Eating Disorders L19

Question 1

Anorexia, bulimia and binge eating disorder are predominantly seen in ______.

Answer 1

Females

Question 2

List the 4 main diagnosed eating disorders in adults.

Answer 2

• Anorexia nervosa (AN)
• Bulimia nervosa (BN)
• Binge Eating Disorder (BED)
• Eating Disorder Not Otherwise Specified (EDNOS)

Question 3

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Anorexia Nervosa

• About 90–95% of cases occur in Adolescence
• The peak age of onset is between 14 and 18 years
• Around 0.5% of females in Western countries develop the disorder
• Many more display some symptoms at least 10% sub-clinical
• Psychiatric comorbidity
• Rates of anorexia nervosa are increasing in North America, Japan, and Europe

Question 4

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Bulimia Nervosa

Bulimia nervosa, also known as “binge-purge syndrome,” is characterized by binges:

• Repeated episodes of uncontrolled eating (binges)
• Followed by compensatory behaviours, such as:
  
  • Vomiting
  • Laxatives, diuretics or enemas
  • Fasting
  • Excessive exercise
  • The name is derived from the greek Bous Limous or “cattle-hunger” because the food in a binge is hardly tasted or thought about
• Like anorexia nervosa, about 90–95% of bulimia nervosa cases occur in females
• Around 1-2% of females in Western countries develop the disorder
• The peak age of onset is between 15 and 21 years
• Symptoms may last for several years with periodic letups

Question 5

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Binges

• Binges are usually preceded by feelings of great tension
• During the binge, the person feels unable to stop eating
• Although the binge itself may be pleasurable, it is usually followed by feelings of extreme self-blame, guilt, depression, and fears of weight gain and being discovered

Question 6

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Binge Eating Disorder

• The most common eating disorder affecting 3.5% of females and 2% of males and is prevalent in up to 30% of those seeking weight loss treatment.
• Frequent episodes of uncontrollable binge eating.
• Feeling extremely distressed or upset during or after bingeing.
• Unlike bulimia, there are no regular attempts to compensate for the binges through vomiting, fasting, or over-exercising.

Question 7

Describe the similarities between Bulimia Nervosa and Anorexia Nervosa. (7)

Answer 7

• Develop from a period of dieting by people afraid of becoming obese
• Preoccupied with food, weight & appearance
• Drive to become thin
• Elevated risk of self-harm or attempts at suicide
• Feelings of anxiety, depression, perfectionism
• Substance abuse
• Disturbed attitudes toward eating

Question 8

Describe the differences between Bulimia Nervosa and Anorexia Nervosa. (4)

Answer 8

• People with bulimia are more worried about pleasing others, being attractive to others, and having intimate relationships
• They tend to be more sexually experienced and active than anorexics
• People with bulimia display fewer of the obsessive qualities that drive restricting-type anorexia
• People with bulimia are more likely to have histories of mood swings, low frustration tolerance, and poor coping

Question 9

Define the DSM criteria.

What is its use?

Answer 9

• The Diagnostic and Statistical Manual of Mental Disorders (DSM) from the American Psychiatric Association (APA) is the standard classification of mental disorders used by mental health professionals in the United States.
• It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioural, interpersonal, family/systems).

Question 10

What is the ICD-10?

Answer 10

The International Classification of Diseases (ICD) is the WHO’s diagnostic tool for epidemiology, health management and clinical purposes.

Question 11

Define perseveration (psychology).

Example of disorder?

Answer 11

The repetition of a particular response, such as a word, phrase, or gesture, despite the absence or cessation of a stimulus, usually caused by brain injury or other organic disorder.

Anorexia nervosa

Question 12

______ is the psychologic disorder with the highest mortality rate. This is in a large part due to suicide through depression.

Answer 12

Anorexia

Question 13

Anorexia, bulimia and binge eating disorder predominantly seen in ______.

Answer 13

Females

Question 14

In late stage anorexia, why does the patient have very thin arms and legs?

