Feeding and Eating Disorders

What disorders are included in feeding and eating disorders

Pica / rumination disorder / avoidant restrictive food intake disorder / anorexia nervosa / bulimia nervosa / binge eating disorder / other specified feeding or eating disorder / unspecified feeding or eating disorder

What broadly defines feeding and eating disorders

Persistent disturbance of eating or eating related behavior that alters food consumption or absorption and significantly impairs physical health or psychosocial functioning

Can anorexia nervosa bulimia nervosa and binge eating disorder all be diagnosed during the same episode

No / these diagnoses are mutually exclusive during a single episode

Is obesity classified as a mental disorder in DSM 5 TR

No

Can obesity occur with mental disorders

Yes / it is associated with disorders including binge eating disorder / depressive disorders / bipolar disorders / schizophrenia

What is pica

Persistent eating of nonnutritive nonfood substances for at least 1 month

How long must pica persist

At least 1 month

What kinds of substances may be eaten in pica

Paper / soap / cloth / hair / soil / chalk / paint / metal / pebbles / clay / starch / ice and other nonfood substances

What developmental requirement applies to pica

Eating nonfood substances must be inappropriate for the person's developmental level

What cultural requirement applies to pica

Behavior must not be part of a culturally supported or socially normative practice

What approximate minimum age is suggested for diagnosing pica

About age 2

Why is pica generally not diagnosed in infants

Developmentally normal mouthing and swallowing of objects can occur

Can pica occur with autism or intellectual developmental disorder

Yes

When is pica diagnosed separately in someone with another mental disorder

When the eating behavior is severe enough to require additional clinical attention

What medical complications can occur with pica

Intestinal obstruction / perforation / infection / poisoning / nutritional deficiency

What nutritional deficiencies may be associated with pica

Iron or zinc deficiency may occur although no deficiency is required

What environmental factors may increase pica risk

Neglect / poor supervision / developmental delay / lack of available food

Can pica occur during pregnancy

Yes

When should pregnancy related cravings be diagnosed as pica

When they involve actual ingestion of nonfood substances and create potential medical risk

How does pica differ from anorexia nervosa

Pica involves nonfood substance consumption / anorexia involves restriction related to weight gain or body shape concerns

What if a person with anorexia eats paper or another nonfood item to suppress appetite

Anorexia nervosa is primary when the behavior is used for weight control

How does pica differ from factitious disorder

Factitious disorder involves intentional ingestion or injury as part of deception

What should be medically assessed when pica is identified

Gastrointestinal complications / poisoning / infection / nutritional deficiency

What is rumination disorder

Repeated regurgitation of food for at least 1 month

What can happen to food after regurgitation in rumination disorder

It may be rechewed / reswallowed / or spit out

How long must rumination disorder persist

At least 1 month

How does regurgitation in rumination disorder typically occur

Without apparent nausea / involuntary retching / or disgust

How frequently does rumination typically occur

At least several times per week and commonly daily

What medical causes must be excluded before diagnosing rumination disorder

Gastrointestinal or other medical conditions such as reflux / pyloric stenosis / gastroparesis

Can rumination disorder occur during anorexia or bulimia

No / it cannot occur exclusively during anorexia / bulimia / binge eating disorder / or ARFID

Can rumination disorder occur with intellectual developmental disorder

Yes / if severe enough to require additional clinical attention

At what age can rumination disorder occur

Infancy / childhood / adolescence / or adulthood

At what age does infant rumination disorder commonly begin

About 3 to 12 months

What serious consequence can rumination disorder cause

Malnutrition and growth delay

How does rumination disorder differ from vomiting due to gastrointestinal disease

Rumination involves characteristic repeated regurgitation without the usual nausea or retching and medical causes are excluded

How does rumination disorder differ from regurgitation in anorexia or bulimia

Anorexia or bulimia regurgitation may be used intentionally to dispose of calories because of weight concerns

What is avoidant restrictive food intake disorder or ARFID

Avoidance or restriction of food intake causing significant nutritional / physical / or psychosocial consequences without weight or shape disturbance

What are the 3 common reasons people with ARFID restrict food

Lack of interest in food / sensory sensitivity / fear of aversive consequences from eating

What sensory features can trigger ARFID restriction

Appearance / color / smell / texture / temperature / taste

What aversive experiences can trigger ARFID

Fear after choking / vomiting / painful gastrointestinal experiences / traumatic feeding procedures

What 4 consequences can satisfy ARFID Criterion A

Significant weight loss or poor growth / significant nutritional deficiency / dependence on supplements or tube feeding / marked psychosocial interference

Does ARFID require low weight

No

Can failure to gain expected weight in a child meet ARFID criteria

Yes

Can significant psychosocial impairment alone satisfy the consequence requirement for ARFID

Yes

What is an example of psychosocial impairment from ARFID

Inability to eat with others / attend school or work normally / maintain relationships / severe family accommodation around food

Can ARFID be caused solely by food insecurity

No

Can culturally sanctioned fasting be diagnosed as ARFID

No

Does ARFID involve fear of becoming fat

No

Does ARFID involve body shape distortion

No

What is the key difference between ARFID and anorexia nervosa

ARFID lacks fear of weight gain and body image disturbance

Can ARFID occur in adults

Yes

When does ARFID commonly begin

Infancy or childhood although some forms can develop at any age

Which ARFID pattern can begin at any age

Avoidance based on fear of aversive consequences such as choking or vomiting

Can autism and ARFID occur together

Yes / if the feeding disturbance exceeds typical autism related rigidity or sensory sensitivity and requires specific treatment

