Feeding & Eating Disorders PDF

Feeding & Eating Disorders Cang, Cosmo, Dampog, Felicia, Gerasol, Lim, Tabanao, Villarete What are Feeding and Eating Disorders? Persistent disturbance of eating or eating-related behaviors that affects consumption or absorption of food that significantly impairs physical health or psych...

Feeding & Eating Disorders Cang, Cosmo, Dampog, Felicia, Gerasol, Lim, Tabanao, Villarete What are Feeding and Eating Disorders? Persistent disturbance of eating or eating-related behaviors that affects consumption or absorption of food that significantly impairs physical health or psychosocial functioning. Similar Behavioral Patterns Some eating disorders show similarities with substance use disorders (e.g., craving, compulsive patterns), potentially linked to shared neural systems that regulate... Self-control Reward or Pleasure Topic Outline: Pica Rumination Disorder Avoidant/Restricitive Food Intake Disorder Anorexia Nervosa Bulimia Nervosa Binge-Eating Disorder Other specified eating disorder Other specified eating disorder  Pica chu... Diagnostic Criteria: A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month. B. Eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. C. Eating behavior is not part of a culturally supported or socially normative practice. Specify If: D. If the eating behavior occurs in the context of another mental health disorder (e.g., intellectual developmental disorder In remission: After full criteria for pica [intellectual disability], autism spectrum disorder, were previously met, the criteria have schizophrenia) or medical condition (including pregnancy), it is not been met for a sustained period of sufficiently severe to warrant additional clinical attention. time. Pica Prevalence Approximately 5% of Associated school-age children Features 1/3 or 33.33% of pregnant women, especially those facing food insecurity (i.e., Vitamin/Mineral without reliable access to Deficiencies (e.g., zinc and affordable and nutritious iron deficiency). food) Medical Complications (e.g., bowel blockages, intestinal damages, etc.) Pica Course May persist over time and Development lead to medical emergencies (e.g., Often begins in childhood intestinal obstruction and but can start un poisoning) adolescence or adulthood Fatal depending on Can occur in normally substance ingested. developing children For adults, occurs in the context of intellectual or other mental disorders. Pica Culture-Related Diagnostic Issues Eating behavior is not Risk and culturally or socially supported. Otherwise, it Prognostic does not qualify as pica Factors (criteria C) Further evaluation is necessary to determine if it is Environmental: Neglect, socially normative. lack of supervision, and developmental delay can increase the risk. Pica Functional Consequences Diagnostic Can significantly impair physical Markers functioning Rarely the sole cause of Sex- and Gender- X-rays, ultrasounds, and impairment in social functioning. related Diagnostic scans can detect Pica often occurs with other obstructions caused by Issues pica. disorders associated with impaired social functioning. Occurs in both MALES and Blood tests and other lab FEMALES. tests help identify poisoning or infections. Around 28% of pregnant or postpartum women may experience pica, based on global data. PHEW! Differential Diagnosis ANOREXIA NERVOSA Ingestion is primarily for weight control. FACTITIOUS DISORDER Intentionally consume foreign objects to create fake physical symptoms, includes deception. NONSUICIDAL SELF-INJURY Swallow harmful items (such as pins or knives) as part of maladaptive behaviors associated with personality disorders or nonsuicidal self-injury. Find Pica... A 6-year-old girl was brought to the psychiatry clinic at North Sumatera University Hospital after her mother reported that she had been eating non-food items like paper, sawdust, crayon, ice cubes, and clothing since age 3. This behavior started after her younger brother was born, when her mother noticed the girl would secretly consume A these items. Efforts to stop her were unsuccessful, often leading to family conflict. Recently, the girl developed diarrhea after eating a crayon, prompting the general physician to recommend psychiatric evaluation. During the assessment, the girl was alert, cooperative, and appropriate in speech and mood, though slightly tense. No delusions or perceptual disorders were present. She is the eldest child and often feels neglected, as her father favors her younger brother, which has caused feelings of anger and rivalry. Find Pica... A 7-year-old boy, recently moved to a new school, was brought to a general pediatric