Answer 14

When the body’s fat and glucose reserves are depleted, the body starts burning muscle. This leads to very thin arms and legs from muscle wastage.

Question 15

Vomiting (e.g. in bulimia) causes a loss of ______ which can put a strain on the heart.

Answer 15

Electrolytes

Question 16

Anorexia is the psychologic disorder with the highest mortality rate. This is in a large part due to ___1___ due to ___2___.

Answer 16

1. Suicide
2. Depression

Question 17

Describe the types of anorexia nervosa according to DSM V.

Answer 17

Restricting Type

• During the last three months, the person has not engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas)

Binge-Eating/Purging Type

• During the last three months, the person has engaged in recurrent episodes of binge eating or purging behaviour (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas

Question 18

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The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the standard classification of mental disorders used by mental health professionals in the United States. It is intended to be used in all clinical settings by clinicians of different theoretical orientations. It can be used by mental health and other health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors. DSM-5 can also be used for research in clinical and community populations. It is also a necessary tool for collecting and communicating accurate public-health statistics.

Question 19

Describe the diagnostic criteria for anorexia nervosa according to DSM V.

Answer 19

• A. 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. Significantly low weight is defined as a weight that is less than minimally normal, or, for children and adolescents, less than that minimally expected.
• B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain, even though at a significantly low 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.

Question 20

Describe the diagnostic criteria for binge eating disorder according to DSM V.

Answer 20

• A. Recurrent episodes of binge eating. An episode of binge eating is characterized byboth of the following:
  
  • 1. eating, in a discrete period of time (for example, within any 2-hour period), an amount of food that is definitely larger than 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 (for example, a feeling that one cannot stop eating or control what or how much one is eating)
• B. The binge-eating episodes are associated with three (or more) of the following:
  
  • 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 offeeling embarrassed by how much one is eating
  • 5. feeling disgusted with oneself, depressed, or very guilty afterwards
• C. Marked distress regarding binge eating is present.
• D. The binge eating occurs, on average, at least once a week for three months.
• E. The binge eating is not associated with the recurrent use of inappropriate compensatory behavior(for example, purging) and does not occur exclusively during the course Anorexia Nervosa, Bulimia Nervosa, or Avoidant/Restrictive Food Intake Disorder.

Question 21

Describe the diagnostic criteria for bulimia nervosa according to DSM V.

Answer 21

• 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 (for example,within any 2-hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances.
  • 2. A sense of lack of control over eating during the episode (for example, a feeling that one cannot stop eating or control what or how much one is eating).
• B. Recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications, fasting; or excessive exercise.
• C. The binge eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 months.*
• D. Self-evaluation is unduly influenced by body shape and weight.
• E. The disturbance does not occur exclusively during episodes of anorexia nervosa.

Question 22

DSM-V: Feeding and Eating Conditions Not Elsewhere Classified

Describe Atypical Anorexia Nervosa according to DSM-V.

Answer 22

All of the criteria for Anorexia Nervosa are met, except that, despite significant weight loss, the individual’s weight is within or above the normal range.

Question 23

DSM-V: Feeding and Eating Conditions Not Elsewhere Classified

Describe Subthreshold Bulimia Nervosa (low frequency or limited duration) according to DSM-V.

Answer 23

All of the criteria for Bulimia Nervosa are met, except that the binge eating and inappropriate compensatory behaviours occur, on average, less than once a week and/or for less than for 3 months.

Question 24

DSM-V: Feeding and Eating Conditions Not Elsewhere Classified

Describe Subthreshold Binge Eating Disorder (low frequency or limited duration) according to DSM-V.

Answer 24

All of the criteria for Binge Eating Disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than for 3 months.

Question 25

_DSM-V: Feeding and Eating Conditions Not Elsewhere Classified_ Describe Purging Disorder according to DSM-V.

Answer 25

Recurrent purging behaviour to influence weight or shape, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, in the absence of binge eating. Self-evaluation is unduly influenced by body shape or weight or there is an intense fear of gaining weight or becoming fat.

