B. Eating Disorders
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Questions and Answers

What is a primary characteristic of an episode of binge eating?

  • Eating a larger amount of food than usual in a short time (correct)
  • Eating slowly and savoring each bite
  • Eating until feeling completely full
  • Feeling satisfied and in control during the meal
  • Which of the following is NOT one of the associated behaviors during binge eating episodes?

  • Avoiding food when feeling emotionally upset (correct)
  • Feeling disgusted or guilty after eating
  • Eating alone due to embarrassment
  • Eating much more rapidly than normal
  • How frequently must binge eating episodes occur to meet the diagnostic criteria?

  • At least once a day for 1 month
  • At least twice weekly for 2 months
  • At least every 10 days for 6 weeks
  • At least once weekly for 3 months (correct)
  • What distinguishes binge eating disorder from bulimia nervosa?

    <p>Binge eating without inappropriate compensatory behavior (D)</p> Signup and view all the answers

    What might indicate partial remission of binge eating disorder?

    <p>Episodes occur less than once a week after previously meeting full criteria (B)</p> Signup and view all the answers

    What compensatory method might individuals with bulimia nervosa use to avoid weight gain?

    <p>Thyroid hormone intake (A)</p> Signup and view all the answers

    Which behavior is considered excessive exercise among individuals with bulimia nervosa?

    <p>Exercising at inappropriate times and settings (A)</p> Signup and view all the answers

    What is a common feature of individuals with bulimia nervosa regarding their body image?

    <p>They may resemble those with anorexia nervosa. (B)</p> Signup and view all the answers

    What is one hallmark criterion that differentiates bulimia nervosa from anorexia nervosa?

    <p>Presence of binging episodes (A)</p> Signup and view all the answers

    How do individuals with bulimia nervosa typically manage their weight between eating binges?

    <p>They employ restrictive caloric intake. (C)</p> Signup and view all the answers

    What is a potential complication of purging behavior among individuals with bulimia nervosa?

    <p>Esophageal tears (C)</p> Signup and view all the answers

    What distinguishes the prevalence of bulimia nervosa among different body weight categories?

    <p>It typically occurs in individuals with a BMI between 18.5 and 30. (B)</p> Signup and view all the answers

    What factor is often uncertain in causing menstrual irregularities in females with bulimia nervosa?

    <p>Weight fluctuations (C)</p> Signup and view all the answers

    What psychological feature is NOT present in individuals with Kleine-Levin syndrome despite disturbed eating behavior?

    <p>Excessive worry about weight (A), Overconcern with body shape (C)</p> Signup and view all the answers

    Which disorder is associated with binge-eating behavior as part of its impulsive behavior criterion?

    <p>Borderline personality disorder (A)</p> Signup and view all the answers

    In individuals with bulimia nervosa, what is the percentage lifetime prevalence of substance use disorder?

    <p>30% (A)</p> Signup and view all the answers

    What typically improves following effective treatment of bulimia nervosa?

    <p>Anxiety symptoms (D)</p> Signup and view all the answers

    When may mood disturbances in individuals with bulimia nervosa begin?

    <p>Both A and B (C)</p> Signup and view all the answers

    What is the BMI threshold for determining severe anorexia nervosa severity in adults?

    <p>BMI 15–15.99 kg/m2 (A)</p> Signup and view all the answers

    Which behavior is characteristic of individuals with the binge-eating/purging type of anorexia nervosa?

    <p>Regularly engaging in self-induced vomiting (A)</p> Signup and view all the answers

    What is a distinguishing feature of major depressive disorder with atypical features compared to bulimia nervosa?

    <p>Inappropriate compensatory behaviors (D)</p> Signup and view all the answers

    What is commonly observed in individuals with bulimia nervosa regarding mood disorders?

    <p>Low self-esteem (C)</p> Signup and view all the answers

    Criterion A for diagnosing anorexia nervosa includes maintaining a body weight that is:

    <p>Below a minimally normal level for age or developmental trajectory (B)</p> Signup and view all the answers

    Which personality disorder is most frequently associated with bulimia nervosa?

    <p>Borderline personality disorder (B)</p> Signup and view all the answers

    What is the minimum BMI required to classify as having mild anorexia nervosa in adults?

    <p>BMI ≥ 17 kg/m2 (A)</p> Signup and view all the answers

    How is body mass index (BMI) calculated?

    <p>Weight in kilograms divided by height in meters squared (A)</p> Signup and view all the answers

    What is a common challenge when assessing body weight in individuals?

    <p>Normal weight range varies among individuals. (A)</p> Signup and view all the answers

    What is the estimated 12-month prevalence of anorexia nervosa in men according to U.S. studies?

