Feeding and Eating Disorders

Psyc 3034

prevalence of eating disorders

13% if children/adolescents will develop at least one eating disorder by age 20

sociocultural influences on food and bodies

western values- thin ideal

• internalized as young as age 7

• dieting as young as 7-9

higher impact on girls

• more emphasis on appearance and anxiety around weight loss

binge-purge cycle

strict dieting → diet slips or difficult situations → binge eating triggered → purging to avoid weight gain → feelings of shame and self-hatred → repeat cycle

anorexia nervosa

intense fear of gaining weight

self image dictated by weight/shape

restriction of intake (clinically underweight)

2 subtypes:

• restrictive

• binge-purge

anorexia severity specifier

based on BMI

• mild: 17+

• moderate: 16-16.99

• severe: 15-15.99

• extreme: less than 15

physical symptoms of anorexia

emaciation (extreme thinness), hypotension, hypothermia, bradycardia (slow heart rate), lanugo (growth of fine body hair), brittle hair

health consequences of anorexia

risk of heart failure, slowed digestion and stomach pain, difficulties concentrating and staying asleep, lowered hormones, bone loss, seizures, numbness

course of anorexia

onset: 14-18

5% mortality rate

about ½ show recovery, 1/3 show fair improvement, and 1/5 have a chronic course

bulimia nervosa

recurrent binges followed by compensatory behaviors to control weights

at least 1x a week for 3+ months

self-evaluation influenced by body and shape

not only present during anorexia episode

binge

eating a large mount over a short period of time

lack of control during eating episodes

compensatory behaviors

self-induced vomiting

laxatives/diuretics

fasting

excessive exercise

bulimia severity specifier

based on average weekly compensatory behaviors

• mild: 1-3/week

• moderate: 4-7/week

• severe: 8-13/week

• extreme: 14+/week

health consequences of bulimia

irregular heartbeat, risk of heart failure, slowed digestions, dependence on laxitives for bowels, pancreatitis, increased risk of T2 diabetes

course of bulimia

onset in late adolescence and young adulthood

binge eating develops during or after a period of restrictive dieting

may be chronic or occur intermittently

50-75% of children show full recovery over several years

binge eating disorder

recurrent binges

3+:

• eating more rapidly than normal

• eating until uncomfortably full

• eating large amounts of food when not feeling hungry

• eating alone because embarrassment

• feeling disgusted, depressed, or very guilty after overeating

1x+/week for 3+ months

binge eating severity specifier

by number of binge episodes per week

• mild: 1-3/week

• moderate: 4-7/week

• severe: 8-13/week

• extreme: 14+/week

course of binge eating disorder

peak onset in late adolescence to early adulthood

• comparatively high rates into middle age

episodic course

high rates of recovery and low rates of relapse compared to AN and BN

• 82% recovery over 5 years

eating disorder prevalence

binge eating (most) → other → bulimia → anorexia (least)

95% of EDs occur in ages 12-25

anorexia: 25% male, 75% female

sex differences

men: 50% binge eating, 20% bulimia, 5% anorexia

women: 95% anorexia, 80% bulimia, 50% binge eating

gay men are at greater risk, often emphasis in muscularity rather than thinness

cultural differences

anorexia may manifest differently around the world

bulimia is culture-bound

women of higher SES are more likely to have and ED

etiology of eating disorders

genetics- run in families

neuroendocrine system disruptions

sociocultural and family influences

personality traits: perfectionism, low self-esteem

treatments for anorexia

initial: restore weight and monitor medical complications

comprehensive treatment plans- psychotherapist, nutritionist, psychopharmacologist

sometimes hospitalization

psychological treatments:

• CBT-E

• family-based therapy

treatments for bulimia

individual or family-oriented CBT-E

interpersonal therapy (IPT)

SSRIs

treatment for binge eating

psychoeducation

CBT-E

IPT

DBT or ACT

pica

ingestion of inedible, nonnutritive substances

can lead to serious health problems

prevalence of pica

10-30% of kids age 1-6 have it

most common in children w: IDs and ASD

risk factors:

• nutritional deficiencies, malnutrition, parental neglect, lack of supervision, food deprivation

treatments for pica

home- teach your child what is safe, store craved items in a locked cabinet/out of reach, offer child a well-balanced diet

rumination disorder

repeated regurgitation of food or repeated re-chewing of food

risk factors:

• physical illness or severe stress, neglect, manifestation of MI such as depression or anxiety

most often in infants and children with cognitive impairments

treatments for rumination disorder

reducing distractions during eating times

behavior therapy

• diaphragmatic breathing training

• habit reversal behavior therapy

• aversive conditioning

medication to protect esophagus lining

avoidant/restrictive food intake disorder (ARFID)

eating disturbance resulting in failure to meet appropriate nutrition/energy needs

1+:

• weight loss/failure to gain weight for young children

• nutritional deficiency

• dependence on supplemental nutrition

• psychosocial interference

NO body image concerns

3 ARFID presentations

food selectivity due to sensory sensitivity

fear of aversive consequences

lack of interest in food or eating

treatment for ARFID

psychoeducation

CBT- restructuring, behavioral experiments/exposure

feeding therapy

other specified feeding or eating disorder (OSFED)

atypical anorexia nervosa- all criteria except low body weight

bulimia nervosa (of low frequency and/or limited duration)- less than once a week for less than 3 months

binge-eating (of low frequency and/or limited duration)- less than 1 per week for less than 3 months

purging disorder- recurrent purging in absence of bingeing

night eating syndrome- recurrent excessive night eating (after dinner or waking from sleep)