Eating disorders - DSM criteria Flashcards
What are the three main diagnostic criteria for Anorexia Nervosa (AN)?
- Restriction of energy intake, leading to significantly low body weight.
- Intense fear of gaining weight or persistent behavior that prevents weight gain.
- Disturbance in self-perception, with undue influence of weight on self-evaluation.
What are the two subtypes of Anorexia Nervosa (AN)?
- Restricting Type – Weight loss achieved through dieting, fasting, or excessive exercise. No binge-eating or purging in the last 3 months.
- Binge-Eating/Purging Type – Episodes of binge-eating or purging (e.g., vomiting, laxative misuse) in the last 3 months.
How is remission classified in Anorexia Nervosa (AN)?
- Partial remission: Low body weight is no longer present, but fear of weight gain or distorted self-evaluation persists.
- Full remission: None of the criteria for AN have been met for a sustained period.
What BMI ranges define the severity levels of Anorexia Nervosa (AN) in adults?
- Mild: BMI ≥ 17 kg/m²
- Moderate: BMI 16–16.99 kg/m²
- Severe: BMI 15–15.99 kg/m²
- Extreme: BMI < 15 kg/m²
What are the three essential features of Anorexia Nervosa (AN)?
- Persistent energy intake restriction.
- Fear of gaining weight or behavior preventing weight gain.
- Distorted perception of body weight and shape.
What are some potential life-threatening medical conditions associated with AN?
- Amenorrhea
- Vital sign abnormalities
- Loss of bone mineral density
- Cardiac complications (bradycardia, arrhythmia)
What psychological symptoms are common in individuals with AN?
- Depressed mood, social withdrawal, insomnia
- Obsessive-compulsive traits (e.g., preoccupation with food, hoarding recipes)
- Anxiety disorders, especially OCD
What is the estimated 12-month prevalence of Anorexia Nervosa (AN) in young females?
0.4% (Less is known about male prevalence, with a female-to-male ratio of 10:1).
At what age does Anorexia Nervosa (AN) typically begin?
During adolescence or young adulthood, often triggered by a stressful life event (e.g., leaving home for college).
What is the crude mortality rate for Anorexia Nervosa (AN) per decade?
Approximately 5% per decade, with deaths commonly caused by medical complications or suicide.
What temperamental risk factor increases the likelihood of developing AN?
Childhood anxiety disorders or obsessional traits.
What environmental risk factor is associated with Anorexia Nervosa (AN)?
Occupations that emphasize thinness (e.g., modeling, athletics).
What genetic factor is linked to an increased risk of Anorexia Nervosa (AN)?
A family history of eating disorders or psychiatric disorders.
What are some common laboratory abnormalities in AN patients? - biological abnormalities
- Hematology: Leukopenia (low white blood cells), mild anemia
- Serum chemistry: Dehydration, high cholesterol, metabolic alkalosis (from vomiting)
- Endocrine: Low estrogen/testosterone, thyroid dysfunction
- Bone mass: Low bone mineral density, increased fracture risk
How is suicide risk in individuals with AN?
Elevated – Approximately 12 per 100,000 individuals with AN commit suicide.
How does AN affect daily functioning?
Some individuals remain socially and professionally active, while others experience severe isolation and academic/career impairment.
What are some differential diagnoses of Anorexia Nervosa (AN)?
- Major depressive disorder (MDD): Weight loss, but no intense fear of gaining weight.
- Schizophrenia: Strange eating habits, but no body image disturbance.
- Substance use disorder: Weight loss due to drug use, not body image issues.
- Bulimia Nervosa (BN): Similar behaviors, but weight remains normal or above normal.
- Avoidant/restrictive food intake disorder (ARFID): Weight loss due to lack of interest in food, but no body image concerns.
- Social anxiety disorder (SAD), OCD and body dysmorphic disorder
What comorbid psychiatric disorders commonly occur with Anorexia Nervosa (AN)?
- Bipolar disorder
- Major depressive disorder (MDD)
- Anxiety disorders (especially OCD)
- Substance use disorders (more common in binge-eating/purging type AN)
What are the five diagnostic criteria for Bulimia Nervosa (BN)?
