Comprehensive Guide to Feeding and Eating Disorders (DSM-5-TR)

What are Feeding and Eating Disorders (FEDs)?

Characterized by persistent disturbances in eating or eating-related behaviors that lead to altered food consumption/absorption and significant impairment in physical health or psychosocial functioning.

What are the main categories of Feeding and Eating Disorders according to DSM-5-TR?

Anorexia Nervosa (AN), Bulimia Nervosa (BN), Binge-Eating Disorder (BED), Avoidant/Restrictive Food Intake Disorder (ARFID), Pica, Rumination Disorder, and Other Specified Feeding or Eating Disorder (OSFED).

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 are some serious medical risks associated with eating disorders?

Electrolyte imbalance, cardiac complications, and high mortality rates, especially in Anorexia Nervosa.

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.

What are the treatment principles for eating disorders?

Evidence-based psychotherapies (e.g., CBT-E, FBT), medical and nutritional monitoring, adjunctive pharmacotherapy, and a multidisciplinary approach.

What is the diagnostic essence of Anorexia Nervosa?

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

What are common behaviors associated with Anorexia Nervosa?

Severe calorie restriction, ritualized eating, avoidance of high-calorie foods, and excessive exercise.

What are some medical complications of Anorexia Nervosa?

Bradycardia, hypotension, electrolyte abnormalities, osteopenia, and increased risk of sudden death.

What is the diagnostic essence of Bulimia Nervosa?

Recurrent binge-eating episodes followed by inappropriate compensatory behaviors to prevent weight gain, occurring at least once per week for 3 months.

What are hallmark behaviors of Bulimia Nervosa?

Secretive binge episodes followed by guilt, normal or above-average body weight, and dental erosion.

What are medical complications associated with Bulimia Nervosa?

Electrolyte disturbances, dehydration, esophagitis, and dental erosion.

What is the diagnostic essence of Binge-Eating Disorder (BED)?

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

What are common behaviors associated with Binge-Eating Disorder?

Recurrent distressing binges, often in private, with feelings of guilt and shame.

What are medical complications of Binge-Eating Disorder?

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

What is the essence of Avoidant/Restrictive Food Intake Disorder (ARFID)?

Persistent failure to meet nutritional needs due to lack of interest in eating or sensory aversion, leading to weight loss or nutritional deficiency.

What distinguishes ARFID from other eating disorders?

It is not driven by 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.

What is a common example of Pica?

A child eating pieces of chalk and dirt, leading to stomachaches and anemia.

What is a clinical example of Anorexia Nervosa?

A 19-year-old college student restricting intake to <800 kcal/day, losing 25% of body weight in 6 months, and exercising excessively.

What is a clinical example of Bulimia Nervosa?

A 24-year-old reporting episodes of eating large meals followed by induced vomiting and excessive running, occurring 2-3 times per week.

What is a clinical example of Binge-Eating Disorder?

A 35-year-old reporting weekly episodes of eating large quantities of food with feelings of loss of control and guilt, without compensatory behaviors.

What is a clinical example of Avoidant/Restrictive Food Intake Disorder?

A child avoiding textured foods since preschool, becoming underweight and requiring supplement drinks.

What are the potential consequences of Rumination Disorder?

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.

What is the first step in assessing a suspected eating disorder?

Conducting a clinical interview to elicit eating patterns, weight history, and compensatory behaviors.

What medical evaluations are important in assessing eating disorders?

Vital signs, ECG, basic labs (CBC, electrolytes, glucose), and bone density if long-standing AN.

What is the age of onset for eating disorders?

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

Which eating disorder has the highest mortality rate?

Anorexia Nervosa (AN) has the highest mortality of psychiatric disorders.

What are the biological factors contributing to eating disorders?

Genetic heritability, neurobiological differences in reward processing, and cognitive control.

What psychological factors are associated with eating disorders?

Perfectionism, cognitive inflexibility, body dissatisfaction, low self-esteem, and trauma history.

What sociocultural factors influence the development of eating disorders?

Pressures valuing thinness, cultural/occupational pressures, diet culture, and social media influence.

What is the differential diagnosis for eating disorders?

Includes major depressive disorder, PTSD, somatic conditions, and endocrine conditions.

What are some common medical complications associated with eating disorders?

Cardiovascular issues, electrolyte abnormalities, amenorrhea, and osteopenia.

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

Severe bradycardia, marked hypotension, severe electrolyte abnormalities, and rapid weight loss.

What is Enhanced Cognitive Behavioral Therapy (CBT-E)?

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

What is Family-Based Treatment (FBT)?

A first-line treatment for adolescents with AN that involves parents in the re-feeding process.

What is Interpersonal Psychotherapy (IPT) used for?

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

What role does nutritional rehabilitation play in treating eating disorders?

It is essential in AN and medically compromised patients, often integrated with psychotherapy.

What medication is FDA-approved for bulimia nervosa?

Fluoxetine at higher doses (e.g., 60 mg/day) reduces binge-purge frequency.

What is the primary treatment for anorexia nervosa?

Psychotherapies and nutritional rehabilitation; no medication reliably reverses core symptoms.

Which stimulant is FDA-approved for binge-eating disorder?

Lisdexamfetamine.

What is the role of pharmacotherapy in treating anorexia nervosa?

Medications may target comorbid mood or anxiety symptoms but are not substitutes for refeeding.

What are the levels of care for eating disorder treatment?

Outpatient, day program/partial hospitalization, inpatient medical stabilization, and residential treatment.

What is the evidence-based treatment for adolescents with anorexia nervosa?

Family-Based Treatment (FBT).

What are the key components of effective eating disorder treatment?

Multidisciplinary care including psychotherapy, nutrition, and medical monitoring.

What is the prognosis for anorexia nervosa?

Earlier intervention and family involvement improve outcomes; it has one of the highest mortality rates among psychiatric disorders.

What screening tools can be used for early identification of eating disorders?

SCOFF and brief questions addressing eating behaviors.

What differentiates bulimia nervosa from binge-eating disorder?

Bulimia nervosa includes compensatory behaviors, while binge-eating disorder does not.

What is the typical follow-up care for patients recovering from eating disorders?

Regular medical and psychiatric monitoring to prevent relapse and address psychosocial stressors.

What should clinicians consider when treating eating disorders in diverse populations?

Be aware of underdiagnosis in men, BIPOC, and LGBTQ+ individuals; presentations may vary by cultural background.

What are common medical risks associated with anorexia nervosa?

Electrolyte imbalances, cardiovascular issues, and osteoporosis.

What is the recommended first-line treatment for adult bulimia nervosa?

Cognitive Behavioral Therapy (CBT-E) combined with medication if indicated.

What role does psychoeducation play in preventing eating disorders?

It addresses dieting culture and promotes healthy body image, improving outcomes.

What is the significance of multidisciplinary care in treating eating disorders?

It yields the best outcomes by integrating various specialties like psychotherapy, nutrition, and medical care.

What are the common features of Avoidant/Restrictive Food Intake Disorder (ARFID)?

ARFID does not involve weight- and shape-related concerns, unlike anorexia nervosa.

What is a common misconception about eating disorders?

That thinness is the only presentation; behaviors and functional/medical impacts are also critical.

What is the importance of addressing psychosocial stressors in recovery?

It is critical for sustained recovery and preventing relapse.

What should clinicians do when they suspect an eating disorder?

Screen routinely and ask about behaviors directly and nonjudgmentally.

What is the role of community resources in eating disorder recovery?

They provide long-term stabilization and support for individuals in recovery.