Feeding/Eating, Elimination, and Sleep-Wake Disorders

Pica diagnostic criteria

eating non-nutritive, nonfood substances for 1+ months and is inappropriate for their developmental level and is not a culturally or socially acceptable practice.

can occur at any age but is most common in women and pregnant women.

anorexia nervosa diagnostic criteria

restriction of energy intake that causes a significantly low body weight for their age, sex, developmental trajectory, and physical health.

must have:

• intense fear of gaining weight or enage in behavior that interferes with gaining weight

• a disturbance in the way they experience their weight or shape, or a lack of awareness of the seriousness of their weight

specifiers for anorexia

type (restricting or binge-eating/purging)

course (partial or full remission)

severity (determined but their BMI).

disorders comorbid with anxorexia

depression and anxiety (especially OCD)

there is evidence that anxiety often precedes the onset of anorexia.

Prognosis for anorexia

One of the most difficult disorders to treat because they don’t believe they have a problem.

Poorer than the prognosis for bulimia but there is evidence that long-term outcomes for the two disorders may be more similar than previously believed.

treatment goals for anorexia (initial goals then subsequent goals, 7 total)

1. (initial goals) restore the person to a healthy weight and address physical complications

2. increase their motivation to participate in treatment

3. provide them with education about healthy nutrition

4. help them identify and change beliefs, attitudes, and emotions contributing to the eating disorder

5. treat psychological conditions that are contributing to the eating disorder (e.g., low self-esteem, impulse control problems)

6. enlist family support and provide family therapy when appropriate

7. help them identify strategies for preventing relapse

treatments for anorexia (list the 3)

CBT for anorexia nervosa

enhanced CBT (CBT-E) for eating disorders

family-based treatment (FBT) for anorexia nervosa

CBT for anorexia nervosa

a post-hospitalization intervention based on the assumption that shape- and weight-related concerns engender dietary restriction and other extreme methods of weight control that maintain anorexia symptoms

it employs behavioral strategies to establish regular eating patterns and eliminate frequent body-checking and cognitive strategies to identify and replace problematic thinking and enhance motivation

CBT-E

transdiagnostic treatment that proposes that eating disorderes share the same core psychopathology (i.e., excessive value given to a physical appearance and weight)

it is a personalized and flexible treatment that focuses on the factors that are maintaining the patient’s symptoms

FBT for anorexia nervosa

an outpatient intervention for adolescents who are medically stable. consists of 3 phases:

1. parents take charge of the adolescent’s nutritional rehabilitation and weight restoration with the help of the therapist

2. control over eating is gradually returned to the adolescent

3. adolescent developmental issues are addressed and include establishing age-appropriate independence for the adolescent and healthy parent-child relationships

pharmacotherapy for anorexia

the antipsychotic olanzapine is useful for fostering initial weight gain

SSRI fluoxetine for improving weight maintenance

because of the inconsistent findings about the effectiveness of meds to treating anorexia, some experts recommend that meds only be used to treat comorbid symptoms such as anxiety and depression

bulimia nervosa diagnostic criteria and specifiers

recurrent episodes of binge eating that are accompanied by a sense of a lack of control, inappropriate conpensatory behavior to prevent weight gain, and self-evaluation that’s excessively influenced by body shape and weight

binge eating and compensatory behavior must occur at least 1x/week for 3+ months

specifiers are for course (partial or full remission) and severity (based on average number of episodes of compensatory behavior per week)

comorbidity with bulimia

depression and anxiety, with anxiety sometimes preceding the disorder

medical aspects of bulimia

usually within normal to overweight range

medical complications about usually the result of compensatory behavior (e.g., purging causing dental problems, acid reflux, dehydration that can result in electrolyte balance and heart arrhythmia and death

treatments for bulimia (list the 4 and their effectiveness)

nutritional rehabilitation + CBT

enhanced CBT (CBT-E) for eating disorders

interpersonal therapy (IPT)

family-based treatment (FBT) for bulimia

effectiveness: CBT, CBT-E, and IPT have comparable effects, but CBT and CBT-E are generally preferred because IPT takes longer to produce those effects

CBT-E for bulimia

transdiagnostic intervention for eating disorders that is based on the assumption that these disorders share the same core psychopathology (excessive value given to physical appearance and weight)

FBT for bulimia

outpatient intervention for adolescents that involves 3 phases that are similar to those when treating anorexia, except some differences that are in bold:

1. parents take charge of the adolescent’s nutritional rehabilitation with the focus on disrupting their binging, purging, restrictive dieting, and other undesirable methods of weight control

2. control over eating is gradually returned to the adolescent

3. adolescent developmental issues are addressed and include establishing age-appropriate independence for the adolescent and healthy parent-child relationships

since symptoms are more egodystonic and they are more motivated to change than those with anorexia, the phases are slightly different because treatment is more collaborate with the adolescent and parent working together to alter undesirable food-related behaviors

pharmacological treatment for bulimia

antidepressants (especially fluoxetine) have been found effective for alleviate comorbid depression and reducing binge eating and purging in patients without depression

binge-eating (BED) disorder criteria

eating an amount of food that is larger than what most people would eat in a similar amount of time and in similar circumstances, plus a sense of lack of control over eating during episodes

must have:

• 3 out of 5 symptoms (eating more rapidly than usual, eating until uncomfortably full, eating large amounts when not feeling hungry, feeling alone due to embarrassment about binging, feeling disgusted, depressed, or guilty about binging)

• episodes occur at least 1x/week for 3 months

levels of severity and how severity is determined for binge-eating disorder

mild, moderate, severe, extreme

determined by the number of episodes in each week

rates of binge-eating disorder based on individual characteristics

2-3x more common in women than men

occurs in people who are normal, overweight, or obese

binge eating disorder vs bulimia

binge eating disorder (BED): do not engage in recurrent compensatory behaviors and usually have a better response to treatment

dieting often follows the onset of BED whereas dieting usually precedes bulimia

similar comorbidity to bulimia and anorexia