clinic after his parents noticed him chewing on and occasionally swallowing small pieces of chalk, erasers, and bits of cardboard. His mother reported that this behavior began just a few weeks ago after starting the new school year and making new friends who sometimes playfully chew on similar items during class. His parents were concerned B because he had a mild stomachache one evening, though this resolved by the next day without further complications. During the interview, the boy was alert and cooperative, with normal speech and age-appropriate behavior. He denied any discomfort or fear related to school but admitted that he found chewing on chalk "fun," as some classmates did it too. No signs of delusions, perceptual issues, or underlying emotional distress were noted. The family and cultural background showed no support for such behavior, and they agreed it seemed unusual. Find Pica... A 6-year-old girl was brought to the psychiatry clinic at North Sumatera University Hospital after her mother reported that she had been eating non-food items like paper, sawdust, crayon, ice cubes, and clothing since age 3. This behavior started after her younger brother was born, when her mother noticed the girl would secretly consume A these items. Efforts to stop her were unsuccessful, often leading to family conflict. Recently, the girl developed diarrhea after eating a crayon, prompting the general physician to recommend psychiatric evaluation. During the assessment, the girl was alert, cooperative, and appropriate in speech and mood, though slightly tense. No delusions or perceptual disorders were present. She is the eldest child and often feels neglected, as her father favors her younger brother, which has caused feelings of anger and rivalry.  THE CASE OF JAKE Jake, a 12-year-old boy, has recently been brought to a pediatrician by his mother due to concerns about his eating habits. For the past few months, Jake has been observed to regurgitate food that he has eaten, chew it again, and then either re-swallow it or spit it out. This behavior occurs after most meals and has led to noticeable weight loss. His mother mentions that this behavior started after Jake experienced stress due to his parents’ recent divorce. He often seems unaware of what he is during these episodes and does not appear to be experiencing nausea or discomfort before or after the regurgitation. Jake expresses feelings of shame about his behavior, but he finds it difficult to stop being aware that it is unusual.  Rumination Disorder A. Repeated regurgitation of food over a period of at lea st 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit ou t. B. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (ex. gastroesopha geal reflux, pyloric stenosis). C. The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating dis order, or avoidant/restrictive food intake disorder. D. If the symptoms occur in the context of another mental disorder (ex. intellectual disability = ID or another neurodevelopmental disord er), they are sufficiently severe to warrant additional clinical attention.  Rumination Disorder Specify if Diagnostic Features (A) Repeated regurgitation of food occurring after feeding or eating IN REMISSION: After over a period of at least 1 month. meeting the full criteria for Previously swallowed food/partially digested rumination disorder, the Food may be re-chewed, ejected, or re-swallowed person no longer meets Regurgitation occurs frequently, at least several times a week, those criteria for an often daily extended period (B) The behavior is not due to another gastrointestinal or medical condition. (C & D) The behavior does not occur only during anorexia, bulimia, binge-eating disorder, or avoidant/restrictive food intake disorder. If it appears with another mental disorder (ex. intellectual disability), symptoms must be severe enough to need additional clinical attention and should be a primary focus for intervention.  Rumination Disorder NOTE THE FOLLOWING: can be diagnosed at any age Clinicians may directly observe individuals engaging in the behavior. Diagnosis can also rely on self-reports or information from parents or caregivers. Individuals often describe the behavior as habitual or beyond their control.  Associated Features Prevalence Infants w/ Rumination Disorder: often strain and arch their backs while making movements, appearing satisfied but can be irritable and hungry historically noted mainly in individuals between episodes. with intellectual disabilities Weight loss and malnutrition are common, despite large food intake, especially when regurgitation Limited European data suggest a follows feeding. prevalence of about 1% to 2% among Older Children & Adults: may also face malnutrition, grade-school-age children. often hiding the behavior or avoiding eating in social situations to prevent embarrassment.  