Eating Disorders Flashcards
ICD-9 for ED
Avoidant/Restrictive Food Intake Disorder 307.59
Anorexia Nervosa 307.1
Bulimia Nervosa 307.51
Binge Eating Disorder 307.51
Other Specified Feeding or Eating Disorder 307.59
Unspecified Feeding or Eating Disorder 307.50
Anorexia Nervosa
sxs
Characterized by self-starvation and excessive weight loss.
Anorexia is the deadliest of all psychological disorders.
Symptoms include:
- Restriction of energy intake relative to requirements leading to low body wt
- Refusal to maintain body weight at or above a minimally normal weight for height, body type, age, and activity level
- Intense fear of weight gain or being “fat”
- Feeling “fat” or overweight despite dramatic weight loss
- Extreme concern with body weight and shape, or lack of recognition of the seriousness of the current low body weight
**Specify if in partial remission or full remission
Anorexia Is when restricting and binge subtype, they are underweight
Restricting type: during the last 3 months the pt has not engaged in recurrent episodes of binge eating or purging behavior (wt loss is accomplished primarily through restricting, fasting or excessive exercise)
Binge-eating/purging type: during the last 3 months the individual has engaged in recurrent episodes of binge eating or purging behavior 9slef induced vomiting, misuse of laxatives, diuretics, or enemas) \+++specify in partial or full remission Mild: BMI at or below 17 Moderate BMI 16-16.99 Severe: BMI 15-15.99 Extreme: bMI les than 15
Specify if:
Partial remission: after full criteria for AN were previously met, low body weight has not been met (criterion A) but Criterion B (intense fear of wt gain) or Criterion C (disturbances in self perception of wt and shape) is still met
Full remission: after dx of AN, none of the criteria have been met for a sustained period of time
Warning signs:
Loss of menstrual periods (removed for DSM 5)
Dramatic weight loss
Refusal to eat certain foods or food categories (e.g. no fats, no carbs)
Consistent excuses to avoid situations involving food
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives
Health risks: Heart failure Kidney failure Low protein stores Digestive problems Electrolyte imbalance
Avoidant/Restrictive Food Intake Disorder 307.59
An eating disturbance (lack of interest in eating food, avoidance based on sensory concerns or aversion to eating) manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with 1+ of the following:
1. significant weight loss
2. Significant nutritional deficiency
3. Dependence on enteral feeding or oral nutritional supplements
4. Marked interference with psychosocial functioning
We might see this a lot
Bulimia Nervosa 307.51
Recurrent episodes of binge eating. Binge eating characterized by:
- eating within 2 hours an amt of food that is much larger than what most would eat in a a similar time under similar circumstance.
- A sense of lack of control over eating during the episode.
B. Recurrent inappropriate compensatory behaviors (vomiting, laxatives, diuretics, other meds, fasting, excessive exercise).
C. The binge eating and compensatory behaviors occur at least 1/wk for 3 months.
D. Self eval is unduly influenced by body shape and weight. The disturbance does not occur exclusively during episodes of AN.
Severity: Mild, Mod, Severe, Extreme
**Specify if in partial remission or full remission.
Warning signs and severity of BN
Ourging is taking off calories by vomitting, laxative, or others
Mild: 1-3 bx/wk
Moderate 4-7 bx/wk
Severe: 8-13 bx/wk
Extreme 14+ bx/wk
Warning signs:
Wrappers/containers indicating consumption of large amounts of food
Frequent trips to bathroom after meals
Signs of vomiting e.g. staining of teeth, calluses on hands
Excessive and rigid exercise routine
Withdrawal from usual friends/relatives
Binge Eating Disorder 307.51
Recurrent episodes of binge eating.
The binges are assoc. with 3+ of the following:
Eating more rapidly than normal.
Eating until uncomfortably full.
Eating large amts of food when not hungry.
Eating alone because of embarrassment by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty after.
C. Marked distress re: binge eating
D. The binge eating occurs at least 1x/wk for 3 months.
E. The binge eating is not assoc. with use of inappropriate compensatory behaviors.
- *Severity: Mild, Mod, Severe, Extreme
- *Specify if in partial or full remission.
Other Specified Feeding or Eating Disorder 307.59
- Atypical anorexia nervosa
- Bulimia nervosa (low frequency and/or limited duration)
- Binge-eating disorder (of low frequency and/or limited duration
- Purging disorder
- Night eating syndrome
Unspecified Feeding or Eating Disorder 307.50
Impairment in social, occupational, or other areas.
Does not meet criteria for any of disorders in feeding and eating disorders dx class.
The clinician may choose not to specify the reason criteria are not met for a specific feeding/eating disorder.
Presentation in which there is insufficient information to make specific dx (ie: ER).
The Impact on Women
One study showed that 55% of college women thought that they were overweight though only 6% were.
94% of one sample of women wanted to be smaller than they currently were.
96% thought that they were larger than the current societal ideal.
Half the women in a study said they would rather be hit by a truck than be fat.
Impact on Men
10% of individuals with ED are men
- Low weight oriented sports at increased risk (jockeys, wrestlers, runners, gymnasts)
- Men have a variety of images to emulate (Mick Jagger vs. Arnold Schwarzenegger)
- Reasons why men diet: prevent weight gain, excel in sports, avoid health complications, improve appearance, after childhood teasing, for their jobs
- Barriers to treatment
Effects of Malnutrition
Starvation research experiments & prisoners of war: Food preoccupation Food hoarding Abnormal taste preferences Binge eating Appetite dysregulation Depression Obsessionality Apathy Irritability Personality changes Minnesota Starvation Experiment
FYI
Zinc supplement will help people taste better
Cognitively not intact
Vitamin deficiency can cause psychosis
Studies of volunteers who have submitted to semi starvation experiments and semi starved prisoners of war report the development of food preoccupation, food hoarding, abnormal taste preferences, binge eating, and other disturbances of appetite regulation, as well as symptoms of depression, obsessionality, apathy, irritability, and other personality changes.
In patients with Anorexia, some of these starvation related symptoms (such as taste preference) may complete reverse with refeeding, although it may take a long time after weight restoration for them to completely resolve.
Take a moment and look up the Minnesota Starvation Experiment. This was a study done in the 1940’s in Minnesota to look at the effects of starvation on the human body and has very interesting results
Challenges to treatment
Lack of motivation to change
intrinsically reinforced by the weight loss, because it feels good to them
may deny the existence of the problem, or the severity of it
Lack of insight
Not really about food.
Interpersonal factors
GENETICS
1st degree relatives higher rates of ED
Identical twins higher rates
Families of patients with BN have higher rates of substance abuse (esp. ETOH)
