Feeding and eating disorders, and body dysmorphic disorder ppt

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Questions and Answers

What is considered a hallmark symptom of anorexia nervosa that distinguishes it from other psychiatric syndromes?

Fear of becoming fat (correct)

Significantly low body weight

Distorted body image

Compulsive exercise habits

Which of the following factors is NOT included in the diagnostic criteria for anorexia nervosa?

Restriction of food intake

Fear of excessive weight gain

Presence of electrolyte imbalances (correct)

Body image disturbance

What is the recommended first step in the treatment of severe anorexia nervosa when weight loss has been critical?

Immediate psychotherapy

Nutritional counseling

Prompt restoration of weight (correct)

Medication management

Why is anorexia nervosa considered to have the highest mortality rate among psychiatric disorders?

Due to increased suicide rates Signup and view all the answers

Which of the following statements regarding the epidemiology of eating disorders is accurate?

Transgender individuals show a higher prevalence Signup and view all the answers

What characteristic behavior is commonly associated with individuals suffering from anorexia nervosa?

Ritualistic food preparation and intake Signup and view all the answers

What is the typical BMI threshold for diagnosing significantly low body weight in anorexia nervosa for adults?

BMI < 17 kg/m2 Signup and view all the answers

Which treatment approach is recommended for children and adolescents with anorexia nervosa?

Family-based treatment Signup and view all the answers

Which of the following is a common consequence of dehydration in individuals with anorexia nervosa?

Dizziness and fainting Signup and view all the answers

What behavior might an individual with bulimia nervosa typically exhibit following a binge-eating episode?

Recurrent inappropriate compensatory behavior Signup and view all the answers

Which of the following is NOT a characteristic of bulimia nervosa?

Significant weight loss Signup and view all the answers

Which treatment is recognized as the most effective for binge-eating disorder?

Cognitive behavioral therapy (CBT) Signup and view all the answers

What is a distinguishing feature of avoidant/restrictive food intake disorder (ARFID) compared to anorexia nervosa (AN)?

Absence of specific aversions to food Signup and view all the answers

What is a common manifestation of purging disorder?

Irregular heartbeat Signup and view all the answers

In binge-eating disorder, individuals report a sense of loss of control over their eating. Which additional criteria must they meet?

Eating alone due to embarrassment Signup and view all the answers

How does body dysmorphic disorder (BDD) differ from typical concerns about appearance?

Preoccupation with non-noticeable flaws Signup and view all the answers

Which of the following statements about PICA is incorrect?

It is primarily diagnosed in individuals over age 30. Signup and view all the answers

What is a primary reason for addressing findings from physical exams with individuals suspected of bulimia nervosa?

To prompt exploration of disordered behaviors Signup and view all the answers

Which of the following is the most effective treatment for avoidant/restrictive food intake disorder (ARFID)?

Cognitive behavioral therapy (CBT) Signup and view all the answers

What does the diagnosis of rumination disorder require?

Daily regurgitation behavior for at least 1 month Signup and view all the answers

Which of the following is NOT a common complication associated with PICA?

Binge eating episodes Signup and view all the answers

What is the most commonly reported symptom in individuals with binge-eating disorder?

Sense of loss of control over eating Signup and view all the answers

Which of the following is a significant risk factor for developing body dysmorphic disorder?

Frequent cosmetic surgeries Signup and view all the answers

Study Notes

Eating Disorders

Complex psychiatric illness with disturbances in body image, impacting body function, and causing significant distress
Individuals with eating disorders frequently experience medical concern including cardiovascular, pulmonary, gastrointestinal, and electrolyte issues
Most medical and psychiatric practitioners lack competence in the treatment of eating disorders
Pharmacological interventions have less empirical support, though they may enhance the effects of psychotherapy
Referral to a specialist is recommended due to the complexity of management.