Development and Course Onset: infancy, childhood, adolescence, or adulthood Risk and Prognostic Factors Environmental often remits spontaneously but can lead to severe malnutrition and potentially be fatal, especially in Functional Consequences of Rumination Disorder infancy. Malnutrition from repeated regurgitation: can lead to growth occur episodically or continuously and delays and negatively impact development and learning can serve a self-soothing or self- potential stimulating function in infants and older individuals with Some older individuals with rumination disorder may restrict neurodevelopmental disorders. food intake due to the social stigma of regurgitation, resulting in weight loss or low weight. In older children, adolescents, and adults, social functioning is more likely to be adversely affected.  Rumination Disorder Differential Diagnosis Comorbidity Gastrointestinal Conditions: Gastroesophageal Regurgitation with rumination can happen Reflux, Gastroparesis, Pyloric Stenosis, Hiatal alongside a medical condition or another mental Hernia, and Sandifer Syndrome in infants = can be disorder (ex. GAD) ruled out through history and clinical observation Diagnosis of rumination disorder is appropriate only Anorexia and Bulimia Nervosa: regurgitate food and if the severity of the symptoms is greater than what spit out to avoid weight gain as away to dispose is typically seen with those conditions. The consumed calories symptoms have to be serious enough to need clinical attention.  Avoidant/Restrictive Food Disorder A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) associated with one (or more) of the following: 1. Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 2. Significant nutritional deficiency. 3. Dependence on enteral feeding or oral nutritional supplements. 4. Marked interference with psychosocial functioning. B. The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.  Avoidant/Restrictive Food Disorder C. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced D. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention Specify if In remission: After full criteria for avoidant/restrictive food intake disorder were previously met, the criteria have not been met for a sustained period of time. Diagnostic Features A/RFID extends the DSM-IV diagnosis of feeding disorders of infancy or early childhood to include older children, adolescents, and adults. For some individuals, 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, food avoidance or restriction develops as a conditioned negative response linked to eating after, or in anticipation of, an unpleasant experience, such as choking, a traumatic gastrointestinal procedure (e.g., esophagoscopy), or repeated vomiting. Functional Dysphagia: Sensation of food sticking or feeling of delay in food passage through the esophagus Globus Hystericus: Physical sensation of a lump in the throat that cases difficulty or discomfort in swallowing.  Associated Features Features may vary across ages. Very young Older infants children and adolescents Infants and They may present with symptoms such as food Associated with more generalized young children refusal, gagging, or vomiting. emotional difficulties that do not meet diagnostic criteria for an anxiety, depressive, or bipolar May not engage with a disorder, sometimes called “food primary caregiver during avoidance emotional disorder.” feeding or communicate hunger in favor of other activities  Prevalence There is limited information on the prevalence of avoidant/restrictive food intake disorder. One study conducted in Australia found a frequency of 0.3% among individuals aged 15 years and older.  Development and Course Commonly develops in infancy or early childhood and may persist in adulthood. Avoidance based on sensory characteristics: Arise in the first decade of life but may persist into adulthood. Relatively stable and long-standing, but when persisting into adulthood, such avoidance/restriction can be associated with relatively normal functioning. Avoidance related to aversive consequences: At any age  Development and Course Insufficient evidence directly linking a/rfid and subsequent onset of an eating disorder. Avoidant/restrictive food intake disorder in infants, children, and prepubertal adolescents may lead to growth delays and malnutrition, which can harm development and learning. In older children, adolescents, and adults, social interactions may be negatively affected.  