Eating Disorders: Psychogenic Vomiting and Pica

Involves the persistent consumption of non-nutritive substances like hair, paper, or stones.
Could indicate a mineral deficiency.
Common in individuals with intellectual disabilities, autism, and schizophrenia.
Associated with pregnancy and iron deficiency conditions.
Diagnosis requires persistence or severity of the behavior.
Risks include poisoning, obstruction, nutritional deficiencies, or parasitosis.

A newly defined disorder in DSM-5 focusing on inadequate dietary intake, especially in children.
Can lead to nutritional deficiencies, failure to thrive, and social impairments.
Individuals may show little interest in food or have concerns about food's sensory properties.
Unlike other disorders, it lacks body image distortion or weight obsession.
Replaces earlier category named "Feeding Disorder of Infancy and Early Childhood."

Antidepressants can reduce binge eating frequency, effective in about 20% of cases.
Faster action compared to depression treatment may require higher doses (e.g., fluoxetine 60mg daily).
Long-term compliance issues evident with antidepressant use.
Recommended as a second-line treatment after unsuccessful psychological approaches.
Topiramate can reduce binge eating but is limited by side effects; not recommended for bulimia nervosa.

Easier to manage than anorexia nervosa due to a higher likelihood of patient recovery and positive dynamics.
No immediate need for weight restoration or severe complication management.
Continuous monitoring of electrolyte levels necessary for patients with frequent vomiting or laxative misuse.
Utilization of a "stepped-care" approach for diverse patient needs.

Step 1: Identify individuals needing urgent specialist care due to severe depression, physical complications, or substance issues.
Step 2: Provide guided cognitive behavioral self-help over approximately 4 months, typically 8-10 facilitated sessions, applicable in primary care with one-third showing good progress.
Step 3: For individuals not improving in 4-6 weeks, initiate Cognitive Behavioral Therapy-Enhanced (CBT-E). Consider antidepressants like fluoxetine for persistent severe depressive symptoms.
Step 4: If CBT-E fails, conduct a comprehensive reassessment considering intensive cognitive therapy or antidepressant treatment, discussing and agreeing upon a suitable plan with the patient.

Recognized as a new category in DSM-5, defined by recurrent binge eating without bulimia features.
Non-existent compensatory behaviors such as vomiting or purging.
Classified as unspecified eating disorder in ICD-10.
Patients often have depressive symptoms and body dissatisfaction, typically less severe than those with bulimia nervosa.
Similar impact on personal and public health as bulimia, linked to increased mortality often due to obesity.
Conceptualized mechanisms are similar between binge eating disorder and bulimia nervosa.
Roughly 25% of obesity treatment patients exhibit binge eating disorder traits.
More prevalent among older demographics compared to bulimia; up to 25% of treatment seekers may be men.
High rates of spontaneous remission; effective treatment options include CBT, interpersonal therapy, and antidepressants.
Lisdexamfetamine is newly approved for binge eating disorder treatment in the USA.

Questions and Answers