    <p>0% to 0.01% (D)</p> Signup and view all the answers

    Which statement best describes the impact of age on the assessment of anorexia nervosa?

    <p>Children may fail to gain expected weight rather than lose weight. (B)</p> Signup and view all the answers

    Which group seems to have the lowest prevalence of anorexia nervosa among U.S. ethnoracial groups?

    <p>Latinx Americans (D)</p> Signup and view all the answers

    Which of the following is NOT an essential feature of anorexia nervosa?

    <p>Regular excessive exercise (D)</p> Signup and view all the answers

    At what life stage is anorexia nervosa most commonly initiated?

    <p>Adolescence or young adulthood (C)</p> Signup and view all the answers

    What is the general crude mortality rate for anorexia nervosa per decade?

    <p>5% (B)</p> Signup and view all the answers

    Which factor is often associated with the onset of anorexia nervosa?

    <p>Stressful life events (C)</p> Signup and view all the answers

    What aspect of anorexia nervosa may differ in older individuals compared to younger individuals?

    <p>Longer duration of illness (C)</p> Signup and view all the answers

    What is Criterion B associated with anorexia nervosa typically inferred from?

    <p>Observational data and collateral history (D)</p> Signup and view all the answers

    How do individuals with anorexia nervosa often perceive their body weight?

    <p>They feel certain body parts are too fat (B)</p> Signup and view all the answers

    What percentage of individuals with anorexia nervosa may experience remission within 5 years of presentation?

    <p>Most individuals (D)</p> Signup and view all the answers

    What typically motivates individuals with anorexia nervosa to seek professional help?

    <p>Distress over physical and psychological issues from starvation (D)</p> Signup and view all the answers

    What is a common outcome for those admitted to hospitals for anorexia nervosa?

    <p>Lower overall remission rates (A)</p> Signup and view all the answers

    Which of the following is a common physiological disturbance associated with anorexia nervosa?

    <p>Amenorrhea (D)</p> Signup and view all the answers

    Which statement accurately describes the self-esteem of individuals with anorexia nervosa?

    <p>It heavily depends on their weight and body shape perceptions. (D)</p> Signup and view all the answers

    What is a common misconception individuals with anorexia nervosa have regarding their condition?

    <p>They are often unaware of the medical implications of their state. (B)</p> Signup and view all the answers

    Which symptom may indicate the severity of medical issues in anorexia nervosa?

    <p>Vital sign abnormalities (B)</p> Signup and view all the answers

    Why is obtaining collateral information from family members crucial in assessing anorexia nervosa?

    <p>They can assist in evaluating the history of weight loss. (B)</p> Signup and view all the answers

    Flashcards

    Anorexia Nervosa Severity

    Severity of anorexia is determined by BMI (Body Mass Index). For adults, it's the current BMI; for children, it's BMI percentile. Severity can be increased if clinical symptoms or functional disability is present.

    Anorexia Nervosa Subtypes

    Anorexia Nervosa can be categorized by subtypes. The main subtype relates to binge eating (and subsequent purging). A subtype includes purging without significant binge eating.

    Anorexia Nervosa: Key Feature 1

    Persistent reduction in food intake.

    Anorexia Nervosa: Key Feature 2

    Intense fear of gaining weight or becoming fat or behavior that interferes with weight gain.

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    Anorexia Nervosa: Key Feature 3

    Disturbance in self-perceived weight or shape.

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    Body Mass Index (BMI)

    A measure of body fat based on weight and height.

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    Mild Anorexia Nervosa (Adult)

    BMI of 17kg/m2 or more.

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    Normal BMI (Adult)

    BMI of 18.5 kg/m2 or more is considered normal body weight for adults. Lower than this is considered underweight.

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    Anorexia Nervosa Criterion B

    Clinician inference from history, observations, physical/lab findings, or longitudinal course (fear of weight gain/preventing it) supports the diagnosis.

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    Anorexia Nervosa Criterion C

    Distorted body image, individuals may feel overweight despite being thin or may focus on specific body areas as "too fat."

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    Anorexia Nervosa Weight Obsession

    Frequent weighing, measuring body parts, and excessive mirror use are common in individuals with anorexia nervosa.

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    Anorexia Nervosa Self-Esteem

    Strongly related to perceived body shape and weight, weight loss is viewed positively while weight gain is negative.

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    Anorexia Nervosa Medical Implications

    Not recognizing the severity of their malnourished state, despite possible thinness.

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    Diagnostic Importance of Collateral Info

    Obtaining information from family or others is crucial to accurately assess weight loss history and illness features.

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    Anorexia Nervosa Physical Complications

    Semistarvation can cause serious medical conditions, affecting organ systems and producing various disturbances, often seen alongside purging behaviors.