Development and Course Across all ages, family dynamics can suffer, causing increased stress during mealtimes and in meals with friends and relatives. Manifests more commonly in children and adolescents than adults. Long delay between onset and clinical presentation.  Risk and Prognostic Factors Temperamental Genetic and Anxiety disorders, autism spectrum disorder, Physiological obsessive-compulsive A history of gastrointestinal disorder, and attention- conditions, gastroesophageal deficit/hyperactivity reflux disease, vomiting, and Environmental disorder may increase risk various other medical issues for avoidant or restrictive has been linked to feeding feeding or eating behavior and eating behaviors typical characteristic of the Familial anxiety, children of of avoidant/restrictive food disorder. mothers with eating intake disorder. disorders may have higher rates of feeding disturbances.  Culture-Related Diagnostic Issues Presentations similar to A/RFID occur in US, Canada, Australia, Europe, Japan, and China It should not be diagnosed when avoidance of food is related to religious or cultural practices. Sex- and Gender-Related Diagnostic Issues Approximately equally common in boys and girls. A/RFID comorbid with Autism Spectrum Disorder has male predominance. Functional Consequences of Avoidant/Restrictive Food Intake Impairment of physical development and social difficulties can have significant negative impact on family function. Differential Diagnosis Other medical conditions (e.g., gastrointestinal disease, food allergies and intolerances, occult malignancies) The disturbance in food intake goes beyond what can be directly explained by physical symptoms of a medical condition. The eating disturbance may also persist after initially being triggered by a medical condition, continuing even after the medical issue has resolved. Obsessive-compulsive and related disorder due to pediatric acute-onset neuropsychiatric syndrome A sudden onset, late onset, or unusual symptoms may indicate the need for a detailed assessment to rule out obsessive-compulsive and related disorders linked to pediatric acute-onset neuropsychiatric syndrome (PANS), characterized by a rapid onset of obsessive-compulsive symptoms or extreme food restriction, along with various other neuropsychiatric symptoms. Differential Diagnosis Specific neurological/neuromuscular, structural, or congenital disorders and conditions associated with feeding difficulties Avoidant/restrictive food intake disorder may still be diagnosed in these individuals if all diagnostic criteria are met. Reactive attachment disorder Should only be diagnosed if all criteria are met for both disorder and feeding disturbance is a primary focus for intervention. Autism spectrum disorder Individuals’ with autism spectrum disorder’s rigid eating behaviors and heightened sensitivities do not always result in the level of impairment required for A/RFID diagnosis. Diagnose both if eating disturbance requires specific treatment. Differential Diagnosis Specific phobia, social anxiety disorder, and other anxiety disorders. Diagnose A/RFID if the eating problem becomes the primary focus of clinical attention. Social anxiety disorder: individuals may present with a fear of being observed by others while eating which can also occur in A/RFID. Anorexia nervosa Individuals with anorexia nervosa display fear of gaining weight or becoming fat, specific disturbances in relation to perception and experience of their own body weight and shape. Should NOT be diagnosed concurrently. In some individuals, A/Rfid may precede onset of anorexia nervosa. Differential Diagnosis Obsessive-compulsive disorder Diagnose both OCD and A/RFID if aberrant eating is a major aspect of the clinical presentation requiring specific intervention. Major depressive disorder Avoidant/restrictive food intake disorder should only be used concurrently if full criteria are met for both disorders and when the eating disturbance requires specific treatment. Schizophrenia spectrum disorders Avoidant/restrictive food intake disorder should be used concurrently only if all criteria are met for both disorders and when the eating disturbance requires specific treatment. Differential Diagnosis Factitious disorder or factitious disorder imposed on another Individuals with factitious disorder: Individuals may portray their diets as more restrictive than they are, leading to complications like reliance on enteral feedings, limited food tolerance, and difficulty in age- appropriate food-related social situations. Factitious disorder imposed on another: The caregiver reports symptoms consistent with avoidant/restrictive food intake disorder and may induce physical effects, such as failure to gain weight. Developmentally normal behavior Avoidant/restrictive food intake disorder does not encompass developmentally normal behaviors unless they become severe enough to result in inadequate nutritional intake or significant impairment in functioning.  