Eating Disorder Epidemiology

~30 million individuals are affected by an eating disorder in their lifetime
Prevalence is higher in women than men
Prevalence is higher in gay men and transgender individuals
Some research suggests that prevalence is lower in lesbian women compared to heterosexual women
~1/3 of those with an eating disorder never receive treatment
~1 in 5 individuals with an eating disorder require hospitalization
Eating disorders have the highest mortality rate of any psychiatric disorder due to high suicide rates, especially in AN patients

Screening Tool: SCOFF

Assesses for the presence of an eating disorder

Anorexia Nervosa (AN)

Characterized by persistent dietary restriction that leads to significantly low body weight, intense fear of gaining weight or becoming fat, and body image disturbance.
Develop "food rules" related to both quantity and type of food
Exhibit obsessive preoccupation with food, eating, dieting, weight, and body shape
Frequently engage in ritualistic eating behaviors
Have difficulty eating in settings that are not highly controlled environments
Frequently engage in exercise that is driven and compulsive.
Binge eating and purging behaviors can be present in the binge/purge subtype of AN
Hallmark fear of becoming fat and relentless pursuit of thinness is absent in other psychiatric syndromes

Anorexia Nervosa Clinical Manifestations

Dehydration, dizziness, headaches
Fainting, fatigue
Low blood pressure, low body temperature
Osteoporosis, electrolyte imbalances
Low BMI, extreme weight loss, and thinness
Irregular menstruation or absence of menstruation
Delayed puberty or slow growth
Brittle nails, bruising, depression
Dry hair, skin, sensitivity to cold, slow heart rate

Anorexia Nervosa Diagnosis Criteria

Restriction of food intake → significantly low body weight
Fear of excessive weight gain or obesity
Body image disturbance or denial of the seriousness of illness
In adults, a BMI of < 17 kg/m² is considered significantly low
A BMI of 17 to < 18.5 kg/m² may also be significantly low depending on the patient’s initial weight.

Additional Considerations for Anorexia Nervosa

Individuals with AN have significantly distorted views of their body (often see themselves as fat)
Weight or shape has an undue influence on their self-evaluation
If the patient does not have a distorted view of their body or exhibit a preoccupation with their weight or shape, a diagnosis can be made if there is a persistent lack of recognition of the seriousness of the current low body weight
Individuals who meet the above criteria but have a BMI within the average or above-average range despite significant weight loss are classified as having atypical AN

Anorexia Nervosa Treatment and Management

Nutrition supplementation
Psychotherapy (ie., cognitive behavioral therapy)
For children and adolescents, family-based treatment is recommended
When weight loss has been severe, rapid, or when weight has fallen below ~75% of the recommended weight, prompt restoration of weight becomes critical, and hospitalization should be considered.
If any doubt, patients should be hospitalized.

Bulimia Nervosa (BN)

Characterized by recurrent episodes of binge eating accompanied by feelings of loss of control followed by recurrent inappropriate compensatory behaviors to prevent weight gain
These behaviors occur at least once a week for 3 months
Compensatory behaviors include self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, and/or excessive exercise
Key feature of BN is the centrality of body image in self-evaluation and extreme dissatisfaction with body weight/shape
Individuals with BN often experience symptoms as distressing

Bulimia Nervosa Clinical Manifestations

Gastritis, esophagitis, dehydration, and or electrolyte disturbances
Tooth enamel decay and parotid gland enlargement due to recurrent vomiting
Scars on the back of the hand
Discussing findings from physical exam and laboratory values with individuals may prompt exploration of self-induced vomiting, use of diuretics or laxatives, and disordered eating patterns even when an individual does not initially bring forward these concerns

Bulimia Nervosa Diagnosis Criteria

Recurrent episodes of binge eating accompanied by feelings of loss of control overeating
Occurs, on average, at least once a week for 3 months
Recurrent inappropriate compensatory behavior to influence body weight
Self-evaluation that is unduly influenced by body shape and weight concerns

Bulimia Nervosa Treatment and Management

Cognitive behavioral therapy (CBT) is the treatment of choice
Interpersonal psychotherapy
Selective serotonin reuptake inhibitors (SSRIs)

Binge Eating Disorder (BED)

