Anorexia Nervosa: DSM-5 Flashcards
Eating Disorders, General
Most common: anorexia nervosa, bulimia nervosa, and binge-eating disorder
BMI is the most common way to judge/evaluate the presence of these disorders
Similarities between anorexia nervosa and bulimia nervosa
o An intense fear of gaining weight and a pursuit to be thin despite the consequences
• Often leading to illness, organ failure, or even death
o Grappling with perfection and control despite actual weight
3 general body types
o From skinny to heavy: ectomorphic, mesomorphic, endormorphic
Anorexia Nervosa
DSM-5
A:
Restriction of energy intake relative to requirements, leading to a significantly low body weight
*“significantly low weight” is defined as a weight that is less than minimally normal
**for children and adolescents = less than minimally expected
B:
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly lower weight
C:
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
Anorexia Nervosa: Restricting Type
Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise
During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior
Anorexia Nervosa: Binge-eating/purging type
During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior
- Self-induced vomiting
- Misuse of laxatives, diuretics, or enemas
Some individuals with the subtype do not binge eat but do regularly purge after the consumption of small amounts of food
Binge-eating/purging type demonstrates higher rates of impulsivity and are more likely to abuse alcohol and other drugs
*crossover between subtypes is not uncommon – therefore subtype description should be used to describe current symptoms rather than longitudinal course
Anorexia Nervosa: Diagnostic Features
Persistent energy intake restriction
Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
Disturbance in self-perceived weight or shape
Often, individuals brought professional attention by family members after marked weight loss has occurred
This individual seek help on their own, it is usually because of distress over the somatic and psychological sequalae of starvation
Anorexia Nervosa: Fear of Gaining Weight
The intense fear of becoming fat is usually not alleviated by weight loss
Concern about weight gain may increase even as weight falls
Anorexia Nervosa: Experience of Body Weight
Distortion of the experience and significance of body weight and shape (Criterion C)
Some individuals feel globally overweight
Others realize that they are thin but are still concerned that certain body parts, particularly the abdomen buttocks and thighs are “too fat”
Anorexia Nervosa Associated Features: Physiological
Nutritional compromise affects most major organ systems and can produce a variety of disturbances
Physiological disturbances:
- Amennorhea
- Vital sign abnormalities
- Malnutrition
Most of the physiological disturbances associated with malnutrition are reversible, but some such as loss of bone mineral density are often not completely reversible
Anorexia Nervosa Associated Features: Depressive signs and symptoms
Depressive mood
social withdrawal
irritability
insomnia
diminished interest in sex
*These features may be secondary to physiological consequences of semi-starvation, but they may also be sufficiently severe to warrant an additional diagnosis of MDD
Anorexia Nervosa Associated Features: Other Features
]concern about eating in public
feelings of ineffectiveness
strong desire to control one’s environment
inflexible thinking
limited social spontaneity
overly restrained emotional expression
Anorexia Nervosa Associated Features: OCD Features
Obsessive-compulsive features, both related and unrelated to food, are often prominent
Most individuals are preoccupied with thoughts of food
Some collect recipes airport food
Obsessions or compulsions related to food may be exacerbated by undernutrition
When exhibiting obsessions and compulsions not related to food, body shape, overweight, and additional diagnosis of OCD may be warranted
Anorexia Nervosa: Prevalence
Females–0.4%
Less is known about males, but anorexia nervosa is far less common, 10:1 in clinical populations
Anorexia Nervosa: Onset
Commonly begins during adolescence are young adulthood
Rarely begins before puberty or after age 40, but cases of both early and late onset have been described
Onset is often associated with a stressful life event, such as leaving home for college
Anorexia Nervosa: Course
Course and outcome are highly variable
Older individuals are more likely to have a longer duration of illness, and the clinical presentation may include more signs and symptoms of a long-standing disorder
Clinician should not exclude anorexia nervosa from the differential diagnosis solely on the basis of older age
Anorexia Nervosa Risk Factors: Temperamental
Individuals develop anxiety disorders or display of sessional traits in childhood are at increased risk of developing anorexia nervosa
