Feeding and Eating Disorders

What is Pica?

Persistent eating of nonnutritive, nonfood substances, such as paper, chalk, gum etc

What is the minimum age for a Pica diagnosis?

2 years old

What are common comorbid conditions associated with Pica?

ASD (Autism Spectrum Disorder), IDD (Intellectual Development Disorder), OCD (Obsessive-Compulsive Disorder), Schizophrenia

What complications can arise from Pica?

Mechanical bowel problems, intestinal obstruction, perforation infections, and poisoning

What is Rumination Disorder?

Repeated regurgitation of food that may be re-chewed, re-swallowed, or spit out without nausea

What are the risk factors for Rumination Disorder?

Lack of stimulation, neglect, and stressful life situations.

What is ARFID?

Avoidant/restrictive food intake disorder characterized by lack of interest or avoidance based on sensory characteristics of food.

What psychiatric comorbidities are associated with ARFID?

Anxiety disorders, ASD, ADHD, and OCD.

What are the consequences of ARFID?

Significant weight loss, nutritional deficiency, and dependence on enteral feeding or supplements.

What are the four main categories of factors contributing to eating disorders?

Genetics, Neurochemical, Psychosocial, Sociocultural

What is the Neurochemical process behind Eating Disorders?

Serotonin precursor (5-HIAA) reduced in anorexia when ill and normalize upon recovery

What are some risk factors for developing eating disorders?

Activities with weight/shape demands, public spotlight, childhood obesity, familial psychiatric history, diabetes, routine dieting.

What does RED-s stand for?

Relative Energy Deficiency in Sport

What is the female athlete triad?

Menstrual dysfunction, decreased bone density, and disordered eating/low energy availability

What is the consequence of female athlete triad?

Functional Hypothalamic Amenorrhea

What hormone levels are low in individuals with amenorrhea?

Leptin, GnRH, LH, and FSH.

What is Secondary Amenorrhea?

Cessation of menses after menarche.

What are some consequences of low or normal FSH levels?

Chronic anovulation, Hypothyroidism, Cushing syndrome, and Functional hypothalamic amenorrhea

What is low energy availability (EA)?

lack of adequate caloric needs for their exercise or training

What is the BMI threshold for low energy availability?

BMI < 17.5 kg/m2 or 85% of expected body weight.

What are the DSM-5 criteria for Anorexia Nervosa?

- Energy intake restriction leading to significantly low body weight

- Intense fear of gaining weight

- Disturbance in self-perceived weight or shape

What is the restricting type of Anorexia Nervosa?

Dieting, fasting, and/or excessive exercise

What is the Binge-eating/purging type of Anorexia Nervosa?

Recurrent episodes of binge eating or purging behavior in the last 3 months characterized by self-induced vomiting, laxative, diuretic, and enema misuse

What are some symptoms of Binge-eating/purging type of Anorexia?

Impulsivity, increased likelihood of abusing alcohol, and drugs

What is the severity status of anorexia based on BMI?

Mild: ≥ 17

Moderate: 16-16.99

Severe: 15-15.99

Extreme: < 15

What are some symptoms of anorexia?

Amenorrhea, delayed menarche, constipation, abdominal pain, cold intolerance, lethargy, excess activity

What are the physical exam findings of anorexia?

Emaciation, bradycardia, lanugo hair, peripheral edema, petechiae, ecchymosis, hypercarotenemia (skin yellowing), salivary gland hypertrophy, dental enamel erosion

What are some obsessive-compulsive food behaviors in anorexia?

Elaborate meal planning/preparation for others without eating themselves, compulsive calorie counting, cutting food into small pieces, covering mouth while eating or chewing

What are common food manipulations in anorexia?

excessive fluid/caffeine intake, exclusive condiment consumption, and consuming zero grams of fat

What are some laboratory findings of anorexia nervosa?

Leukopenia with lymphocytosis, Thrombocytopenia, Hypercholesterolemia, Metabolic alkalosis (vomiting)/acidosis (laxative)

What is the SCOFF Questionnaire?

