Podcast
Questions and Answers
What is the primary goal of treatment for Anorexia Nervosa?
What is the primary goal of treatment for Anorexia Nervosa?
Which disorder is characterized as ego dystonic?
Which disorder is characterized as ego dystonic?
What is a common treatment strategy for Pica?
What is a common treatment strategy for Pica?
How is Rumination Disorder characterized in patients?
How is Rumination Disorder characterized in patients?
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Which of the following is NOT included in the criteria for Avoidant Restrictive Food Intake Disorder (ARFID)?
Which of the following is NOT included in the criteria for Avoidant Restrictive Food Intake Disorder (ARFID)?
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What percentage of individuals with Intellectual Developmental Disorders (IDDs) in residential care meet the criteria for Pica?
What percentage of individuals with Intellectual Developmental Disorders (IDDs) in residential care meet the criteria for Pica?
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Which treatment is often recommended for managing Rumination Disorder?
Which treatment is often recommended for managing Rumination Disorder?
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Which of the following is a recognized condition under Other Specified Feeding and Eating Disorders?
Which of the following is a recognized condition under Other Specified Feeding and Eating Disorders?
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Which of the following is NOT a criteria for diagnosing Avoidant Restrictive Food Intake Disorder (ARFID)?
Which of the following is NOT a criteria for diagnosing Avoidant Restrictive Food Intake Disorder (ARFID)?
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What is a commonly employed strategy in behavior analytic treatment for ARFID patients under 10?
What is a commonly employed strategy in behavior analytic treatment for ARFID patients under 10?
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Which of the following best describes a symptom associated with both anorexia nervosa and bulimia nervosa?
Which of the following best describes a symptom associated with both anorexia nervosa and bulimia nervosa?
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Which statement is true regarding ARFID in relation to other mental disorders?
Which statement is true regarding ARFID in relation to other mental disorders?
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What role does chaining play in the treatment of ARFID in younger patients?
What role does chaining play in the treatment of ARFID in younger patients?
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During which stage of treatment for ARFID patients aged 10 and older is relapse prevention emphasized?
During which stage of treatment for ARFID patients aged 10 and older is relapse prevention emphasized?
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Which of the following treatments is specifically indicated for patients with ARFID?
Which of the following treatments is specifically indicated for patients with ARFID?
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What is one common misconception about the relationship between psychosocial functioning and ARFID?
What is one common misconception about the relationship between psychosocial functioning and ARFID?
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What is a defining characteristic of Anorexia Nervosa?
What is a defining characteristic of Anorexia Nervosa?
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Which of the following behaviors is a common compensatory method in Bulimia Nervosa?
Which of the following behaviors is a common compensatory method in Bulimia Nervosa?
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In Binge Eating Disorder, what is a primary factor considered for diagnosis?
In Binge Eating Disorder, what is a primary factor considered for diagnosis?
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What type of eating disorder involves the consumption of non-food items?
What type of eating disorder involves the consumption of non-food items?
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Which of the following is NOT a risk associated with Anorexia Nervosa?
Which of the following is NOT a risk associated with Anorexia Nervosa?
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ARFID is most accurately described as which of the following?
ARFID is most accurately described as which of the following?
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The severity of Bulimia Nervosa is based on which factor?
The severity of Bulimia Nervosa is based on which factor?
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Which of these psychological traits is often associated with the development of eating disorders?
Which of these psychological traits is often associated with the development of eating disorders?
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Which eating disorder is least likely to involve compensatory behaviors?
Which eating disorder is least likely to involve compensatory behaviors?
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The multidisciplinary approach in eating disorder treatment typically includes which of the following disciplines?
The multidisciplinary approach in eating disorder treatment typically includes which of the following disciplines?
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Study Notes
Eating & Feeding Disorders
- Current focus in medicine and public health is on weight-centric care and rising obesity rates
- Weight stigma is the social devaluation of people with larger bodies and is linked to adverse health behaviors, maladaptive eating behaviors, low levels of physical activity, and weight cycling.
- Physiological stress, anxiety, depression, low self-esteem, and dissatisfaction with appearance are also linked to weight stigma and higher BMI, which is correlated with poorer patient care.
Eating Disorders
- Anorexia Nervosa: Restriction of energy intake, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Fear of gaining weight, distorted body perception/self-evaluation, and restricting or binge-purge types. Severity is based on BMI and has high risk of death, often from suicide completion.