Comorbidity Anxiety disorders Obsessive-compulsive disorder Neurodevelopmental disorders, specifically: Autism spectrum disorder Attention-deficit/hyperactivity disorder Intellectual developmental disorder (intellectual disability)  Diagnostic Criteria Anorexia Restriction of energy intake relative to requirements, leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Nervosa Significantly low weight is identified as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. 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 the current low body weight.  Subtypes Specify whether: Restricting type Last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). Binge-eating/purging type Last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self- induced vomiting or the misuse of laxatives, diuretics, or enemas)  Subtypes Specify if: In Partial Remission after full criteria were previously met, Criterion A (low body weight) has not been met for sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met. In Full Remission after full criteria were previously met, none of the criteria have been met for a sustained period of time.  Subtypes Specify current severity: Minimum level of severity is based, for adults, on current body mass index (BMI) For children and adolescents, on BMI percentiles Diagnostic Features Fear of weight gain: Some younger individuals or certain adults may 1. Persistent energy intake restriction leading to a not explicitly acknowledge this fear, but significantly low body weight. persistent behaviors indicate an aversion to 2. Intense fear of gaining weight or of becoming weight gain. fat, or persistent behavior that interferes with weight gain. Distorted body image: perceive themselves as overweight or have 3. Disturbance in self-perceived weight or shape concerns about specific body areas. (abdomen, Weight Criteria: thighs, etc.) Adults often defined by a BMI under 18.5 km/m2 frequent weighing & measuring behaviors. Moderate or severe thinness is indicated by a Lack of insight: BMI under 17.0 kg/m2 lack of awareness of their state and may deny Children and adolescents, a BMI below the 5th their condition. percentile may suggest underweight status. family members or others often recognize. Associated Features Behavioral Features fear of eating in public, feelings of ineffectiveness, a desire for control, rigid Medical Complications thinking, limited social spontaneity, and Severe malnutrition restricted emotional expression. amenorrhea (loss of menstrual cycle) show higher impulsivity and are more prone to loss of bone density Substance abuse. Impact of purging behaviors Excessive Physical Activity abnormal lab results and various health engage in excessive physical activity, which complications, although some individuals may may begin before the disorder onset and often show no lab abnormalities. worsens weight loss, making recovery harder. Psychological Effects Medication Misuse include insulin (in those with diabetes), to control Depressive symptoms or lose weight by altering or skipping doses in Obsessive-compulsive features order to minimize carbohydrate utilization.  Prevalence in U.S. Ethnoracial the US Groups Prevalence 12-month prevalence ranges generally lower from 0.00% to 0.05% among latinx and Rates are higher in women Black Americans than in men. compared to non- Lifetime prevalence is 0.60% Latinx White to 0.80%. With 0.9% to 1.42% Americans. in women and 0.12% to 0.3% in men. Gender differences Global trends common in postindustrial, Women have higher high-income countries like rates than men, though the U.S., Europe, Australia, a study on adolescents found similar rates New Zealand, and Japan. across gender. Prevalence appears to be rising in the Global South, including regions of Asia and the Middle East Typical Onset Age-related differences begins in adolescence Younger individuals or young adulthood, may have atypical with cases rarely Course of illness features, like denying a starting before puberty or after age 40. “fear of fat” Remission and Mortality Older individuals may Stressful life events gradual pattern before experience a (e.g., leaving for the disorder fully prolonged illness college) often precede develops. duration with long- remission within 5 years, onset. some recover fully standing symptoms. though