body image and eating disorders

Question 1

what are the different eating disorders characterised by the DSM-5?

8 types

Answer 1

• anorexia nervosa
• bulimia nervosa
• binge eating disorder
• other specified feeding and eating disorder
• pica
• rumination disorder
• avoidant / restrictive food intake disorder
• unspecified feeding or eating disorder

Question 2

what are the subtypes for anorexia?

Answer 2

• restricting type
• binge-eating / purging type

Question 3

what is the diagnostic criteria for anorexia nervosa (AN)?

Answer 3

• restriction of energy intake relative to requirements
  → leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health
• intense fear of gaining weight / becoming fat
  or persistent behaviour 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 / shape on self-evaluation
• or persistent lack of recognition of the seriousness of the current low body weight

Question 4

what is the diagnostic criteria for the restricting type of anorexia nervosa?

Answer 4

during the last 3 months
- has not engaged in recurrent episodes of binge eating or purging behaviour

weight loss primarily through dieting, fasting, and / or excessive exercise

Question 5

what is the diagnostic criteria for the binge-eating / purging type of anorexia nervosa?

Answer 5

for the last 3 months
- recurrent episodes of binge eating or purging behaviour

Question 6

what are some examples of purging behaviour?

Answer 6

• self-induced vomiting
• misuse of laxatives, diuretics, enemas

Question 7

what is the diagnostic criteria for bulimia nervosa (BN)?

5 criteria

Answer 7

• recurrent episodes of binge eating — an episode of binge eating is characterised by both
  of the following:
  
  • 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 individuals would eat in a similar period of time & under similar circumstances
  • 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)
• recurrent inappropriate compensatory behaviours in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise
• binge eating & inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months
• self-evaluation is unduly influenced by body shape and weight (body dysmorphia)
• disturbance does not occur exclusively during episodes of anorexia nervosa

Question 8

what are the BMIs of individuals of bulimia nervosa?

Answer 8

individuals with bulimia often have a normal BMI

Question 9

when can bulimia be described as mild?

Answer 9

an average of 1-3 episodes of inappropriate compensatory behaviours per week

Question 10

when can bulimia be described as moderate?

Answer 10

an average of 4 -7 episodes of inappropriate compensatory behaviours per week

Question 11

when can bulimia be described as severe?

Answer 11

an average of 8 -13 episodes of inappropriate compensatory behaviours per week

Question 12

when can bulimia be described as extreme?

Answer 12

an average of 14 or more episodes of inappropriate compensatory behaviours per week

Question 13

what is the difference between bulimia and anorexia nervosa with binging episodes?

Answer 13

in anorexia: intense fear of gaining weight & low BMI

Question 14

what is the diagnostic criteria for binge eating disorder (BED)?

Answer 14

• recurrent episodes of binge eating — an episode of binge eating is characterised by both
  of the following:
  
  • 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 individuals would eat in a similar period of time & under similar circumstances
  • 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)
  • • arked distress regarding binge eating is present
• the binge eating occurs, on average, at least once a week for 3 months
• the binge eating is not associated with the recurrent use of inappropriate compensatory behaviour (as in bulimia nervosa) and does not occur exclusively during the course of bulimia nervosa / anorexia nervosa

Question 15

what are binge eating episodes characterised by? (5)

(at least three of these must be fulfilled)

Answer 15

• eating much more rapidly than normal
• eating until feeling uncomfortably full
• eating large amounts of food when not feeling physically hungry
• eating alone because of feeling embarrassed by quantity of food eaten
• feeling disgusted with oneself, depressed, or very guilty afterward

Question 16

what is the difference between BED and overeating?

& what is it associated with?

Answer 16

binge eating disorder is less common but much more severe than overeating

→ associated with more subjective distress regarding the eating behaviour & commonly other co-occurring psychological problems

Question 17

what is the diagnostic criteria for other specified feeding and eating disorder (OSFED)?

Answer 17

• symptoms of a feeding / eating disorder that cause clinically significant distress / impairment in social / occupational / other important areas of functioning but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class

Question 18

when is the diagnostic criteria of other specified feeding and eating disorder (OSFED) applied?

Answer 18

used in situations where clinician chooses to indicate the specific reason that the presentation does not meet the criteria for any specific feeding and eating disorder

→ “other specified feeding or eating disorder” followed by the specific reason (e.g., “bulimia nervosa of low frequency”)

Question 19

what are some examples of OSFEDs?

Answer 19

• atypical anorexia nervosa
• bulimia nervosa (of low frequency and/or limited duration)
• binge-eating disorder (of low frequency and/or limited duration)
• purging disorder
• night eating syndrome

Question 20

what is the diagnostic criteria for pica disorder?

Answer 20

• persistent eating of nonnutritive, nonfood substances over a period of at least 1 month
• the eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual
• the eating behaviour is not part of a culturally supported or socially normative practice
• if the eating behaviour occurs in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophrenia)or medical condition (including pregnancy)→ it is sufficiently severe to warrant additional clinical attention

Question 21

what is the diagnostic criteria for rumination disorder?

Answer 21

• repeated regurgitation of food over a period of at least 1 month
• regurgitated food may be re-chewed, re-swallowed, or spit out
• the repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis)
• the eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder
• if the symptoms occur in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder] or another neurodevelopmental disorder)→ they are sufficiently severe to warrant additional clinical attention

Question 22

what is the diagnostic criteria for avoidant / restrictive food intake disorder (ARFID)?

Answer 22

• 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) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) symptoms:
  
  • significant weight loss or failure to achieve expected weight gain or faltering growth in children
  • significant nutritional deficiency
  • dependence on enteral feeding or oral nutritional supplements
  • 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 + 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 condition or disorder (&?) the severity of the eating disturbance exceeds that routinely associated with the condition or disorder = warrants additional clinical attention

Question 23

what is the difference between ARFID and anorexia nervosa (restrictive type)?

Answer 23

DUNNOOOOO

Question 24

what is the diagnostic criteria for unspecified feeding or eating disorder (UFED)?

Answer 24

symptoms of a feeding / eating disorder that cause clinically significant distress / impairment in social / occupational / other important areas of functioning but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class

Question 25

when is the criteria of unspecified feeding or eating disorder (UFED) applied?

Answer 25

clinician chooses not to specify the reason that the criteria are not met for a specific feeding and eating disorder, and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings)