided. It is now rare for the necessary comprehensive multidisciplinary treatment required for early and effective intervention to be paid for by insurance. Susan Wooley (1993) has summarized the process by which this deterioration