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    Anorexia Nervosa Seeking Help

    Individuals are often prompted to seek help due to distress over physical and mental health consequences of starvation, rather than the weight loss itself.

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    Anorexia Nervosa Prevalence

    Anorexia Nervosa is more common in developed countries with higher incomes like the US, Europe, Australia, and Japan. It's also increasing in some developing countries.

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    Anorexia Nervosa Demographics

    Anorexia Nervosa affects mostly women and usually starts in adolescence or early adulthood. It's less prevalent in people of color compared to non-Latinx White individuals.

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    Anorexia Nervosa Course

    The progress of anorexia nervosa can vary a lot. Some individuals recover fully after a single episode, while others may experience a fluctuating pattern of weight gain and relapse or a chronic course.

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    Anorexia Nervosa Triggers

    The onset of anorexia nervosa is often associated with stressful life events, such as leaving home for college or major life changes.

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    Anorexia Nervosa: Typical Features

    Individuals experiencing anorexia nervosa often present with a strong fear of gaining weight, a distorted body image, and a persistent reduction in food intake.

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    Anorexia Nervosa: Atypical Features

    Some individuals with anorexia nervosa may not exhibit the typical fear of fat or have a more nuanced relationship with their weight.

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    Anorexia Nervosa: Long-term Impact

    People with anorexia nervosa may experience a chronic course over many years, leading to complications and potential requirement for hospitalization.

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    Anorexia Nervosa: Mortality

    Individuals with anorexia nervosa have a higher mortality rate, approximately 5% per decade.

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    Compensatory Behaviors in Bulimia

    Methods used to counteract binge eating, like purging (vomiting, laxatives), excessive exercise, or fasting, to prevent weight gain.

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    Thyroid Hormone Use in Bulimia

    Some individuals with bulimia may try to avoid weight gain by taking thyroid hormone, hoping it will increase metabolism.

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    Insulin Manipulation in Bulimia

    Individuals with bulimia and diabetes might alter their insulin doses to reduce food metabolism after binging.

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    Excessive Exercise in Bulimia

    Exercise that interferes with daily life, occurs at inappropriate times or places, or continues despite injury.

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    Self-Esteem in Bulimia

    Body shape and weight are extremely important to self-worth for individuals with bulimia.

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    Bulimia vs. Anorexia

    Bulimia shares similarities with anorexia (fear of weight gain, dissatisfaction with body), but unlike anorexia, bulimia involves binge eating and compensatory behaviors.

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    Common Weight Range in Bulimia

    Individuals with bulimia typically have a normal or overweight BMI, not typically underweight like those with anorexia.

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    Potential Complications of Bulimia

    Purging behaviors can lead to serious health problems like esophageal tears, gastric rupture, heart rhythm issues, and dependence on laxatives.

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    Bulimia Nervosa: What's NOT required?

    Unlike bulimia nervosa, conditions like Kleine-Levin syndrome involve disturbed eating, but NOT the excessive concern with body shape and weight that characterizes BN.

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    Bulimia Nervosa vs. Atypical Depression: Key Difference?

    Atypical depression involves overeating, but unlike bulimia nervosa, those with this disorder lack the urge to compensate for the overeating and do not have an excessive concern with body shape and weight.

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    Bulimia Nervosa & Borderline Personality Disorder: Shared Feature?

    Both disorders involve binge-eating behavior, but the underlying motivation and context differ. In borderline personality disorder, it's seen as part of impulsive behavior.

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    Bulimia Nervosa: Is it just a single disorder?

    No, individuals with bulimia nervosa frequently experience other mental health conditions, like depression, anxiety, and substance abuse.

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    Bulimia Nervosa & Mood Disorders: What's the Connection?

    Individuals with bulimia nervosa often experience depression, bipolar disorder, or anxiety. These mood issues may begin alongside or after bulimia, or even precede it.

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    Bulimia Nervosa & Substance Use: Common Co-occurrence?

    At least 30% of those with bulimia nervosa also struggle with substance abuse, particularly alcohol or stimulants. The reason? Stimulants are sometimes used to suppress appetite.

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    Bulimia Nervosa & Personality Disorders: Who else gets involved?

    Bulimia often coexists with personality disorders, especially borderline personality disorder. This reflects shared impulsive behaviors and emotional dysregulation.

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    Bulimia Nervosa vs. Binge-Eating Disorder: What makes them different?

    While both involve binge eating, bulimia nervosa includes recurrent purging behaviors (vomiting, laxatives, exercise) to compensate. Binge-eating disorder lacks these compensatory behaviors.

