Feeding and Eating Disorders Flashcards
Learn about the current diagnostic classification of feeding and eating disorders Distinguish these disorders by their features, epidemiology, and aetiology Understand the medical risk associated with each condition Appraise the management and treatment options for eating disorders, and their prognosis
Describe the difference between feeding and eating
Feeding implies a relationship aspect - being given food by another - whereas eating is more autonomous
What percentage of parents with children below age 5 would say their child has a feeding difficulty?
40%
Describe some factors involved in the progression from feeding to eating
Being able to select appropriate foods, being able to handle food (swallow, chew, use cutlery), sensory integration, managing social aspects of food, regulating food intake, effective interpretation of emotions (recognising when not feeling hungry means feeling upset), moving from dependence t self-care
Describe how the progression from feeding to eating relates to obesity
One theory of obesity states that parents who are overly controlling of their child’s food intake lead to a child unable to recognise their own satiety cues, leading to issues with food regulation when they progress to controlling their own intake
Why is food often used by children to signal unhappiness to parents?
Mealtimes can be one of the few times when the whole family sits down and interacts
What is the difference between an eating disorder and disordered eating?
An eating disorder is a phenotype of behaviours, whereas disordered eating is a single behaviour
What is rumination disorder?
Where an individual regurgitates and re-swallows food - this is widely seen as a self-soothing behaviour
Which 2 population groups typically develop rumination disorder?
Those with disabilities and those who have experienced extreme trauma
In which 3 population groups is disordered eating more common?
Those with intellectual disabilities, those with severe food allergies, and type 1 diabetics - all groups which encourage the obsessive checking of food
What percentage of individuals with disordered eating have a comorbid medical condition?
80%
What are eating disorders?
Mental health disorders n which people experience severe disturbances in their eating or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning
How are eating disorders distinguished from feeding disorders?
They are caused by negative thoughts about weight and shape
Give some examples of behaviours intended to control weight
Restricted eating, self-induced vomiting, excessive exercise, use of laxatives or diuretics, appetite suppressing medications (including caffeine and smoking)
How can eating disorders affect physical health?
They can impair growth and development in childhood and cause amenorrhoea, osteoporosis, and affects on the brain
Name the 7 eating disorders in DSM-V
Anorexia nervosa, bulimina nervosa, binge-eating disorder, atypical anorexia nervosa, atypical bulimia nervosa, purging disorder, night-eating syndrome
Define atypical anorexia nervosa
Exhibiting anorexia nervosa-type behaviour and losing a lot of weight very quickly but still falling within the normal weight range; typically affects individuals who were severely overweight
Define atypical bulimia nervosa
Exhibiting bulimia nervosa-type behaviour but not bingeing and purging often enough to meet criteria
State the 3 main diagnostic criteria for anorexia nervosa in DSM-V
1) Persistent restriction of energy intake leading to significantly low bodyweight in the context of what is minimally expected for age, sex, developmental trajectory, and physical health
2) Intense fear of gaining weight or persistent behaviour that interferes with weight gain, despite being low weight
3) Disturbance in the way one’s body weight or shape is experienced or lack of recognition of the seriousness of current low body weight
Define binge eating
Eating in a discrete period of time (e.g. 2 hours) an amount of food that is definitely larger than most people would eat during a similar period of time and similar circumstances, and a sense of lack of control over eating during the episode
State the 5 main diagnostic criteria for bulimia nervosa in DSM-V
1) Recurrent episodes of binge eating
2) Recurrent inappropriate compensatory behaviour to prevent weight gain
3) Both binge eating and compensatory behaviours occur at least once a week for 3 months
4) Self-evaluation is unduly influenced by body shape and weight
5) Does not meet criteria for anorexia nervosa
State the 5 main diagnostic criteria for binge-eating disorder in DSM-V
1) Recurrent episodes of binge eating
2) Binge-eating associated with eating more rapidly than normal, eating until feeling uncomfortably full, eating when not hungry, eating alone due to embarrassment, or feelings of guilt or shame afterwards
3) Marked distress over binge eating
4) Binge eating occurs once a week for 3 months
5) Does not meet criteria for anorexia or bulimia nervosa
Is obesity an eating disorder?