- Recurrent binge-eating episodes with a sense of lack of control.
- Recurrent inappropriate compensatory behaviors (e.g., vomiting, laxatives, excessive exercise).
- Bingeing and compensatory behaviors occur at least once a week for 3 months.
- Self-evaluation is unduly influenced by body shape and weight.
- The disturbance does not occur exclusively during anorexia nervosa episodes.
What are the two remission states in Bulimia Nervosa (BN)?
- Partial remission: Some but not all BN criteria are still met for a sustained period.
- Full remission: None of the BN criteria have been met for a sustained period.
How is the severity of Bulimia Nervosa (BN) classified?
Based on the number of compensatory behaviors per week:
* Mild: 1–3 episodes/week
* Moderate: 4–7 episodes/week
* Severe: 8–13 episodes/week
* Extreme: 14+ episodes/week
What defines an episode of binge eating in Bulimia Nervosa (BN)?
- Eating an excessively large amount of food in a discrete time (usually less than 2 hours).
- A sense of lack of control over eating during the episode.
Why do individuals with Bulimia Nervosa (BN) binge-eat?
- Emotional distress (e.g., negative affect, interpersonal stress, body dissatisfaction).
- Dietary restraint leading to increased hunger.
- Boredom or impulsivity.
What is the most common compensatory behavior in BN?
Self-induced vomiting, which provides temporary relief from discomfort and fear of weight gain.
What weight range do most individuals with BN fall into?
Normal weight or overweight range.
What menstrual irregularities are associated with BN?
Menstrual irregularity or amenorrhea, potentially due to weight fluctuations, nutritional deficiencies, or emotional distress.
What are some rare but potentially fatal medical complications of BN?
- Esophageal tears
- Gastric rupture
- Cardiac arrhythmias
What is the estimated 12-month prevalence of Bulimia Nervosa (BN) in females?
1%–1.5% (with a 10:1 female-to-male ratio).
When does Bulimia Nervosa (BN) typically begin?
During adolescence or young adulthood, often following a period of dieting or stressful life events.
What is the mortality rate for Bulimia Nervosa (BN) per decade?
Approximately 2% per decade.
What percentage of individuals transition from Bulimia Nervosa (BN) to Anorexia Nervosa (AN)?
10–15%, though many revert to BN afterward.
What temperamental factors increase the risk of developing BN?
- Weight concerns
- Low self-esteem
- Depressive symptoms
- Social anxiety disorder (SAD)
- Generalized anxiety disorder (GAD)
What environmental factors increase the risk for BN?
- Internalization of a thin body ideal
- Childhood sexual or physical abuse
What genetic and physiological factors increase the risk for BN?
- Childhood obesity
- Early pubertal maturation
- Familial transmission and genetic vulnerabilities
What are some common laboratory abnormalities in BN?
- Hypokalemia (low potassium) → can cause cardiac arrhythmias.
- Hypochloremia and hyponatremia (electrolyte imbalances).
- Loss of dental enamel from stomach acid due to purging.
What differential diagnoses should be considered when diagnosing BN?
- Anorexia Nervosa (Binge-Eating/Purging Type) – BN is only diagnosed if bingeing occurs outside of AN episodes.
- Binge-Eating Disorder (BED) – BED has binge-eating but no compensatory behaviors.
- Major Depressive Disorder (MDD) with atypical features – Overeating occurs but without extreme concern over body shape/weight.
- Borderline Personality Disorder (BPD) – Binge-eating can be an impulsive behavior in BPD, but both diagnoses can be given if criteria are met.
What are the most common comorbid disorders with BN?
- Depressive disorders (especially Major Depressive Disorder - MDD)
- Bipolar disorder
- Anxiety disorders (especially Generalized Anxiety Disorder - GAD & Social Anxiety Disorder - SAD)**
- Substance use disorder (particularly alcohol and stimulant use)
- Borderline Personality Disorder (BPD)
What are the five diagnostic criteria for Binge-Eating Disorder (BED)?
- Recurrent binge-eating episodes with a lack of control.
- Binge episodes include at least 3 of the following:
- Eating more rapidly than normal.
- Eating until uncomfortably full.
- Eating large amounts when not physically hungry.