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    Binge Eating Disorder: Key Feature

    Recurrent episodes of binge eating, characterized by eating a significantly larger amount of food than most people would in a short period, with a sense of lack of control during the episode.

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    Binge Eating: Control Loss

    A defining characteristic of binge eating is a feeling of lack of control over the amount or type of food consumed during the episode.

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    Binge Eating Disorder: Additional Symptoms

    Besides the core features of binge eating, there are other common symptoms like eating rapidly, feeling uncomfortably full, eating when not hungry, and feeling guilty afterward.

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    Binge Eating Disorder: Frequency

    For a diagnosis, binge eating episodes need to occur at least once a week, on average, for a period of three months.

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    Binge Eating Disorder: Distinguishing from Bulimia

    Binge eating disorder is distinct from bulimia, as it doesn't involve the recurrent use of inappropriate compensatory behaviors like purging.

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    Study Notes

    Comorbidity

    • Anxiety disorders, obsessive-compulsive disorder, and neurodevelopmental disorders (autism spectrum disorder, attention-deficit/hyperactivity disorder, intellectual disability) are commonly observed with avoidant/restrictive food intake disorder.

    Anorexia Nervosa - Diagnostic Criteria

    • A. Restriction of energy intake relative to requirements, leading to a significantly low body weight. Low weight is defined as less than minimally normal for age, sex, and development.
    • B. Intense fear of gaining weight or becoming fat; persistent behaviors that impede weight gain despite low weight.
    • C. Disturbance in the perception of body weight or shape, undue influence of weight/shape on self-evaluation, or persistent lack of recognition of the dangerousness of the low weight.

    Coding note

    • The specific ICD-10-CM code depends on the subtype.

    Subtypes

    • F50.01 Restricting type: No recurrent binge-eating or purging (self-induced vomiting, laxative/diuretic misuse, enemas) during the last three months. Weight loss primarily achieved through dieting, fasting, or excessive exercise.
    • F50.02 Binge-eating/purging type: Recurrent binge-eating or purging behaviors in the last three months.

    Severity

    • Severity is based on BMI (body mass index). Ranges for adults and children/adolescents are different and detailed below.
      • Mild: BMI ≥ 17 kg/m²
      • Moderate: BMI 16–16.99 kg/m²
      • Severe: BMI 15–15.99 kg/m²
      • Extreme: BMI < 15 kg/m²

    Partial & Full Remission

    • Partial remission: Criterion A (low body weight) is no longer met but either B (intense fear) or C (disturbance in self-perception) is still met.
    • Full remission: None of the criteria are met for a sustained period.

    Diagnostic Features (Anorexia Nervosa)

    • Persistent restriction of energy intake
    • Intense fear of gaining weight or becoming fat
    • Disturbance in self-perception of weight/shape.
    • Weight significantly below a healthy level.

    Subtypes (Anorexia Nervosa)

    • Individuals with binge-eating/purging type tend to purge (self-induced vomiting or use of laxatives, diuretics, or enemas) as well as binge eat.
    • Some individuals with this type do not binge eat but regularly purge.

    Diagnostic Markers (Anorexia Nervosa)

    • Commonly observed are: leukopenia (loss of all blood cells), lymphocytosis, mild anemia, thrombocytopenia, and bleeding problems.
    • Elevated blood urea nitrogen
    • Elevated cholesterol
    • Elevated liver enzymes
    • Hypomagnesemia, hypozincemia, hypophosphatemia, or hyperamylasemia
    • Hypokalemia, hypochloremia, and metabolic acidosis.
    • Low levels of thyroid hormones (T3 and T4)
    • Low estrogen (females)
    • Low testosterone (males)

    Associated Features (Anorexia Nervosa)

    • Physiological disturbances (amenorrhea, vital sign abnormalities, etc) are common.
    • Depressive signs and symptoms like withdrawal, irritability, insomnia, and diminished interest in sex are common.
    • Obsessive-compulsive features related to food
    • Concerns about eating in public
    • Difficulty with decision-making, inflexibility, and emotional restraint.
    • Higher risk of suicide attempts.

    Prevalence (Anorexia Nervosa)

    • 12-month prevalence: 0.0% to 0.05% (with higher rates in women).
    • Lifetime prevalence: 0.60% to 0.80% (with higher rates in women)
    • Prevalence is highest in post-industrialized, high-income countries.

    Development and Course (Anorexia Nervosa)

    • Commonly begins in adolescence or young adulthood.
    • May manifest atypical symptoms in younger individuals.

    Risk Factors (Anorexia Nervosa)

    • Temperamental traits (anxiety, obsessionality)
    • Environmental factors (cultures that value thinness, specific occupations like modeling).

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