Characterized by recurrent episodes of binge eating, associated with significant distress, and occurs, on average, at least once a week for 3 months
Most commonly among people overweight or obese
Contributes to excessive caloric intake
Compared with people with AN or BN, those with binge-eating disorder are older and more likely to be male

Binge-Eating Disorder Epidemiology

Affects ~3.5% of women and 2% of men in the general population during their lifetime
May be present in ≥ 30% of patients in some weight-reduction programs
Among those seeking bariatric surgery, approximately 1/3 have BED
BED can emerge in adolescence but typically in early adulthood onset

Binge Eating Disorder Clinical Manifestations

Characterized by eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not hungry, eating alone because of embarrassment, and/or feeling disgusted with oneself, depressed, or guilty afterward
Unlike BN, binge eating is not followed by recurrent compensatory behaviors
Associated with a sense of loss of control.

Binge Eating Disorder Diagnosis Criteria

Binge eating episodes occur, on average, at least once a week for 3 months
Patients have a sense of lack of control over overeating
Also, ≥ 3 of the following must be present:
- Eating much more rapidly than normal
- Eating until feeling uncomfortably full
- Eating large amounts of food when not feeling physically hungry
- Eating alone because of embarrassment
- Feeling disgusted, depressed, or guilty after overeating

Binge Eating Disorder Treatment and Management

Cognitive behavioral therapy (CBT) is the most studied and best-supported treatment for BED
Sometimes interpersonal psychotherapy appears equally effective
Consideration of drug therapy, usually selective serotonin reuptake inhibitors (SSRIs) or lisdexamfetamine (Vyvanse)
Both result in remission rates of ≥ 60%, and improvement is usually well-maintained over the long term

Avoidant/Restrictive Food Intake Disorder (ARFID)

Characterized by restrictive eating patterns in the absence of body image concerns
Avoid food for reasons unrelated to body image disturbance
Three types of ARFID are specified in the DSM-5:
- Aversion to the sensory characteristics of food (ie., textures, smells, and visual appearance)
- Lack of interest in food or limited appetite
- Fear of negative consequences of eating, (ie., vomiting, choking, gastrointestinal pain), often related to specific trauma around eating

Avoidant/Restrictive Food Intake Disorder Epidemiology

May first appear in adulthood or persist from childhood into adulthood
Usually presents in infancy or early childhood
Affects males greater than seen in AN or BN disorders
Between 13%-29% of children and adolescents meet the criteria for ARFID upon initial presentation to eating disorder services
Other eating disorders such as AN, BN, and BED most typically occur in early-late adolescence after a period of normative eating
Individuals with ARFID may have long-standing difficulties with eating

Avoidant/Restrictive Food Intake Disorder Diagnosis Criteria

Food restriction leads to significant weight loss, failure to thrive or grow as expected in children, significant nutritional deficiency, dependence on nutritional support, and or marked disturbance of psychosocial functioning
Food restriction is not caused by the unavailability of food, a cultural practice, physical illness, medical treatment, or another eating disorder
No evidence of a disturbed perception of body weight or shape

Avoidant/Restrictive Food Intake Disorder Additional Considerations

AN can emerge out of restrictive eating and malnourishment associated with an earlier ARFID presentation
Gathering a detailed history of eating and feeding behaviors, including longstanding food preferences, and other behaviors that may indicate concern about weight/shape is critical

Avoidant/Restrictive Food Intake Disorder Treatment/Management

Cognitive behavioral therapy (CBT)

Purging Disorder

Characterized by recurrent purging behavior intended to influence weight or shape in the absence of binge eating
Absence of low weight, significant weight loss, or binge episodes

Purging Disorder Clinical Manifestations

Tooth/enamel decay
Irregular heartbeat, dizziness, fainting
Scarred hands
Pregnancy complications
Digestive issues or constipation
Dehydration, Nutritional deficiencies, Electrolyte imbalances

Purging Disorder Treatment and Management

Inpatient treatment is more common in cases that require medical monitoring or daily assessments
Outpatient treatment might include psychotherapy and nutrition counseling
Medications aren’t used to treat purging disorder but are prescribed to treat concurrent mood disorders that may be causing additional stress or making it harder to cope with recovery

