Chp 9: Eating disorders

What are Feeding and Eating Disorders (FEDs)?

Persistent disturbances in eating-related behaviors, leading to altered food consumption/absorption and significant impairment in physical psychosocial functioning.

Why is early detection and treatment of eating disorders important?

Early detection and treatment improve prognosis and reduce serious medical risks associated with eating disorders.

What factors contribute to the etiology of eating disorders?

Multi-factorial influences including biological, psychological, and sociocultural factors, such as genetics, personality traits, and cultural pressures for thinness.

Treatment for FED

Therapy: (CBT-E, FBT), medical and nutritional monitoring, adjunctive pharmacotherapy, and a multidisciplinary approach.

DSM5 Criteria Anorexia Nervosa

Restriction of energy intake leading to significantly low body weight, intense fear of gaining weight, and disturbance in self-perceived weight/shape.

Anorexia w/ binge-purge type

Episodes of binge eating followed by compensatory behaviors (vomiting, laxatives, diuretics, excessive exercise). FBT BEST THERAPY

Medical Complication AN

Bradycardia, hypotension, osteopenia instability, menstrual irregulations and increased risk of sudden death.

DSM5 Criteria Bulimia Nervosa

Recurrent binge-eating episodes (out of control), inappropriate compensatory behaviors to prevent weight gain, occurring at least 1/ per week for 3 months.

Medical effects of Bulimia Nervosa?

Secretive binge episodes followed by guilt, body-weight can be on a spectrum or “normal”. Electrolyte disturbances, arrhythmias, Russell’s sign (dental erosion)

DSM5 Criteria of Binge-Eating Disorder (BED)?

Recurrent binge-eating episodes associated with 3> distress and NO regular compensatory behaviors, occurring at least once a week for 3 months.

Medical complications of BED?

Metabolic syndrome, type 2 diabetes risk, and gastrointestinal discomfort.

DSM5 Criteria Avoidant/Restrictive Food Intake Disorder (ARFID)?

Persistent failure to meet nutritional needs due to lack of interest in eating or sensory AVERISON, leading to weight loss or nutritional deficiency. NOT BODY IMAGE CONCERNS

What is Pica?

Persistent eating of non-nutritive, non-food substances for at least 1 month, which can lead to GI obstruction or lead poisoning.

What is Rumination Disorder?

Repetitive regurgitation of food, which may be re-chewed, re-swallowed, or spit out, not due to a medical condition. >1 Month & It may lead to malnutrition and dental erosion.

What is Other Specified Feeding or Eating Disorder (OSFED)?

Clinically significant eating-disordered behavior causing distress or impairment that does not meet full criteria for other eating disorders.

What are some examples of OSFED?

Atypical Anorexia Nervosa (AN), subthreshold Bulimia Nervosa (BN), binge eating disorder (BED), and purging disorder.

Clinical Tests for FED

Validated screen; SCOFF, EDE-Q, Binge eating scale

Treatment for BN

Fluoxetine & SSRI reduce binge-purge frequency

Treatment for BED

lisdexamfetamine (stimulant) & SSRIs

Medical/ Nutritional Evaluation

Vital signs, ECG (electrolytes concerns), Labs (glucose, Mag+, TSH, LFT), Diet history, BMI, growth charts

Age of onset for FED

Most commonly begins in adolescence and young adulthood, but can occur at any age.

FED common population

Anorexia Nervosa (AN) has the highest mortality of psychiatric disorders and BED is the most common form of eating disorder

What are the emergent red flags indicating the need for hospitalization?

Severe bradycardia (slow Heart rate), marked hypotension, severe electrolyte abnormalities, and rapid weight loss.

Treatment (CBT-E) for Eating disorders

A transdiagnostic CBT adapted for eating disorders, effective for BN, BED, and OSFED.

Family-Based Treatment (FBT)

A first-line treatment for adolescents with AN that involves parents in the re-feeding process. BN may also used FBT; parents are responsible

Interpersonal Psychotherapy (IPT)

It is effective for BED and bulimia variants, particularly when interpersonal issues maintain disordered eating.

Levels of Care

Outpatient (low risk), Day/ partial program (structured meals not long term), Inpatient medical stabilization (red flags emergent), Residential treatment (INTENSIVE)