Feeding/Eating disorders

Feeding/eating disorders: HiTOP

Internalizing: eating problems: Anorexia, bullimia, binge eating

was once considered an externalizing disorder for its interaction with environment

what’s happening (normatively)

• body changes 

• emphasis on social standing 

• identity formation 

• adultification 

occur during puberty and cause insecurities of appearance and social acceptance 

adolescent feeding disorder

persistent disturbance of eating behaviors that alter eating habits, which then cause impairment of health/psychosocial functioning

what falls under adolescent feeding disorders?

anorexia nervosa, bullimia, binge eating disorder

what are the three main parts of Anorexia’s clinical representation?

• restriction

• fear of weight gain

• body image distortion

Anorexia diagnosis criteria:DSM

restriction of energy intake despite requirements causing very low weight in the context of one’s age and height

intense fear of gaining weight in the form of persistant behaviors that prevent weight gain

Body image distortion causes one to see themselves as bigger even at a low body weight

Bullimia nervosa

frequent episodes of binge eating (once a week or more for at least one month) accompanied with compensatory behaviors (excessive exercise, self, induced vomiting use of laxatives, etc)

Purging behavior

self-induced vomiting, laxative/diarrhetic use, enemas

Non purging behavior

fasting or excessive exercise

how does Bullimia nervosa differ from anorexia nervosa?

people with bulimia nervosa don’t need to have a low body weight while people with anorexia nervosa do

what do binge eating episodes look like in Bullimia nervosa 

eating (within a 2 hr period) copious amounts of food accompanied by a lack of control during the episode (person cannot stop or control what they eat)

Bullimia Nervosa diagnosis 

• persistent episodes of binge eating 

• persistent compensatory behaviors that prevent weight gain 

• bing eating and compensatory behaviors occur at least once a week for three months

• self evaluation is highly influenced by body shape/weight

• the disturbance does not exclusively occur during episodes of anorexia nervosa

binge eating disorder

binge eating episodes have three (or more) of the following symptoms 

• eating very rapidly 

• eating until one feels uncomfortably full

• eating large amounts of food even when one doesnt feel hungry

• eating alone due to embarrassment of eating habits

• feeling disgusted with oneself, depressed, or guilty after episodes

what should be the attitude of someone with binge eating disorder to be considered for diagnosis?

the person should be very distressed by their binge eating

how long should binge eating disorder symptoms occur to be diagnosed

once per week for three months 

how does binge eating disorder compare to bullimia or anorexia nervosa?

binge eating is NOT associated with compensatory behaviors (bulimia and anorexia)

binge eating is not exclusive to bulimia or anorexia nervosa 

binge eating disorder, unlike anorexia, does have a restriction on food 

medical consequences of eating and feeding disorders: weight loss and starvation 

• 80% of AN have low heart rate, blood pressure, and heart arrhythmia 

• amenorrhea

• low bone density, osteoperosis, increased bone fracturing, slow gastric movements 

• dry skin 

• carotenmia (orange skin due to eating excess fruits/veg—mainly carrots)

• laugo — fine hair that grows on the body to create warmth after extreme weight loss

medical consequences of eating and feeding disorders: purging

• electrolyte imbalance

• cardiac arrhythmias

• gastrointestional complications from excessive vomiting/laxative use (constipation and diarrhea)

• irregular periods

• cathartic colon syndrome — nerve cells in the colon are permanently damaged causing refractory constipation 

• tooth enamel errosion and gingivitis  

• russell’s sign — scars on knuckles due to exposure of stomach acid 

medical consequences of eating and feeding disorders: binge eating

sudden enlargement of gastric system

percentage of ED’s in populations 

1.7% AN

0.8% BN

2.3% BED

gender differences 

1 male for every 3-4 females 

average onset

15.1 years — AN

16 —- BN

13.29 BED

Comorbidity

eating/feeding disorders are highly comorbid with anxiety and depression 

depressive symptoms improve as weight is restored and ED symptoms decrease 

anxiety often comes prior to ED’s (heterotypic continuity)

what about homotypic continuity for ED’s in general?

homotypic continuity is HIGH within EDs - BUT VARIES within subdiagnoses

20-40% of people with AN will cross over to BN

20-30% of people with BN will migrate to AN 

environmental factors

• social pressures (feedback, focus on body image)

• social media 

• familial ED's

• Mood/anxiety disorders

• Neglect/abuse 

• Poly trauma

Individual risk factors

low self worth

all or none thinking (“i had a cookie, my diet is ruined”)

perfectionism/control

resiliance factors

social support

healthy eating attitudes

positive self image

body size acceptance