Pica

Diagnosed when the individual, aged >2 years, eats one or more non-nutritive, non-food substances for a month or more → and requires medical attention as a result
No specific aversion to food in general but a preferential choice to ingest substances such as clay, starch, soap, paper, or ash
Onset is most common in childhood
Can occur in association with other major psychiatric conditions in adults
An association with pregnancy has been observed
Only diagnosed when medical risks are increased by behavior
More common among pregnant African American women and institutionalized individuals with intellectual disability
The cause is not known, but an association with iron deficiency has been reported
No known genetic factors specifically associated with pica
The proper treatment of pica is unclear
Proper supervision of young children and behavioral techniques for older children are recommended

Pica Complications

Laboratory studies are needed to rule out lead poisoning
Pica can also lead to excessive weight gain, malnutrition, intestinal blockage, intestinal perforation, and malabsorption
Other complications such as poisoning, intestinal obstruction, intestinal perforation, and infections may occur from ingesting feces or dirt

Rumination Disorder

Individuals have no demonstrable associated gastrointestinal or other medical condition but repeatedly regurgitate their food after eating and either rechew or swallow it or spit it out
Typically occurs daily and must persist for at least 1 month
Weight loss and malnutrition are common sequelae
In infancy, the onset is typically between 3 and 12 months of age
Exact cause unknown
For some children, the act of chewing is comforting
Infants who are neglected, abused, or ill may develop this behavior → , which may be a way child to gain attention

Rumination Disorder Manifestations

Repeatedly bringing up food from the throat or stomach and re-chewing
Weight loss
Bad breath and tooth decay
Repeated stomach aches and indigestion
Raw and chapped lips

Rumination Disorder TREATMENT AND MANAGEMENT

Mainly focuses on changing a child's behavior
Changing a child's posture during and right after eating
Giving children more attention
Making feeding time relaxing and pleasant
Distracting your child when he or she starts the rumination behavior

Body Dysmorphic Disorder (BDD)

Involves individuals having an irrational preoccupation with what they believe to be a defect or a flaw in their physical appearance
Flaws or defects are not noticed by others, or concerns are disproportionate to what others perceive
Common areas include the skin (eg, acne, scars, wrinkles), hair (eg, thinning hair or unwanted body or facial hair), and nose
However, the preoccupation can focus on any part of the body

Body Dysmorphic Disorder (BDD) MANIFESTATIONS

Preoccupations are unwanted, difficult for the individual to control, and often very time-consuming
Engage in repetitive behaviors or thoughts at some point during their disorder
Excessive mirror checking
Excessive grooming
Repeatedly applying makeup
Seeking reassurance from peers
Comparing him- or herself to others

Body Dysmorphic Disorder (BDD) ADDITIONAL CONSIDERATIONS

Individuals with body dysmorphic disorder often receive cosmetic treatment such as dermatologic treatment or cosmetic surgery to try to fix their perceived flaws
However, cosmetic treatment rarely relieves the symptoms of body dysmorphic disorder and may instead worsen the severity of the preoccupation
The majority of individuals have an onset in adolescence, with two-thirds of individuals with the disorder having onset before the age of 18 years

Body Dysmorphic Disorder (BDD) TREATMENT AND MANAGEMENT

Cognitive-behavioral therapy (CBT) to be the most effective treatment
CBT is consistently effective in treating a range of somatic symptoms and related disorders, including somatic symptom disorder, conversion disorder, illness anxiety disorder, and body dysmorphic disorder
Pharmacologic treatments (eg, antidepressants, antiepileptic drugs, and antipsychotics) have been proposed for somatic symptom disorders → however, research indicates they generally are not effective
SSRI BENEFICIAL FOR BODY DYSMORPHIC DISORDERS

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Description

Explore the complex nature of eating disorders, which are psychiatric illnesses that disrupt body image and function. This quiz covers key statistics on prevalence and treatment challenges, highlighting the need for specialized care. Understand the diverse impact of eating disorders across different populations and gender identities.