S- Do you make yourself SICK?

C- Have you lost CONTROL over how much you eat?

O- Have you lost more than ONE stone (14lbs) in a 3 month period?

F- Do you believe you are FAT?

F- Does FOOD dominates your life?

What other questions may be included to the SCOFF Questionnaire with high sensitivity for bulimia nervosa?

1. Are you satisfied with your eating patterns?

2. Do you ever eat in secret?

What is the preferred treatment approach for anorexia nervosa?

Outpatient psychotherapy that is culturally appropriate and person-centered

What are the indications for inpatient treatment of anorexia nervosa?

Substantial low weight, malnourishment (<75%), high risk of medical complications or refeeding syndrome (monitor phosphate, potassium, magnesium)

What is the prognosis for anorexia nervosa?

50% have complete recovery with high chance of relapse occurring within the first 4 years of treatment

What are the criteria for bulimia nervosa?

Recurrent binge eating episodes and compensatory behavior to prevent weight gain once weekly x 3 months that is unduly influenced by body shape and weight

What are some inappropriate compensatory behaviors in bulimia nervosa?

Self-induced vomiting, misuse of laxatives, fasting, and excessive exercise.

What are the severity specifiers for bulimia nervosa?

Mild: 1-3 episodes/week

Moderate: 4-7 episodes/week

Severe: 8-13 episodes/week

Extreme: >14 episodes/week.

At what age does bulimia nervosa typically peak?

In older adolescence and young adulthood, rare after age 40.

What are some risk factors for bulimia nervosa?

Weight concerns, low self-esteem, depressive symptoms, social anxiety disorder, childhood obesity, and history of abuse.

What are common characteristics of binge-eating in bulimia nervosa?

Concealed eating until uncomfortably full, using food as an emotional pacifier, impulsivity, and shame

What are the physical exam findings of binge-eating in bulimia nervosa?

Eroded enamel, enlarged salivary glands, abrasions on dorsal hands/fingers, Mallory-Weiss tears, metabolic alkalosis, arrhythmias

What is the preferred management approach for bulimia nervosa?

Outpatient treatment with nutritional repletion, psychotherapy (CBT), and possibly SSRIs.

What are the indications for inpatient treatment of bulimia nervosa?

Unstable vitals, Dehydrated, Severely underweight, Comorbid medical or psychiatric disorders

What pharmacotherapy is approved for bulimia nervosa?

1) Fluoxetine (Prozac)

2) Sertraline, escitalopram

3) TCAs, Trazodone

What is the prognosis for bulimia nervosa?

Median time to recovery is close to 4 years.

What is binge eating disorder (BED)?

recurrent episodes of binge eating without compensatory behaviors

What are the criteria for diagnosing binge eating disorder?

Recurrent binge eating episodes associated with marked distress and at least 3 specific behaviors, occurring at least weekly for 3 months

What behaviors in which 3 must be present for a binge eating disorder diagnosis?

eating rapidly, until feeling uncomfortably full, large amount when not physically hungry, alone out of embarrassment, or feeling disgusted or guilty about oneself

What is the criteria for partial remission status of binge-eating disorders?

< 1 episode per week

What are the severity specifiers for binge eating disorder?

Mild: 1-3 episodes/week

Moderate: 4-7 episodes/week

Severe: 8-13 episodes/week

Extreme: >14 episodes/week.

What are some symptoms of binge eatin disoder?

emotional triggers, dissociative quality, significant weight fluctuations, functional impairment, self-loathing, interpersonal sensitivity

What is the first-line approach to binge-eating disorder?

Psychotherapy (CBT/DBT) +/- interpersonal therapy, and family therapy

What pharmacotherapy is approved for binge-eating disorder?

Lisdexamfetamine (Vyvanse) for mod-severe BED. SSRIs, SNRIs, Buproprion.

What is the prognosis of binge-eating disorder?

average duration of 14-16 years with a high rate of transition to other eating disorders (bulimia)