Class 2 Flashcards
Name all ED
Anorexia nervosa, bulimia nervosa, BED, OtherSpecified Feeding or Eating Disorder, Unspecified Feeding or Eating Disorder, pica, rumination disorder, avoidant/ restrictive food intake disorder
Criteria BED
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
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.
Specify if:
In partial remission: 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.
In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based on the frequency of episodes of binge eating (see below).
The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: 1–3 binge eating episodes per week.
Moderate: 4–7 binge-eating episodes per week.
Severe: 8–13 binge-eating episodes per week.
Extreme: 14 or more binge-eating episodes per week.
Course and prognosis BED
Severe obesity is a long-term effect in over 3 percent of patients with the disorder. One prospective study of women in the community with binge eating disorder suggested that by 5 years of follow-up fewer than one fifth of the sample still had clinically significant eating disorder symptoms. Adolescent/ adulthood. After an attempt to lose weight, multiple stressors can precipitate onset, disturbed eating behavior can persist. Comorbidity with depression.
Trx BED
CBT + SSRIs
Bulimia prevalence
4%, primarily in societies that place emphasis on thinness and where there is an abundance of food +W, adolescence- adulthood
Criteria bulimia
A. Recurrent episodes of binge eating:
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. Recurrent inappropriate compensatory behaviors in order to prevent weight gain
C. A & B at least once a week for 3 mo
D. Self-evaluation is unduly influenced by body shape and weight
E. Not anorexia
Specify if: partial/full remission
Severity: Mild: 1–3 binge eating episodes per week.
Moderate: 4–7 binge-eating episodes per week.
Severe: 8–13 binge-eating episodes per week.
Extreme: 14 or more binge-eating episodes per week.
Course and prognosis bulimia
Bulimia nervosa is characterized by higher rates of partial and full recovery compared with anorexia nervosa. Those treated fare much better than those who are untreated. Patients who are untreated tend to remain chronic or may show small, but generally unimpressive, degrees of improvement with time. In a 10-year follow-up study of patients who had previously participated in treatment programs, the number of women who continued to meet the full criteria for bulimia nervosa declined as the duration of follow-up increased. Approximately 30 percent continued to engage in recurrent binge-eating or purging behaviors. A history of substance use problems and a longer duration of the disorder at presentation predicted worse outcome. Approximately 40 percent of women were fully recovered at follow-up. The mortality rate for bulimia nervosa has been estimated at 2 percent per decade according to DSM-5. Worse prognosis if SUD.
Anorexia prevalence
1% + F 12-30yo less than 10% are M
Course and prognosis anorexia
The course of anorexia nervosa varies greatly—spontaneous recovery without treatment, recovery after a variety of treatments, a fluctuating course of weight gains followed by relapses, and a gradually deteriorating course resulting in death caused by complications of starvation. One study reviewing subtypes of anorectic patients found that restricting-type anorectic patients seemed less likely to recover than those of the binge eating–purging type. The short-term response of patients to almost all hospital treatment programs is good. Those who have regained sufficient weight, however, often continue their preoccupation with food and body weight, have poor social relationships, and exhibit depression. In general, the prognosis is not good.
Indicators of a favorable outcome are admission of hunger, lessening of denial and immaturity, and improved self-esteem. Such factors as childhood neuroticism, parental conflict, bulimia nervosa, vomiting, laxative abuse, and various behavioral manifestations (e.g., obsessive-compulsive, hysterical, depressive, psychosomatic, neurotic, and denial symptoms) have been related to poor outcome in some studies, but not in others.
Ten-year outcome studies in the United States have shown that about one fourth of patients recover completely and another one half are markedly improved and functioning fairly well. The other one fourth includes an overall 7 percent mortality rate and those who are functioning poorly with a chronic underweight condition. About half of patients with anorexia nervosa eventually will have the symptoms of bulimia, usually within the first year after the onset of anorexia nervosa.
Studies have shown a range of mortality rates from 5 to 18 percent.
Criteria anorexia
A. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health.
B. Intense fear of gaining/ becoming fat/ persistent behavior that interferes with weight gain, even though they have a significantly low weight.
C. Disturbance in the way in which one’s body weight shape is experiences, undue influence of body weight/ shape on self-evaluation or persistent lack of recognition of the seriousness of low body weight
Specify:
(50%) Restricting type: during the last 3 mo, individual has not engaged in recurrent episodes of binge eating/ purging. Weight loss is accomplished primarily though dieting, fasting and excessive exercise
(50%)Binge eating/ purging type
Partial/ full remission
Mild: BMI 17, Mod: 16-16.99, Sever 15-15.99 Extreme: less than 15
