Eating & Feeding Disorders (PSYC 3340) PDF

EATING & FEEDING DISORDERS PSYC 3340 LANTIER  2 THINGS TO CONSIDER: Current focuses in medicine and public health= weight centric care and rising obesity rates Weight Stigmatization- the social devaluatio...

EATING & FEEDING DISORDERS PSYC 3340 LANTIER  2 THINGS TO CONSIDER: Current focuses in medicine and public health= weight centric care and rising obesity rates Weight Stigmatization- the social devaluation of people in larger bodies linked to adverse health behaviors: maladaptive eating behaviors low levels of physical activity physiological stress weight cycling also linked to anxiety, depression, low self esteem, and dissatisfaction with appearance Studies have shown that higher BMI= poorer patient care EATING DISORDERS: ANOREXIA NERVOSA BULIMIA NERVOSA BINGE EATING DISORDER FEEDING DISORDERS: ARFID PICA  4 ANOREXIA NERVOSA Restriction of energy intake → significantly low body weight in the context of age, sex, developmental trajectory, and physical health Intense fear of gaining weight, behaviors that interfere with weight gain Distorted perception of body, self-evaluation based on body shape Types: Restricting and Binge-purge Severity: based on BMI Risks include malnourishment, organ failure, can result in death highest risk of death; often from suicide completion BULIMIA NERVOSA Recurring presence of episodes of binge eating Discrete periods of time where large amount of food is consumed along with loss of “control” over eating Compensatory behaviors aimed at preventing weight gain Most common is vomiting, but others include fasting or laxative use Self-image that is overly focused on body size Severity: based on episodes of compensatory behavior per week Mild: 1-3x a week, Moderate: 4-7x a week Severe: 8-13x a week, Extreme: 14+x a week Most risks occur related to the compensatory behaviors: Purging can cause dental erosion, caries, gastroesophageal reflux, and most patients with BN fall into dehydration (electrolyte imbalance that can result in heart arrhythmias and death) the “normal” or “overweight BINGE EATING DISORDER 6 Presence of binge eating episodes and distress related to binge eating Examples: eating rapidly or until uncomfortably food, eating alone due to embarrassment regarding amount of food eaten, feeling disgusted or guilty Diagnosis is NOT based on concerns related to weight loss or appearance Severity: based on number of binge-eating episodes per week Mild: 1-3x, Moderate: 4-7x Severe: 8-13x, Extreme: 14+  7 EATING DISORDER TREATMENT Inpatient or Outpatient Care Inpatient goal: medical stabilization FIRST Multidisciplinary Approach Primary Care Psychiatry Psychology Social Work Nutrition Family Based Interventions Goal: target family dynamics around food  8 ETIOLOGY Source: https://www.huffpost.com/entry/ what-lindsay-lohan-can-te_b_655 657 Environmental variables & Individual Variables contribute Dieting behavior spurred by individual and cultural factors that escalates as physiological changes occur Female sex increases vulnerability Girls consistently outnumber boys in anorexia and bulimia studies Stressful life events Traits: anxiety, perfectionism, high harm avoidance Heritability is noted Cultural factors- thinness and objectification of the female form Reinforcement: Weight loss Praise from others Sense of control Fasting increases hormones that diminish appetite over time Exercise releases endogenous opiods Family factors: Parent psychiatric problems / control Parent attitudes about eating, weight, shape PERSPECTIVES: Will the Ozempic craze mark the end of body positivity and plus-size fas hion? – Reckon  9 TREATMENT Anorexia= Ego Syntonic Primary Goal: weight restoration & medical safety Challenge: Patient Motivation Bulimia and Binge Eating = Ego Dystonic CBT: focus on maladaptive thoughts and disrupting cycles Medications: antidepressants, Vyvanse  10 OTHER SPECIFIED FEEDING & EATING DISORDERS Atypical Anorexia Nervosa Binge Eating Disorder (low frequency, limited duration Bulimia Nervosa (low frequency or limited duration) Purging Disorder Night Eating Syndrome Orthorexia & Disordered Eating Lifetime prevalence of ED in women: 3.5%// in men: 2 % FEEDING DISORDERS  12 PICA Ingesting non-food items Duration: at least a month Unusual for age, developmental level, or cultural context ○ Not diagnosed before age 2 Not diagnosed when behavior is serving a specific purpose (appetite suppression, self-mutilation) or delusion Often associated with IDDs or OCD 10-25% of people with IDDs who are in residential care meet criteria for PICA Can be very dangerous and cause harm or even death  13 PICA: TREATMENT Behavioral ○ Differential reinforcement ○ Response prevention ○ Protection (aka “PICA Proofing”) Pharmacological ○ SSRI’s ○ Antipsychotics Patient Education  14 RUMINATION DISORDER Automatic regurgitation of recently consumed food ○ Food is typically undigested ○ May occur up to 1 to 2 hours after a meal ○ Typically either rechew, re swallow, or spit out the food Rumination is a reflex, not a conscious act Extremely difficult to treat ○ Competing reinforcement ○ Diaphragmatic Breathing ○ Medication Management  AVOIDANT AND RESTRICTIVE FOOD INTAKE 15 DISORDER (ARFID) DSM’s newest feeding disorder An eating/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) as manifested by persistent failure to meet appropriate nutritional and/or energy needs 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 The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice 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 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 mental disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.  16 ARFID: TREATMENT PFD & ARFID Patients under 10 Behavior Analytic Treatment (Bloomfield et al., 2019; Bloomfield et al., 2021; Taylor & Haberlin, 2019) Preference Assessment- allowing child to choose their reward Demand Fading- breaking large demands into smaller ones Contingent Access to Reinforcers- Only allowing access to x with bites/ compliance Differential Attention- reinforcing wanted bx, ignoring unwanted Chaining- breaking steps down into tiny parts and then expanding over time  17 FOOD CHAINING  18 CBT ARFID ARFID Patients 10+ CBT-ARFID (Thomas et al., 2018) Psychoeducation Treatment Planning Understanding the Maintaining mechanism Preventing Relapse 19 20  21 SLIDE CONTENT CREDITS: NINA DEUSCHLE, MS, RD ANNE H. LIPSCOMB, PHD, BCBA-D https://www.psychiatrictimes.com/view/diagnosis-and-assessment-issues-eating-disorders Essentials of Abnormal Psychology, Eighth Edition V. Mark Durand, David H. Barlow, Stefan G. Hofmann https://www.nationaleatingdisorders.org/learn/by-eating-disorder/osfed Agarwal E, Ferguson M, Banks M, Vivanti A, Batterham M, Bauer J, Capra S, Isenring E. Malnutrition, poor food intake, and adverse healthcare outcomes in non-critically ill obese acute care hospital patients. Clinical Nutrition. 2019;38(2):759-766. Mensinger JL, Calogero MC, Tylka TL. Internalized weight stigma moderates eating behavior outcomes in women with high BMI participating in a healthy living program. Appetite. 2016;102:32-43. Lebow JL, Sim LA, Kransdorf LN. Prevalence of a history of overweight and obesity in adolescents with restrictive eating disorders. Journal of Adolescent Health. 2015;56(1):1-126. Eating Disorder Statistics | General & Diversity Stats | ANAD