Feeding and Eating Disorders PDF

Feeding and Eating Disorders Randall Ricardi, DO MS I 01-17-25 Cutler, Pgs. 291-317 1  Learning Objectives 1. Differentiate the core features of various eating disorders. 2. Know the DSM-V-TR criteria and relevant subtypes for An...

Feeding and Eating Disorders Randall Ricardi, DO MS I 01-17-25 Cutler, Pgs. 291-317 1  Learning Objectives 1. Differentiate the core features of various eating disorders. 2. Know the DSM-V-TR criteria and relevant subtypes for Anorexia Nervosa, Bulimia Nervosa, and Binge Eating Disorder. 3. Describe the medical and psychiatric manifestations due to eating disordered behaviors. 4. Summarize levels of care to treat eating disorders. 2  Eating Disorders Pica Persistent intake of non-food substances 3  Feeding/Eating Disorder Pica Ingestion of non-nutritive substances on a regular basis (Plaster, paint, hair, sand, insects, leaves, dirt, clay) Onset between 1-2 years At risk for lead poisoning, bezoar, intestinal obstruction 4  Eating Disorders Rumination Disorder Repeated regurgitation of food (re-chewed, re-swallowed or spit out) Avoidant/Restrictive Food Intake Disorder (ARFID) Restrictive eating leading to inability to meet one’s nutritional needs 5  Eating Disorders Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge eating disorder (BED) Other specified eating disorder (i.e. Night eating syndrome) 6  Anorexia Nervosa Psychiatric disorder characterized by an obsessive desire to lose weight driven by a negative body image.  AN-Prevalence More common in Females 1-3% Females 0.1-0.2% Males 10:1 F/M Frequent onset in adolescence and young adulthood Higher academic achievers Higher socio-economic groups Can develop later – usually prior symptoms or linked to adverse event 8  Anorexia Nervosa-DSM-V-TR A. Restriction of energy intake relative to requirements, leading to a significantly low body weight (Or for children less than expected growth goals) B. Intense fear of becoming fat Not alleviated by weight loss C. Distortion of body image – weight, size, shape 9  Body Dysmorphic Syndrome (BDD) Fixation on a minor or imagined physical defect in appearance Usually of face or head Proof out 10  AN Subtypes-DSM-V-TR Restricting type Weight loss through dieting, fasting, or excessive exercise NO bingeing or purging Binge eating-purging type Excessive fasting, dieting or exercising Regular bingeing and/or purging during current episode May misuse laxatives, diuretics, diet pills, enemas 11  Severity of AN-DSM V-TR Mild: BMI > 17 kg/m2 Moderate: BMI 16 – 16.99 kg/m2 Severe: BMI 15 – 15.99 kg/m2 Extreme: BMI < 15 kg/m2 12  AN Associated Disorders Depression Obsessive Compulsive Disorder Anxiety Disorders i.e. social phobia Personality Disorders 13  AN Associated Psychological Features Feelings of ineffectiveness Fear of eating in public Strong need to control one’s environment Inflexible thinking-rigidity Limited social spontaneity Overly controlled emotional expression Hypo-sexual Denial of having the disorder 14  AN Physical Findings Emaciation - starvation Hypotension Hypothermia Dryness of skin i.e. yellow tinged Lanugo (Fine, downy body hair) Bradycardia Decrease bone density Hair thins, loses luster 15  AN Physical Findings Peripheral edema Electrolyte disturbance Purging-dental enamel erosion, scars or calluses on the dorsum of hand used to induce purging – Russel’s Sign Hypertrophy of salivary glands-parotid glands, “Chipmunk cheeks” Hypothyroidism, anemia, leukopenia, Hypercholesteremia 16  AN Physical Findings Frequent vomiting may lead to a metabolic alkalosis (elevated serum bicarbonate) Frequent laxative abuse may lead to a metabolic acidosis May see amenorrhea Cognitive decline in starvation – completely reversible in 95% with full weight restoration Beware of Refeeding Syndrome (hypophosphatemia) 17  AN- Proposed Etiology Genetics (Heritability 0.5 – 0.8) Gender, age, ethnicity Puberty, medical illness that produces a catabolic state Psychostimulants that caused weight loss can precipitate ED 18  AN-Proposed Etiology Stressor diathesis applicable Predisposing psychological and social factors: Perfectionism, cognitive rigidity, anxiety Low self-esteem Family preoccupied with weight perfectionism Media/social message of thin is beautiful Western culture influences/Globalization 19  AN-Common Criteria for Hospitalization