Untitled Quiz

Feeding and Eating Disorders

• Feeding and eating disorders are persistent disturbances of eating or eating-related behaviors that significantly impair physical or psychosocial functioning.
• Some eating disorders show similarities with substance use disorders, potentially linked to shared neural systems that regulate self-control and reward/pleasure.

Pica

• Diagnostic Criteria:
  • Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.
  • Eating of substances is inappropriate to the individual's developmental level.
  • Eating behavior is not part of a culturally supported or socially normative practice.
  • If the eating behavior occurs in the context of another mental health disorder (e.g., intellectual disability, autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.
• Associated Features:
  • Vitamin/mineral deficiencies (e.g., zinc and iron)
  • Medical complications (e.g., bowel blockages, intestinal damage)
  • Approximately 5% of school-age children experience pica.
  • 1 in 3 pregnant women face food insecurity and experience pica.
• Development:
  • Often begins in childhood, but can start in adolescence or adulthood.
  • Can occur in normally developing children.
  • In adults, occurs in the context of intellectual or other mental disorders.
• Course:
  • May persist over time and lead to medical emergencies (e.g., intestinal obstruction, poisoning).
  • Fatal depending on the substance ingested.
• Risk and Prognostic Factors:
  • Environmental: Neglect, lack of supervision, and developmental delay can increase the risk.
  • Culture-related: Eating behavior not culturally or socially supported (is not socially normative).
• Diagnostic Markers:
  • X-rays, ultrasounds, and scans can detect obstructions caused by pica.
  • Blood tests and other lab tests help identify poisoning or infections.
• Functional Consequences:
  • Can significantly impair physical functioning.
  • Pica often occurs with other disorders associated with impaired social functioning.
• Differential Diagnosis:
  • Ingestion primarily for weight control (anorexia nervosa)
  • Intentionally consuming foreign objects to create fake physical symptoms (factitious disorder)
  • Swallowing harmful items as part of maladaptive behaviors (nonsuicidal self-injury)

Rumination Disorder

• Diagnostic Criteria:
  • Repeated regurgitation of food for at least 1 month.
  • Regurgitated food may be re-chewed, re-swallowed, or spat out.
  • The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).
  • The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
  • If the symptoms occur in the context of another mental disorder (e.g., intellectual disability or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.
• Diagnostic Features:
  • Repeated regurgitation of food occurring after feeding or eating over a period of at least 1 month
  • Previously swallowed food/partially digested: Food may be re-chewed, ejected, or re-swallowed
  • Regurgitation occurs frequently, at least several times a week, often daily
  • The behavior is not due to another gastrointestinal or medical condition.
  • The behavior does not occur only during anorexia, bulimia, binge-eating disorder, or avoidant/restrictive food intake disorder and, if it appears with another mental disorder (e.g., intellectual disability), symptoms must be severe enough to need additional clinical attention and should be a primary focus for intervention.
• Associated Features:
  • Infants with rumination disorder often strain and arch their backs while making movements, appearing satisfied but can be irritable and hungry between episodes.
  • Weight loss and malnutrition are common.
  • Older children and adults may also face malnutrition.
• Development and Course:
  • Onset: infancy, childhood, adolescence, or adulthood
  • Often remits spontaneously but can lead to severe malnutrition and potentially be fatal, especially in infancy.
  • Can occur episodically or continuously and can serve a self-soothing or self-stimulating function in infants and older individuals with neurodevelopmental disorders.
• Risk and Prognostic Factors:
  • Environmental: Neglect, lack of supervision, and developmental delay can increase risk.
• Differential Diagnosis:
  • Rule out gastrointestinal conditions.
  • Rule out anorexia/bulimia nervosa, and other specified feeding/eating disorders.
• Prevalence:
  • Historically noted mainly in individuals with intellectual disabilities but with a prevalence of about 1% to 2% among grade-school-age children.

Avoidant/Restrictive Food Intake Disorder

• Diagnostic Criteria:
  • An eating or feeding disturbance, apparent lack of interest in eating or food, avoidance of foods based on sensory characteristics or concern about aversive consequences of eating, as associated with one of more of the following:
  1. Significant weight loss
  2. Significant nutritional deficiency
  3. Dependence on enteral feeding or oral nutritional supplements
  4. Interference with psychosocial functioning.
  • Disturbance isn't due to lack of availability of food, nor is it part of a culturally sanctioned practice.
  • the disturbance doesn't occur exclusively in the course of another eating disorder. - The disturbance isn't necessarily attributable to another medical condition.
• Diagnostic Features:
  • Food avoidance or restriction stems from heightened sensitivity to sensory qualities of food (such as appearance, color, smell, texture, temperature, or taste).
  • In other individuals, avoidance or restriction develops as a conditioned avoidance response linked to a negative experience, like choking or other traumatic gastrointestinal events.
  • Functional dysphagia (sensation of food sticking or delayed passage) and Globus hystericus (feeling of a lump in the throat) can contribute to the disturbance.
• Associated Features
  • Different presentations based on age
    • Very young infants may present with symptoms like refusal, gagging, or vomiting.
    • Infants and young children may not interact with a caregiver during feeding and don't communicate hunger except for other activities.
    • Older children and adolescents show more generalized emotional difficulties not meeting diagnostic criteria for an anxiety, depressive, or bipolar disorder (some call this “food avoidance emotional disorder”)
• Development and Course:
  • Commonly develops in infancy or early childhood and may persist in adulthood
  • Avoidance based on sensory characteristics arises in the first decade of life but may persist into adulthood
  • Avoidance related to aversive consequences can be seen at any age (some experience relatively normal functioning)
  • The disorder usually arises during adolescence or early childhood with potential onset in infancy
  • There is insufficient evidence linking a/rfid in infants and children with further eating disorders and developmental delays. In older adolescents, social interactions may be negatively impacted.
• Prevalence:
  • 0.3% is the prevalence of A/RFID among 15-year-old individuals.