- Eating alone due to embarrassment.
- Feeling disgusted, guilty, or depressed afterward.
- Marked distress regarding binge-eating is present.
- Binge-eating occurs at least once per week for 3 months.
- No compensatory behaviors (e.g., purging, excessive exercise, as seen in BN).
What are the two remission states in Binge-Eating Disorder (BED)?
- Partial remission: Binge-eating occurs less than once per week for a sustained period.
- Full remission: No binge-eating episodes for a sustained period.
How is the severity of Binge-Eating Disorder (BED) classified?
Based on the number of binge episodes per week:
* Mild: 1–3 episodes
* Moderate: 4–7 episodes
* Severe: 8–13 episodes
* Extreme: 14+ episodes
What weight range do most individuals with Binge-Eating Disorder (BED) fall into?
Normal weight, overweight, or obese. However, BED is distinct from obesity.
What is the most common trigger for a binge-eating episode?
Negative affect (e.g., stress, sadness, boredom).
What is the estimated 12-month prevalence of Binge-Eating Disorder (BED)?
- 1.6% for females
- 0.8% for males
How does the gender ratio of BED compare to AN and BN?
Less skewed – males have a higher prevalence compared to AN and BN.
How does the prevalence of BED compare across ethnic groups in the U.S.?
Appears similar across ethno-racial groups.
When does BED typically begin?
During adolescence or young adulthood, but it can also start in later adulthood.
How do remission rates for BED compare to AN and BN?
Higher remission rates than AN and BN.
How common is the crossover from BED to other eating disorders?
Uncommon – BED typically does not transition into AN or BN.
What genetic factor may contribute to BED?
BED runs in families, suggesting genetic influences.
What functional consequences are associated with BED?
- Social role adjustment problems
- Lower quality of life and life satisfaction
- Increased medical morbidity and mortality
- Higher healthcare utilization
What differential diagnoses should be considered when diagnosing BED?
- Bulimia Nervosa (BN) – BN has compensatory behaviors, BED does not.
- Obesity – BED includes higher body image concerns and more psychiatric comorbidities.
- Bipolar & Depressive Disorders – BED can co-occur, but both diagnoses should be given if criteria are met.
- Borderline Personality Disorder (BPD) – Binge-eating can be an impulsive behavior in BPD, but both can be diagnosed.
How do response rates to treatment compare between BED and BN?
Higher treatment success rates in BED compared to BN.
What psychiatric disorders are commonly comorbid with BED?
- Bipolar disorder
- Depressive disorders
- Anxiety disorders
- Substance use disorders (less common than in BN or AN)
What are the four diagnostic criteria for Pica?
- Persistent eating of non-nutritive, non-food substances for at least 1 month.
- Eating behavior is inappropriate for the developmental level.
- Not part of a culturally supported or socially normative practice.
- If occurring in another mental disorder or medical condition, it is severe enough to warrant clinical attention.
What is the remission criteria for Pica?
Pica is in remission when criteria have not been met for a sustained period of time.
What are the four diagnostic criteria for Rumination Disorder?
- Repeated regurgitation of food for at least 1 month (may re-chew, re-swallow, or spit out).
- Not due to a gastrointestinal or medical condition.
- Not occurring exclusively during another eating disorder (AN, BN, BED, ARFID).
- If occurring with another mental disorder, it is severe enough to require clinical attention.
What is the remission criteria for Rumination Disorder?
Rumination Disorder is in remission when criteria have not been met for a sustained period of time.
What are the four diagnostic criteria for Avoidant/Restrictive Food Intake Disorder (ARFID)?
- Eating or feeding disturbance (e.g., lack of interest in food, avoidance due to sensory issues, or fear of negative consequences from eating).
- Associated with at least one of the following:
- Significant weight loss (or failure to grow in children).
- Nutritional deficiency.
- Dependence on enteral feeding or supplements.
- Marked psychosocial impairment.
- Not due to food scarcity or a culturally accepted practice.
- Not explained by another eating disorder (AN or BN) and not driven by body weight/shape concerns.
When is ARFID considered in remission?
When the individual no longer meets the diagnostic criteria for a sustained period of time.