Question 26

_DSM-V: Feeding and Eating Conditions Not Elsewhere Classified_ Describe Night Eating Syndrome according to DSM-V.

Answer 26

Recurrent episodes of night eating, as manifested by eating after awakening from sleep or excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better accounted for by external influences such as changes in the individual’s sleep/wake cycle or by local social norms. The night eating is associated with significant distress and/or impairment in functioning. The disordered pattern of eating is not better accounted for by Binge Eating Disorder, another psychiatric disorder, substance abuse or dependence, a general medical disorder, or an effect of medication.

Question 27

_DSM-V: Feeding and Eating Conditions Not Elsewhere Classified_ Describe Other Feeding or Eating Condition Not Elsewhere Classified according to DSM-V.

Answer 27

This is a residual category for clinically significant problems meeting the definition of a Feeding or Eating Disorder but not satisfying the criteria for any other Disorder or Condition.

Question 28

Describe the diagnostic criteria for Eating Disorder Not Otherwise Specified (EDNOS) according to DSM IV-R.

Answer 28

The Eating Disorder Not Otherwise Specified category is for disorders of eating that do not meet the criteria for any specific Eating Disorder. Examples include: * **1.** For females, all of the criteria for Anorexia Nervosa are met except that the individual has regular menses. * **2.** All of the criteria for Anorexia Nervosa are met except that, despite significant weight loss, the individual’s current weight is in the normal range. * **3.** All of the criteria for Bulimia Nervosa are met except that the binge eating and inappropriate compensatory mechanisms occur at a frequency of less than twice a week or for a duration of less than 3 months. * **4.** The regular use of inappropriate compensatory behaviorby an individual of normal body weight after eating small amounts of food (e.g., self-induced vomiting after the consumption of two cookies). * **5.** Repeatedly chewing and spitting out, but not swallowing, large amounts of food. * **6.** Binge-eating disorder: recurrent episodes of binge eating in the absence of the regular use of inappropriate compensatory behaviorscharacteristic of Bulimia Nervosa.

Question 29

What is The International Classification of Diseases (ICD)?

Answer 29

The WHO’s diagnostic tool for epidemiology, health management and clinical purposes.

Question 30

**Read** ## Footnote _ICD-10: F50.0 Anorexia Nervosa_ * Body weight is maintained at least 15% below that expected (either lost or never achieved), or Body Mass Index(BMI)is 17.5 or less. Pre-pubertal patients may show failure to make the expected weight gain during the period of growth. * The weight loss is self-induced by avoidance of 'fattening foods' and one or more of the following: self-induced vomiting; self-induced purging; excessive exercise; use of appetite suppressants and/or diuretics. * There is body-image distortion in the form of a specific psychopathology whereby a dread of fatness persists as an intrusive, overvalued idea and the patient imposes a low weight threshold on himself or herself. * There is endocrine disorder, manifesting in women as loss of periods (amenorrhoea) and in men as a loss of sexual interest and potency. * If onset is pre-pubertal, the sequence of pubertal events is delayed or even arrested (growth ceases; in girls the breasts do not develop and the onset of periods is delayed; in boys the genitals remain juvenile). With recovery, puberty is often completed normally, but the menarche is late.

Question 31

**Read** ## Footnote _ICD-10: F50.2 Bulimia Nervosa_ * There is a persistent preoccupation with eating, and an irresistible craving for food; the patient succumbs to episodes of overeating in which large amounts of food are consumed in short periods of time. * The patient attempts to counteract the ‘fattening’ effects of food by purging, starving and other strategies. * The psychopathology consists of a morbid dread of fatness and the patient sets herself or himself a sharply defined weight threshold, well below the weight that constitutes the optimum or healthy weight in the opinion of the physician. There is often, but not always, a history of an earlier episode of anorexia nervosa, the interval between the two disorders ranging from a few months to several years.