those hospitalized after one episode, may have lower remission while others have a rates. relapsing or chronic Mortality rate is about 5 % course. per decade, with common Hospitalization may be causes being medical necessary complications or suicide. Development & Course Risk & prognostic Factors Temperamental Factors childhood anxiety disorders or obsessional traits increase the risk of developing anorexia nervosa. Environmental factors cultures and settings that value thinness. Occupations or activities that emphasize thinness, like modeling and elite athletics are linked to higher risk Genetic and Physiological Factors Exists among biological relatives of affected individuals. Genome-wide association studies have identified risk loci related to psychiatric conditions and metabolic traits. Culture-related Diagnostic Issues Cultural Diversity found across culturally and socially diverse populations, though its prevalence and presentation vary by culture. Cultural variation in Symptoms weight concerns and motivations for dietary restriction differ by culture. may be attributed to gastrointestinal discomfort rather than a fear of weight gain, often referred to as “fat phobia” Service utilization mental health service use for eating disorders is significantly lower among underserved ethnic and racial groups in the United States Diagnostic Markers HEMATOLOGY leukopenia (low white blood cell count), often with lymphocytosis. Mild anemia and thrombocytopenia (low platelets), SERUM CHEMISTRY dehydration often shows as high blood urea nitrogen. Common findings include hypercholesterolemia and sometimes elevated liver enzymes. Electrolyte imbalances- Hypomagnesemia, hypozincemia, hypophosphatemia, and hyperamylasemia. Metabolic alkalosis (due to vomiting) or mild metabolic acidosis (from laxative use) ENDOCRINE low thyroid function - normal to low T4, low T3, elevated reverse T3. low estrogen in females and low testosterone in males. Diagnostic Markers ELECTROCARDIOGRAPHY common sinus bradycardia and sometimes QTc interval prolongation. BONE HEALTH low bone mineral density (osteopenia/osteoporosis), raising fracture risk. ELECTROENCEPHALOGRAPHY (EEG) diffuse abnormalities may occur due to severe electrolyte imbalances REDUCED RESTING ENERGY EXPENDITURE significant decrease in resting energy needs. PHYSICAL SYMPTOMS amenorrhea (missed periods), delayed menarche in young females, constipation, cold intolerance, lethargy, and sometimes excess energy. maciation, hypotension, hypothermia, bradycardia, lanugo (fine hair), peripheral edema (swelling), yellow skin, period gland hypertrophy (if vomiting), and dental enamel erosion. Scars/ calluses on the hands from inducing vomiting may be present. Association with suicidal thoughts or behavior CONTRIBUTING FACTORS greater exposure to sexual ELEVATED SUICIDE RISK abuse, impaired decision- suicide rate 18 times higher than age- and gender- making, and high rates of matched peers. Suicide is the second leading cause nonsuicidal self- injury (a risk of death in individuals with anorexia nervosa. factor for suicide). High PREVALENCE OF SUICIDAL THOUGHTS comorbidity with mood AND ATTEMPTS disorders further elevates one-quarter to one-third of suicide risk. individuals with anorexia nervosa experience suicidal ideation. 9%-25% have attempted suicide. Individuals with anorexia Functional Consequences nervosa experience varying functional limitations, from maintaining social and professional activity to of Anorexia Nervosa experiencing significant social isolation and inability to reach academic or career potential. Differential Diagnosis OTHER MEDICAL CONDITIONS gastrointestinal disease, hyperthyroidism, cancer, and AIDS can cause weight loss but generally lack the disturbance in body image and fear of weight gain seen in anorexia nervosa. Anorexia may develop after bariatric surgery or following weight loss from other medical conditions. MAJOR DEPRESSIVE DISORDER without a desire for excessive weight loss or fear of gaining weight. SCHIZOPHRENIA odd editing behaviors and weight loss but lacks fear of weight gain and body image disturbance essential to anorexia nervosa. SUBSTANCE USE DISORDERS poor nutrition in substance use, especially with appetite-suppressing drugs. SOCIAL ANXIETY DISORDERS, OCD, BODY DYSMORPHIC DISORDER fear of eating in public (social anxiety), obsessions about food (OCD), and preoccupations with perceived body defects (body dysmorphic disorder). BULIMIA NERVOSA Bulimia includes binge and purging with body weight typically at a normal level, contrasting with the often significantly low weight in anorexia nervosa. AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID) ARFID involves weight loss and nutritional deficiency without fear of weight gain or distorted body image as seen in anorexia.  