Anorexia Nervosa

• Diagnostic Criteria:
  • Restriction of energy intake relative to requirements leading to significantly low body weight.
  • Intense fear of gaining weight or becoming fat.
  • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of current low body weight.
• Subtypes:
  • Restricting type: No recurrent episodes of binge eating or purging behaviors in the past 3 months.
  • Binge-eating/purging type: Recurrent episodes of binge eating or purging behaviors in the past 3 months.
• Remission:
  • Partial remission: Full criteria were previously met; low body weight criterion is not met for a sustained period but other criteria are still met.
  • Full remission: All criteria have not been met for a sustained period of time.
• Severity: Severity is assessed based on BMI.
• Diagnostic Markers:
  • Hematology: leukopenia (low white blood cells), anemia, thrombocytopenia (low platelets)
  • Serum Chemistry: dehydration, elevated cholesterol, electrolyte imbalances, metabolic changes.
  • Endocrine: Low thyroid function, low estrogen in females/low testosterone in males.
  • Electrocardiography: common sinus bradycardia and sometimes QTc interval prolongation.
  • Bone Health: low bone mineral density.
  • Electroencephalography: diffuse abnormalities due to severe electrolyte imbalances.
  • Reduced Resting Energy Expenditure: significant decrease
• Weight Criteria:
  • Adults: BMI below 18.5 kg/m²
  • Children and adolescents: below the 5th percentile may indicate underweight.
• Fear of Weight Gain, Distorted Body Image, Lack of Insight:
  • Persistent fear of weight gain or becoming fat
  • Misperception of body size and shape
  • Lack of awareness of current low body weight
• Associated Complications & Features:
  • Severe malnutrition
  • Amenorrhea (loss of menstrual cycle)
  • Loss of bone density
  • Abnormal lab results
  • Depressive & obsessive-compulsive symptoms
  • Purging behaviors (vomiting, laxative abuse)
  • Excessive physical activity to compensate for calories consumed
  • Medication misuse (insulin use or carbohydrate restriction)

Bulimia Nervosa

• Diagnostic Criteria:
  • Recurrent episodes of binge eating. A discrete period of time; consumption of an amount of food that is definitely larger than most individuals would eat in a similar period under similar circumstances. Feelings of lack of control
  • Recurrent inappropriate compensatory behaviors to prevent weight gain, including self-induced vomiting, misuse of laxatives, diuretics or other medications, fasting or excessive exercise.
  • Binge eating and inappropriate compensatory behaviors occur at least once a week for 3 months.
  • Self-evaluation is unduly influenced by body shape and weight
  • Disturbance does not occur exclusively during episodes of anorexia nervosa.
• Subtypes:
  • Purging Type: Compensatory behaviors include purging.
  • Non-Purging Type: Compensatory behaviors do not include purging.
• Severity: Based on the frequency of inappropriate compensatory behaviors
  • Mild: 1-3 episodes/week
  • Moderate: 4-7 episodes/week
  • Severe: 8-13 episodes/week
  • Extreme: 14+ episodes/week
• Associated Features:
  • Fluctuations in body weight (typically within normal range or overweight).
• Diagnostic Features:
  • Dissociative quality during and/or after binge eating.
  • Loss of control during binge eating
  • Loss of control is not absolute
  • Eating is not solely based on hunger

Binge-Eating Disorder

• Diagnostic Criteria:

  • Recurrent binge-eating episodes. A discreet period of time (within any 2-hour period) that is definitely more than most people would eat. Sense of lack of control over eating.
  • Binge-eating episodes are associated with three or more of the following:
  • Eating much more rapidly than normal to feeling uncomfortably full.
  • Eating large amount of food when not physically hungry.
  • Eating alone due to embarrassment.
  • Feeling disgusted, depressed, or guilty afterwards.
  • Marked distress regarding binge eating is present.
  • Binge eating occurs at least once per week for three months.
  • Binge eating is not associated with recurrent use of compensatory behaviors with bulimia or anorexia nervosa.

• Associated Features:

  • Obesity.
  • Overvaluation of weight & shape
  • Psychological Factors connected to body image

• Severity:

  • Mild, Moderate, Severe, or Extreme, based on average number of inappropriate compensatory behaviors per week

Other specified feeding or eating disorders

• This category is used when the symptoms indicate distress or impairment, but the client's symptoms do not meet full criteria for another specific feeding or eating disorder.

Unspecified feeding or eating disorders

• Used when there is insufficient information to more specifically classify the disorder.

Additional information/Case studies

• Information regarding demographic details of different groups, prevalence, age-related differences, diagnosis markers, typical onset for each disorder, risk factors, and potential comorbidities.