- Bulimia Nervosa: Recurring episodes of binge eating, periods of large amounts of food consumed, without control. Compensatory behaviors to prevent weight gain, most common is vomiting, but can include fasting or using laxatives. Self-image focused on body size. Severity is based on the number of compensatory behaviors per week (mild 1-3x, moderate 4-7x, severe 8-13x, extreme 14+x). Significant risks related to purging, potentially leading to dental erosion, caries, gastroesophageal reflux, dehydration, and heart arrhythmias/death.
- Binge Eating Disorder: Presence of binge eating episodes and distress related to the episodes. Eating rapidly or to discomfort, eating alone due to embarrassment, feeling disgusted or guilty after bingeing. Diagnosis is not based on concerns about weight, but the number of binge-eating episodes per week for severity (mild 1-3x, moderate 4-7x, severe 8-13x, extreme 14+x)
- ARFID (Avoidant/Restrictive Food Intake Disorder): DSM's newest feeding disorder, characterized by an apparent lack of interest in eating or food or avoidance based on sensory aspects, failure to meet nutritional needs, and significant weight loss (or failure to achieve expected weight gain). Can be due to factors like fear of aversive consequences, concerns over sensory characteristics of food, significant nutritional deficiency, dependence on enteral feeding or supplements, or marked interference with psychological functioning. Not better explained by lack of food, anorexia nervosa or bulimia nervosa, concurrent medical conditions, or other mental disorders.
- PICA: Ingesting non-food items for at least a month, unusual for age, developmental level, or cultural context. Not diagnosed before age 2, and the behavior isn't serving a purpose like suppression or delusion, or self-mutilation. Often associated with IDDs or OCD. Very dangerous due to potential harms or even death. Treatment involves behavioral reinforcement, response prevention, "Pica proofing", and pharmacological approaches like SSRIs and antipsychotics, plus patient education.
- Rumination Disorder: Automatic regurgitation of recently consumed food, typically within 1-2 hours after eating. Reflexive, not a conscious act. Extremely difficult to treat, involves competing reinforcement, management of diaphragmatic breathing, and medication management.
Treatment
- Inpatient or outpatient care, with inpatient goal of medical stabilization first. Multidisciplinary approach essential, with primary care, psychiatry, psychology, social work, and nutrition.
- Family-based interventions focus on family dynamics around food.
- Anorexia: Ego-syntonic, primary goal weight restoration and medical safety, Patient Motivation a major challenge.
- Bulimia and Binge Eating: Ego-dystonic, with CBT focusing on maladaptive thoughts and disruptive cycles. Medications like antidepressants and Vyvanse.
Etiology (Causes)
- Environmental and individual variables play a role
- Dieting behaviors spurred by individual and cultural factors, escalating as physiological changes occur
- Female sex has increased vulnerability
- Stressful life events, traits like anxiety, perfectionism, and high harm avoidance, heritability, and cultural factors (emphasis on thinness and objectification of the female) are all contributing factors.
- Reinforcement from weight loss, praise from others, and sense of control are noted. Fasting and exercise induce hormones that reduce appetite. Family factors and parent attitudes about eating, weight, and shape are also influential.
Other Specified Feeding & Eating Disorders
- Atypical Anorexia Nervosa
- Binge Eating Disorder
- Bulimia Nervosa
- Purging Disorder
- Night Eating Syndrome
- Orthorexia & disordered eating: Lifetime prevalence is 3.5% in women and 2% in men.
Specific Treatment of ARFID (Avoidant/Restrictive Food Intake Disorder)
- PFD & ARFID Patients under 10: Behavior Analytic Treatment, Preference Assessment, Demand Fading, Contingent Access to Reinforcers, Differential Attention, Chaining.
- CBT for ARFID (10+): Starts with psychoeducation, treatment plans, understanding maintenance mechanisms, and preventing relapse. Includes 4 stages, Learning about ARFID, Early Changes, Continuing changes/setting big goals, Facing Fears, and Preventing Relapse.
- People with ARFID report different concerns: Biological predisposition/food-related trauma, negative feelings/predictions about consequences of eating, food restriction, nutritional compromise, and limited exposure opportunities.
###Additional Notes
- Various charts and diagrams exist with further details on certain foods, etc.
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