No
Define avoidant-restrictive food intake disorder (ARFID)
An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional or energy needs and associated with at least 1 of: significant weight loss or growth failure, significant nutritional deficiency, dependence on enteral feeding or supplements, or interference with psychosocial functioning
How is ARFID different to anorexia nervosa?
There is no evidence of disturbance in the way one’s body weight or shape is experienced
State the 3 main subtypes of avoidant-restrictive food intake disorder (ARFID) (Bryant-Waugh et al, 2010)
Restricted type, sensory type, and phobic type
Describe the restricted subtype of ARFID
Not eating enough or showing little interest in feeding but with no restriction in food variety or texture. Also known as infantile anorexia
Describe the phobic type of ARFID
Refusing food due to past aversive experience, e.g. choking or anaphylaxis. Also known as post-traumatic feeding disorder
Describe the sensory type of ARFID and the main population group it affects
Accepting only a limited diet due to sensory fears, common in autism spectrum disorder
State the incidence of anorexia nervosa in adolescents (Smink et al, 2016)
26.7 per 100,000
State the incidence of anorexia nervosa in adolescent girls
50 per 100,000
State the incidence of bulimia nervosa in adolescents (Smink et al, 2016)
25.8 per 100,000
State the incidence of bulimia nervosa in adolescent girls
50 per 100,000
What is the estimated prevalence of anorexia nervosa and bulimina nervosa?
1-2%
What is the estimated lifetime prevalence of binge-eating disorder?
1.6%
When is eating disorder incidence most common?
Age 13-25
How long does it typically take for an individual with anorexia nervosa to reach care?
Within a year due to rapid escalation
How long does it typically take for an individual with bulimia nervosa or binge-eating disorder to reach care?
4-5 years
What percentage of patients in eating disorder clinics report having ARFID?
15%
State some psychological or behavioural markers distinguishing an eating disorder from ARFID in clinic
Reluctance to attend, resisting weighing and examination, seeking help for physical symptoms instead of eating problems, covering body, paradoxical increased energy, secretiveness or evasiveness, anger or distress when asked about eating
Name a validated screening measure for eating disorders
The SCOFF
State the 5 questions in the SCOFF
Have you ever made yourself sick to lose weight?
Have you ever eaten a lot of food at once in a way that made you feel out of control or like you couldn’t stop?
Have you recently lost most than one stone?
Do you think you’re fat when others don’t?
Do you feel that food has taken over your life?
How much heritability do eating disorders have, and why?
60-70% - due to genetics, the home food environment, and parents’ attitudes towards food
What is the biggest risk factor for an eating disorder?
Being female
State at least 3 predisposing factors to eating disorder development
Family history of an eating disorder, obesity, depression, or alcoholism; personal background of low self-esteem, perfectionism, or depression; adverse life events in childhood; family environment of concern about weight, shape, or eating
State 3 triggers to starting an eating disorder
A recent stressor (e.g. comments about weight or shape, pressure to succeed in school, relationship problems), pressure from the media to be thin, appetite and weight loss in the context of an illness (happiness at lower weight or positive comments about lower weight)
Describe the consequences of weight stigma
Binge eating, increased food consumption, avoidance of physical activity because of shame, avoidance of help-seeking, increased stress, weight gain, and impaired weight loss outcomes
How does being labelled as fat in adolescence affect eating? (Hunger et al, 2018)
It predicts unhealthy weight control behaviours and disordered eating over the next 5 years - regardless of objective BMI and initial levels of disordered eating
How much does dieting increase the risk of an eating disorder?
18x
Describe how ‘starvation syndrome’ perpetuates anorexia nervosa
It can cause a loss of appetite, feelings of fullness, low mood, poor concentration, and a feeling of regaining control.
Describe the effect of body confidence on weight management
It facilitates weight management - overweight individuals who are body confident have gained less weight after 5 years than those who are insecure about their weight