Comorbidities COMMON COMORBIDITIES Bipolar, depressive, and anxiety disorders frequently co-occur with anorexia nervosa ANXIETY DISORDERS Many individuals with anorexia report experiencing anxiety disorders or symptoms of anxiety prior to the onset of their eating disorder. OBSESSIVE-COMPULSIVE DISORDER (OCD) OCD is noted particularly in individuals with the restricting type of anorexia nervosa. SUBSTANCE USE DISORDERS Alcohol use disorder and other substance use disorders may co-occur, especially in those with the binge-eating/ purging type of anorexia nervosa. CASE STUDY CASE STUDY  Bulimia Nervosa HALLMARKS: Eating a larger amount of food—n onnutritive foods— than most people would eat unde r similar circumstances Eating is experienced as out of co ntrol. Individuals compensate for the bin ge eating and potential weight gain, by purging technique s (e.g., self-induced vomiting, using laxatives and diure tics, excessive exercise, fasting for long periods b etween binges). Major features of the disorder: bin geing, purging, overconcern with body shape, an d so on—tend to occur together “cluster together”.  Bulimia Nervosa Diagnostic Criteria: A. Recurrent episodes of binge eating. An episode of B. Recurrent inappropriate compensatory behaviors in binge eating is characterized by both of the following: order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other 1. Eating, in a discrete period of time (e.g., within any medications; fasting; or excessive exercise.C. Binge 2-hour period), an amount of food that is definitely eating and inappropriate compensatory behaviors both larger than what most individuals would eat in a occur, on average, at least once a week for 3 months. similar period of time under similar circumstances. 2. A sense of lack of control over eating during the D. Self-evaluation is unduly influenced by body shape episode (e.g., a feeling that one cannot stop eating and weight. or control what or how much one is eating). E. Disturbance does not occur exclusively during episodes of anorexia nervosa.  Bulimia Nervosa Specify Current Severity: Specify If: Minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below), and may be In Partial Remission: After full criteria for increased to reflect other symptoms and the degree of functional disability. bulimia nervosa were previously met, some, but not all, of the criteria have Mild: Average of 1–3 episodes of inappropriate been met for a sustained period of time. compensatory behaviors per week. Moderate: Average of 4–7 episodes of inappropriate In Full Remission: After full criteria for compensatory behaviors per week. bulimia nervosa were previously met, Severe: Average of 8–13 episodes of inappropriate none of the criteria have been met for a compensatory behaviors per week. sustained period of time. Extreme: Average of 14 or more episodes of inappropriate compensatory behaviors per week.  Diagnostic Feature Binge-eating Episode Does NOT have to happen all in one place Context Sensitivity What is deemed “excessive” can depend on the situation. Loss of Control inability to refrain from eating or to stop eating once started; and loss of control during binge eating can vary. Dissociative Quality some people feel disconnected from themselves during or after binge eating. Impairment is NOT absolute loss of control associated w/ binge-eating isn't always complete. Generalized Uncontrolled Eating Some people might not feel a sudden loss of control but instead experience a constant sense of not being able to control their eating.  Diagnostic Feature Abandoning efforts to control If someone stops trying to control their eating, it's still considered a loss of control. Food Intake Abnormal amount of food consumed, not just a craving. The type of food eaten during binges varies, but foods typically avoided are often consumed during binges Individuals with bulimia often hide their behaviors due to shame, eating in secret until feeling uncomfortably full. Binge eating is often triggered by negative emotions, interpersonal stress, dietary restriction, body-related insecurities, or boredom. Although binge eating may temporarily alleviate these negative feelings, it often leads to further self- evaluation and dysphoria afterward.  Menstrual Irregularity/ Weight Amenorrhea Range common in women with Bulimia Nervosa; Health typically within a likely due to weight normal to changes, nutritional overweight BMI Eating deficiencies, or emotional stress Complications Patterns range (18.5 to