What disorders commonly co occur with ARFID

Anxiety disorders / OCD / autism / ADHD / intellectual developmental disorder

How does normal picky eating differ from ARFID

Picky eating is usually temporary and does not cause major nutritional or functional impairment

How does ARFID differ from specific phobia of choking

When food restriction itself becomes the primary clinical problem and meets ARFID criteria then ARFID is appropriate

How does ARFID differ from depression related appetite loss

Depressive appetite loss usually improves with mood improvement while ARFID is a distinct feeding disturbance

What is anorexia nervosa

Restriction of energy intake leading to significantly low body weight plus fear or behavior preventing weight gain and disturbance in body weight or shape experience

What are the 3 core criteria for anorexia nervosa

Significantly low body weight / intense fear of weight gain or persistent behavior preventing weight gain / disturbed body image or undue influence of weight or lack of recognition of seriousness

Does anorexia nervosa require the person to verbally admit fear of gaining weight

No / persistent behavior interfering with weight gain can satisfy that criterion

How is significantly low weight judged in anorexia nervosa

Relative to age / sex / developmental trajectory / physical health

What body image disturbances can satisfy anorexia nervosa Criterion C

Distorted experience of weight or shape / excessive influence of weight or shape on self worth / failure to recognize seriousness of low weight

What are the 2 anorexia nervosa subtypes

Restricting type / binge eating purging type

What defines anorexia nervosa restricting type

No recurrent binge eating or purging during the previous 3 months

How is weight usually lost in anorexia restricting type

Dieting / fasting / excessive exercise

What defines anorexia nervosa binge eating purging type

Recurrent binge eating or purging during the previous 3 months

Does someone need to binge eat to qualify for anorexia binge eating purging type

No / recurrent purging without binge eating can qualify

What determines anorexia nervosa severity in adults

BMI

What BMI is mild anorexia nervosa

BMI at least 17

What BMI is moderate anorexia nervosa

BMI 16 to 16.99

What BMI is severe anorexia nervosa

BMI 15 to 15.99

What BMI is extreme anorexia nervosa

BMI below 15

Can anorexia severity be increased beyond the BMI category

Yes / based on symptoms / functional disability / or need for supervision

What is partial remission in anorexia nervosa

Low weight criterion is no longer met but fear or weight interfering behavior or body image disturbance remains

What is full remission in anorexia nervosa

None of the anorexia criteria remain for a sustained period

Is amenorrhea required for anorexia nervosa

No

What physical signs can occur with anorexia nervosa

Emaciation / hypotension / hypothermia / bradycardia / lanugo / edema

What symptoms may accompany anorexia nervosa

Constipation / abdominal pain / cold intolerance / lethargy

What is lanugo

Fine downy body hair that may develop with severe weight loss

Can purging signs occur in anorexia nervosa

Yes / dental erosion / enlarged salivary glands / hand calluses may occur in binge eating purging presentations

Is suicide risk elevated in anorexia nervosa

Yes / substantially

Why is anorexia nervosa medically dangerous

Severe malnutrition can affect multiple organ systems and the disorder carries elevated mortality including suicide

How does anorexia nervosa differ from medical causes of weight loss

Medical conditions generally lack intense weight gain fear / body image disturbance / and deliberate weight preventing behavior

How does anorexia nervosa differ from major depressive disorder with weight loss

Depression generally lacks intense fear of weight gain and body image disturbance

How does anorexia nervosa differ from schizophrenia with low weight

Schizophrenia may cause odd eating or low weight but usually lacks the characteristic fear of weight gain and body image disturbance

How does anorexia nervosa differ from ARFID

Anorexia includes weight gain fear or weight shape disturbance / ARFID does not

How does anorexia nervosa differ from bulimia nervosa

Both may involve bingeing or purging and weight concerns / anorexia requires significantly low body weight while bulimia generally occurs at normal or higher weight

Can OCD be diagnosed with anorexia nervosa

Yes / when obsessions and compulsions extend beyond food and eating concerns

Can body dysmorphic disorder be diagnosed with anorexia nervosa

Yes / when the appearance concern involves features other than body weight or shape

What is bulimia nervosa

Recurrent binge eating plus recurrent inappropriate compensatory behavior plus excessive influence of body shape or weight on self evaluation

What 2 features define a binge eating episode

Eating a definitely larger amount than most people would in a discrete period / experiencing loss of control over eating

How long is the typical discrete period used to define a binge episode

About 2 hours

Does continual snacking throughout the day count as a binge episode

No

What does loss of control during a binge mean

Feeling unable to stop eating or control what or how much is eaten

What compensatory behaviors can occur in bulimia nervosa

Self induced vomiting / laxative misuse / diuretic misuse / medication misuse / fasting / excessive exercise

What is the most common compensatory behavior in bulimia nervosa

Self induced vomiting

How often must binge eating and compensatory behaviors occur for bulimia nervosa

At least once per week for 3 months

What role does body shape and weight play in bulimia nervosa

Self evaluation is excessively influenced by body shape and weight

Can bulimia nervosa be diagnosed when bingeing and purging occur only during anorexia nervosa

No