Eating Disorders Lecture - part 1 Flashcards
What are the types of eating disorder?
- Other specified feeding or eating disorder
- Binge eating disorder
- Bulimia nervosa
- Anorexia nervosa
- Avoidant restrictive food intake disorder
ICD 11 features of anorexia nervosa
- Significantly low body weight
- Low body weight not better explained by another medical codnition or unavailability of food
- Persistent pattern of restrictive eating or other behaviours aimed at establishing or maintaining abnormally low body weight
- Excessive pre-occuption with body, weight and shape
What is significantly low body weight for anorexia nervosa ICD-11?
- Adults - BMI less than 18.5 (?17 in ICD-10)
- Children - BMI for age less than 5th percentile or failure to gain weight as expected
- Rapid weight loss - more than 20% total within 6 months
What are behaviours of anorexia nervosa ICD-11 features?
- Fasting
- Choosing low calorie food
- Excessively slow eating of small amounts of food
- Hiding food
- Chewing and spitting
- Purging behaviours
- Increased energy expenditure
Examples of purging behaviours
- Self induced vomiting
- Laxatives
- Diuretics
- Enemas
- Omissions of insulin
What are examples of increased energy expenditure?
- Excessive exercise - proportional to that person
- Motor hyperactivity
- Deliberate exposure to cold
- Diet medication
- Herbal products aimed at weight loss
- Thyroid hormones
What are aspects of excessive pre-occupation with body, weight and shape in anorexia nervosa ICD-11?
- Low body weight is overvalued and central to persons self evaluation
- Body weight or shape is inaccurately perceived to be normal or excessive
- Repeatedly checking body weight using scales
- Repeatedly checking body using tape measures
- Body checking in mirror
- Monitoring calorie content of food or searching information how to lose weight
- Extreme avoidant behaviours - refuse to have mirror at home, avoid tight fitting clothes, refuse to know weight, purchase clothes in specific size
Anorexia nervosa 2 subtypes
- Restricting pattern - weight loss and maintenance of low body weight is attributed to restricted intake/fasting, increased energy expenditure (eg excessive exercise)
- Binge-purge pattern - episodes of binge eating and purging
What often fuels the disorder of anorexia nervosa?
- Disordered body image - feel fat (emotions are interpreted as feeling fat)
- Constant comparison with others
- Involves body checking and avoidance
Anorexia nervosa stats
- Least common ED in adults
- Most common in children
- Aged 15-19 is highest incidence
Bulimia nervosa ICD-11 features
- Frequent, recurrent episodes of binge eating - once a week or more over period of at least 1 month
- Repeated inappropriate compensatory behaviours to prevent weight gain
- Excessive preoccupation with body weight or shape - similar to AN
- Distress about pattern of binge eating and compensatory behaviours
- Symptoms don’t make criteria for AN - eg no low BMI
- Binges objective or subjective
- Binges are very distressing - shame, guilt, disgust
- May be associated with weight gain over time
Examples of compensatory behaviours in bulimia ICD-11
- Self induced vomitting
- Fasting
- Diuretics
- Laxatives
- Enemas
- Omission of insulin
- Excessive exercise
What are binges characterised by in ICD-11 bulimia nervosa?
- Eating larger than usual amount of food in discrete period of time - usually highly calorific
- Lack of control during episode
- Eat rapidly and until uncontrollably full
- Eating when not hungry
- Usually very secretive - hide packets etc
What is the binge-purge cycle?
What can trigger binge?
Physical:
* Not eating enough or regularly
* Staying underweight - body wants to gain weight
* Feeling tired/hungover
* Having PMT
Psychological:
* Ate avoided food
* Broke rule - I’ve blown it, may as well carry on
* Deciding to vomit - green light
Life/mood:
* Argument
* Upset/angry
* Bored
Peak age bulimia
15-25 years
Average duration is 5 years
Binge eating disorder ICD-11 features
- Frequent recurrent episodes of binge eating - once week or more over period of 3 months
- Binge eating episodes not reguarly accompanied by compensatory behaviours
- Symptoms and behaviours are not better accounted by another medical condition (Prader-Willi, depression, EUPD) or due to medication
- Marked distress about pattern of binge eating
- Subjective or objective binge
- Distressing
- Can be associated with weight gain
- May be normal/low weight
- Preoccupation with body weight/shape usually present
Binge eating disorder ICD-11 binge features
- Once a week or more over period of 3 months
- Discrete period of time (eg 2hrs)
- Loss of control - eats more or differently than usual, feeling like they can’t stop or limit amount or type of food eaten
- Larger than usual amount of food - usually high calorific
- Secretive
- Eat rapidly and until uncomfortably full
- Distressing - guilt, disgust, shame, negatively affect self esteem
Binge eating disorder summary
- Similar to bulimia - in terms of binges
- No compensatory mechanisms
- Can have relapsing remitting
- May be obese, normal or low weight
- Can become socially withdrawn - unhappy with appearance
Binge eating disorder cycle
What are OSFED - other specified feeding and eating disorders?
- Eating disorders that do not fit exact diagnostic criteria for N, BN or BED
- Can still have big impact
- Easily hidden and may not be obvious from physical signs
Examples of OSFED that don’t meet criteria for other diagnosis
- Atypical anorexia - BMI not low
- Bulimia nervosa - low frequency and/or of limited duration
- Binge eating disorder - low frequency and/or limited duration
- Purging disorder - no binge
- Rumination-regurgitation disorder - chew food, swallow then bring back up
- Pica - eat substances that are not food eg sponges, sand. Often driven by nutritional deficiency eg iron.
What is avoidnt restrictive food intake disorder (ARFID) ICD11 features?
Avoidance or restriction of food that results in both or either of:
* Intake insufficienct quantity or variety to meet adequate energy or nutritional requirements that has resulted in: weight loss, nutritional deficiency, dependence on oral supplements or tube feeding, otherwise negatively impacted health of person
* Significant impairment in personal, family, social, educational occupational or other areas of functioning
No treatment in Leics for adults
ARFID ICD-11 other essential features
- Pattern of eating not motivated by preoccupation with body weight
- Restricted food intake and consequenct weight loss are not due to unavailability of food, another medical condition, not due to medication
Reasons for restriction of food intake in ARFID ICD-11
- Lack interest in eating - chronic low appetite or poor ability to recognise hunger
- Avoidance of food with certain sensory characteristics (smell, taste, texture, colour, temp)
- Concern about consequences of eating - choking, vomitting, health problems. May be due to history of event of this.
- May be no identified event that has preceeded onset
Key aspects of ARFID
- Does not affect body image
- Dietary restriction is not for specific purpse of losing weight
- Does not have any features of behaviours associated with other eating disorders
Additional features of ARFID ICD-11
- Restriction of food may be variable and affected by emotional or psychological factors - high levels distractability, high levels emotional arousal and extreme resistance at mealtimes
- Do not have difficulty eating foods within their preferred range
- May be underweight or normal weight
- Can negatively impact family functioning - mealtimes can be distressing with children
