Feeding and Eating Disorders

Question 1

1.0

Pica Rumination Dx

Answer 1

DSM 5 change: diagnoses can be made for individual of any age.

1. persistent eating of non-nutritive substances for at least one month without an aversion to food.
2. not appropriate for developmental age or cultural.
3. usually between ages of 12-24 months and sometimes in pregnant women.

Question 2

2.0

Avoidant/Restrictive Food Intake Disorder

Answer 2

DSM-5

was feeding disorder in infancy/early childhood

a large number of individual, primarily but not exclusively children and adolescents, substantially restrict their food intake and experience significant associated physiological and psychosocial problems but did not meet criteria for any DSM IV eating dx.

new broad category to capture this range of presentations.

Question 3

3.0

Anorexia Nervosa

Answer 3

DSM-5 : no more amenorrhea requirement (no menstrual cycle).

1. Criterion A: significantly low body weight for their developmental stage
2. Criterion B: not only overtly expressed fear of weight gain but also persistent behavior that interfers with weight gain.
3. refusal to maintain a minimally normal body weight, intense fear of gaining weight, significant distrubance in the perception of the shape/size of one’s body.
4. Restricting Type: diet, fasting, exercise
5. Binge-Eating/Purging Type: regularly engages in episodes of binge eating and/or purging during the anorectic episode.
6. Purging can lead to: enemia, renal abnormalities, cardiac abnormalities, dental issues and osteoporosis
7. 50% qualify for Anxiety Dx and Depression is also common
8. starts mid-to-late adolescence, may be with a stressful life event. 90% female.

Etiology:

• caused by combination of biological and psychosocial factors
• Biological factors: abnormal serotonin activity: they may have higher than normal serotonin level which causes restlessness, anxiety and obsessive thinking
  
  • food restriction reduces the serotonin level which in turn alleviates these unpleasant feelings.
  • SSRI do not work for underweight people because it increases serotonin even more! (may prevent relapse if normal weight).
• family/individual characteristics: upper SES, competitive, need approval and success. females often ‘good girls’ : compliant, non-assertive, interoverted and conscientious, good in school.
• mothers: dominant and overbearing or ambivalent and fathers are emotionally absent.

Treatment

1. must gain weight to avoid medical issues
2. hospital or contingency management/having rewards for maintaining weight.
3. individual, group and/or family therapy.
4. Cognitive therapy and family therapy key.

Question 4

4.0

Bulimia Nervosa

Answer 4

DSM 5 change:

reduction in the required minimum average frequency of binge eating and inappropriate compensatory (purge, laxatives, fasting, excessive exercise) behavior frequency from twice to once weekly over the last 3 months.

1. recurrent episodes of binge eating that are accompanied by a sense of lack of control
2. inappropriate compensatory bx to prevent weight gain
3. self-evaluation that is unduly influenced by body shape and weight.

• usually w/in the normal weight range
• medical complications: fluid and electrolyte imbalance, metabolic alkalosis (vomiting), metabolic acidosis (from laxatives), dental issues, and menstrual abnormalities.
• Electrolyte imbalances sufficiently severe to cause cardiace arrhythmias and arrest (death)

1. anxiety and depression, Depression most common comorbid condition with Bulimia females.
2. late adolescence and early adulthood begins, onset is often during or after a period of dieting.
3. 90% are female
4. low levels of endogenous opioid beta-endorphin and low levels of serotonin and norepinephrine. (not inhibited)

• nutritional counseling, CBT (self-monitoring, stimulus control, cognitive restructuring, problem-solving and self-distraction)
• Imipramine and fluoxetine effective to reduce bing eating, purging and improve dysphoria.
• CBT associated with better outcomes than antidepressants.

Question 5

4.5

Binge-Eating Disorder

Answer 5

minumum average frequency of binge eating required for diagnosis has been changed from at least twice weekly for 6 months to at least once weekly over the last 3 months.

Question 6

5.0

Elimination Disorders (enuresis)

Answer 6

1. no longer in the dx usually 1st diagnosed in infancy, childhood or adolescence.
2. repeated voiding (day/night) into bed or clothes at least twice a week for 3 or more months. involuntary or intentional.
3. treatment: bell-and-pad/night alarm: rings with pee effective in up to 80% of cases (third may relapse after 6 months).
4. good to combine with behavioral techniques; imipramine 85% effective but most relapse when stopped.