Feeding/eating disorders

Question 1

DSM-5 Highlights

Answer 1

 Anorexia Nervosa
 Bulimia Nervosa
 Binge Eating Disorder (added). There are cautions here. Frequent
in today’s society to have binges and not use compensatory
behaviors like vomiting. Seems to address possible grey area
around Bulimia
 Avoidant / Restrictive Food Intake Disorder (added). There are
cautions here. Frequent in today’s society to have restrictive eating
habits. This disorder does have other criteria to consider (nutrition
deficiency). Seems to address grey area around anorexia

Question 2

Anorexia Criteria

Answer 2

1. Restriction of intake resulting in
   significant low body weight (roughly less
   that 85% of “normal” body weight range)
2. Intense fear of gaining weight or
   becoming fat, OR persistent behaviors to
   interfere with weight gain
3. Disturbance in the way body weight or
   shape is viewed, evaluated, OR lack of
   recognition of seriousness
   Specify: Restricting Type (diet, fasting,
   exercise) OR Binge-eating/purging Type
   (vomiting, laxatives, enemas)
   Specify: Partial or full remission
   Specify: severity (based on Body Mass Index

Question 3

Anorexia Nervosa

Answer 3

 Most commonly found in females (10:1) with onset occurring in late adolescence or early
adulthood.
 While the body weight is dangerously low in most cases, the individual is obsessed with eating,
food, and weight control. Weighing herself or himself repeatedly. Counting or portioning food
carefully. Only eating certain foods, good and bad food categories. Even exercise excessively.
 Key feature is the distorted view of being or feeling fat, unattractive, even unhealthy despite
clear danger with physical signs (loss of period, cold often, trouble sleeping, fine hair growth
on in unusual places).
 Often employs sophisticated concealment strategies: wear baggy clothing, attend multiple
gyms, frequent appetite suppressant tricks (diet sodas, gum chewing), distracting eating habits
to show that they eat but the amount is actually very low (moving food around to look
consumed, “I ate earlier”)
 The progression of the disorder also restricts life involvement: withdraw from social activities,
especially meals and celebrations involving food (eating habits might be exposed), depressed,
lethargic (lacking in energy), isolation or withdrawal from family and friends, mood swings
 Most power feature is the psychological denial of eating problems or weight loss

Question 4

Diagnostic Tips

Answer 4

 Need to check for medical, substance, or impoverished environment impact
on weight loss
 Medical involvement necessary for treatment. If severity is determined to
be more than mild, common outpatient treatment will not be effective.
Team approach with frequent to constant supervision needed.
 Any psychosocial assessment should include cataloging days events. These
include gym visits, food choices, diet pill usage.
 Must investigate psychological view of self from non judging way. The first
hint that you think they have a problem will increase concealment and
manipulation efforts.
 Must get list of all physical issues.

Question 5

Bulimia Criteria

Answer 5

1. Recurrent episodes of binge eating:
   eating large amounts of food within 2-
   hour period and lack of control to stop or
   control how much is consumed
2. Recurrent inappropriate compensatory
   behaviors to prevent weight gain
   (vomiting, laxatives, diuretics, fasting,
   excessive exercise)
3. Both occur at least 1X per week for 3
   months
4. Distorted self-evaluation of shape and
   weight
   Specify: partial or full remission
   Specify: severity (based on # of episodes per
   week)

Question 6

Bulimia Features

Answer 6

 Similar to Anorexia, females are more likely (10:1) to experience this disorder than
males. Usual occurrence in young adulthood. Again , an intense fear of weight gain and
unhappy with body, but the method to control different
 Typical course is periods of uncontrolled eating with high calorie intake as a response
to the body’s starvation alarm. The indulgence is then addressed with extreme fasting,
excessive exercise, vomiting, laxatives, etc. The overall weight may be within normal
ranges but the body is damaged extensively.
 These individuals also engage in high effort behaviors: make excuses to go to the
bathroom immediately after meals , only eat diet or low-fat foods (except during
binges) , regularly buy laxatives, diuretics, or enemas, spend most of his or her time
working out or trying to work off calories
 Psychological results ensue: withdraw from social activities, especially meals and
celebrations involving food, avoiding situations where food is served, depression
and/or anxiety, mood swings, isolation or withdrawal from family and friends
 Concealment and manipulation strategies (conscious and automatic) are plentiful with
a powerful denial of eating problems or weight loss

Question 7

Diagnostic Tips

Answer 7

 Be aware of the often unconscious suspicion that someone is on to them.
Embarrassment is likely high for these individuals.
 Operate with similar investigation as Anorexia. Team approach with high
medical involvement likely.
 Work to assess restriction vs. binging vs. compensation behaviors. These
three elements will determine the diagnosis path. Anorexia and Bulimia may
both be present at some point in the person’s history. Lean toward current
weight as deciding factor.
 Consider normal behaviors first before assuming disorder: often people pig-
out, overeat, go work off the calories, (even take diet pills, want to lose
weight, etc.). Need to assess for psychological impairments and longevity
and impact of course

Question 8

Predictors

Answer 8

Negative comments from their fathers coupled with their own concerns about
weight, prove to be one of the predictors of the start of binge eating in teenage
boys.
 Involvement in so-called “lean” activities or sports such as gymnastic, swimming,
ballet, boxing, figure skating or long distance running, where being thin is very
crucial to success, the risk of developing an eating disorder such as anorexia
nervosa is substantially higher.
 On the flip side engaging in “bulking” and “weight-requirement” sports such as
football, wrestling, or body building may put them at a higher risk for developing
and eating disorder such as bulimia nervosa and binge-eating.
 Going through puberty can trigger an eating disorder in teenage boys, however
they tend to develop eating disorders later in life.
 Being chubby when they were children and experienced teasing or negative
remarks from family members or peers about their body size.
 A family history of eating disorders