12-05 Eating Disorders

Question 1

Eating Disorders in DSM-V

Answer 1

1 Anorexia Nervosa
2 Bulimia Nervosa
3 Binge Eating Disorder
4 Eating Disorder Not Otherwise Specified (NOS)

Question 2

Anorexia Dx Criteria

Answer 2

1. Restriction of energy intake relative to requirements, leading to a significantly low body weight (less than minimally normal or, for children and adolescents, less than that minimally expected)
2. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
3. Disturbed experience of body weight or shape, undue influence of wt/shape on self-eval, or persistent lack of recognition of the seriousness of low weight.

**DSM-V removed amenorrhea criteria

Question 3

Anorexia partial remission

Answer 3

Specify if in partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbance in self-perception of weight and shape) is still met.

Question 4

A.N. complete remission

Answer 4

After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.

Question 5

Dx Criteria

Answer 5

Mild: BMI >17kg/m
Moderate: BMI 16 -16.99 kg/m
Severe: BMI 15- 15.99 kg/m
Extreme: BMI < 15 kg/m
**can increase stage if sx worse

Question 6

DSM-V Dx Criteria for Bulimia Nervosa

Answer 6

1. Recurrent episodes of binge eating characterized by both of the following:
   (a) Eating, (w/in 2hr period), an amount that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
   (b) A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
2. Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, enemas, or other medications; fasting; or excessive exercise. **excessive H2O
3. The binge eating and inappropriate compensatory behaviors both occur, on average, at least 2/wk for 3 months.
4. Self-evaluation is unduly influenced by body shape and weight.
5. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Specify Subtype
a) purging type
b)

Question 7

partial remission in bulemia

Answer 7

After full criteria for bulimia nervosa were previously met, SOME, but NOT ALL, of the criteria have been met for a sustained period of time.

Question 8

full remission in bulemia

Answer 8

After full criteria for bulimia nervosa were previously met, NONE of the criteria have been met for a sustained period of time.

Question 9

Severity in bulemia

Answer 9

Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per week.
Moderate: An average of 4-7 behaviors/wk.
Severe: An average of 8-13 episodes/wk.
Extreme: Avg >14/day
**can bump for other sx; can consume entire day; financial consequences

Question 10

Binge-Eating Disorder dx criteria in DSM-V

Answer 10

A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
1. Eating in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
2. A sense of lack of control over eating during the episode ( e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B. The binge eating episodes are associated with three (or more) of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed, or very guilty afterward.
C. Marked distress regarding binge eating is present.
D. The binge eating occurs, on average, at least once a week for 3 months.
E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

Question 11

Partial Remission in Binge-Eating d/o

Answer 11

After full criteria for binge eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time.

Question 12

Full Remission in Binge-eating d/o

Answer 12

After full criteria for binge eating disorder were previously met, none of the criteria have been met for a sustained period or time.

Question 13

Severity

Answer 13

based on # episodes/wk; may be increased to reflect other symptoms and the degree of functional disability.
Mild: 1-3 binge eating epsiodes per week.
Moderate: 4-7X/week.
Severe: 8- 13X/week.
Extreme: 14+X/week

Question 14

Other Spcified Feeding or Eating Disorder: DSM-V Dx Criteria

Answer 14

The other specified feeding or eating disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific feeding and eating disorder. This is done by recording “other specified feeding or eating disorder” followed by the specific reason (e.g., “bulimia nervosa of low frequency”).

Question 15

Other Spcified Feeding or Eating Disorder: #1 Atypical anorexia nervosa

Answer 15

All of the criteria for AN are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.

Question 16

Other Spcified Feeding or Eating Disorder: #2 Bulimia nervosa (of low frequency and/or limited duration)

Answer 16

All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week, and/or for less than 3 months.

Question 17

Other Spcified Feeding or Eating Disorder: #3 Binge eating disorder (of low frequency and/or limited duration)

Answer 17

All of the criteria for binge eating are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week, and/or for less than 3 months.

Question 18

Other Spcified Feeding or Eating Disorder: #4 Purging Disorder

Answer 18

Recurrent purging behavior to influence weight or shape (e.g., self –induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

Question 19

Other Spcified Feeding or Eating Disorder: #5 Night Eating Syndrome

Answer 19

Recurrent episodes of night eating, as manifested by eating after awakening from sleep or excessive consumption after the evening meal. There is awareness and recall of eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or another mental disorder, including substance use, and is not attributable to another medical condition or to an effect of medication

Question 20

Onset for eating d/o

Answer 20

usu. females in adolescence or young adulthood

Question 21

Anorexia tardive

Answer 21

illness started after 25 years old; <1% newly diagnosed with Anorexia are over 50

Question 22

Body Dysmorphic Disorder (BDD)

Answer 22

**nearly as common in men as women
**Is w/in “Obsessive-Compulsive and Related Disorders” in DSM-V
1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.
2. At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.
3. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4. The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.
—Muscle Dysmorphia or “Adonis Complex”
—Considered “Anxiety Spectrum” more than Eating Disorder

Question 23

Hereditabilty Risk Factors

Answer 23

(AN): FMhx of eating d/o (ED) or affective disorder (hered estimate: 33% to 84%)
(BN): FMhx of ED, affective disorder, substance abuse and personality traits of perfectionism and ineffectiveness (hered estimate: 28% to 83%)

Question 24

Psychological Risks Factors for E.D.’s

Answer 24

1. High childhood anxiety
—AN: overanxious and OCD
—BN: overanxious and social phobia
2. Obsessive-compulsive traits
3. Early perceived body image distortions, body regulatory issues, academic and personal issues
4. Increasingly compulsive exercising