Eating Disorders and Disordered Eating Lecture Notes

Eating Disorder: Defined as a psychiatric disorder that is characterized by severe disturbances in both body image and eating behaviors.
Disordered Eating: These are atypical eating behaviors utilized specifically to keep body weight low. Crucially, these behaviors are not severe enough to classify officially as a clinical eating disorder.
Body Image: This refers to a person’s subjective perception of their own physical appearance.

Psychological Factors: Individual mental health and internal psychological states.
Interpersonal Factors: Personal relationships and interactions with others.
Social Factors: Cultural pressures, societal beauty standards, and external social environments.
Genetic and Biological Factors: Inherited predispositions and physiological biological mechanisms.

Diagnostic Criteria for Anorexia Nervosa: * Extreme dietary restriction that leads to a significantly low body weight. * The presence of overwhelming distress or anxiety regarding weight gain. * Disturbed perception of one’s own body weight or shape. * An overemphasis of body weight or shape on one's sense of self-worth. * A significant failure to recognize the medical dangers associated with maintaining a low body weight.
Common Behaviors Associated with Anorexia Nervosa: * Engagement in extreme dieting. * Maintaining a very short list of "safe foods." * Hiding and storing food in secret. * Preparing meals for other people while refusing to eat themselves. * A constant drive for perfection. * Frequent weighing of oneself. * Being intensely critical of self. * Withdrawal from family members and friends. * Potential refusal of treatment due to the intense fear of weight gain.

Diagnostic Criteria for Bulimia Nervosa: * Recurrent episodes of binge eating followed by compensatory behaviors. * Binge Eating: Consuming an abnormally large amount of food within a short duration of time. * Compensatory Behaviors/Purging: Specific actions taken to rid the body of excess calories.
Common Behaviors Associated with Bulimia Nervosa: * Hidden binge-and-purge habits. * Binge Specifics: A binge may consist of more than $3,000\,\text{kcal}$ within a period of $2\,\text{hours}$ . Food types often include convenience foods, cookies, cakes, and ice cream. * Purge Specifics: Methods include self-induced vomiting, the abuse of laxatives, and excessive exercise. * Weight Status: Because most calories are absorbed before purging occurs, individuals are typically at or above normal body weight.

The disorder follows a vicious cycle consisting of the following stages: * Anxiety: Triggering initial distress. * Bingeing: The compulsive consumption of high-calorie foods. * Fear of Fat Gain: The immediate reaction to the binge. * Purging: The compensatory behavior to alleviate the fear and remove food. * Loss of Fear of Fat Gain: A temporary relief provided by purging. * Guilt: Feelings of shame following the purging episode, which leads back to anxiety.

Diagnostic Criteria for Binge-Eating Disorder: * Repeated episodes of binge eating involving a large amount of food in a short period. * Experiencing a distinct loss of control during these binges. * Absence of Purging: Unlike Bulimia Nervosa, this is not followed by compensatory purging behaviors. * Weight Association: Individuals with this disorder are often overweight or obese.
Common Behaviors Associated with Binge Eating Disorder: * Isolating oneself to eat large quantities of food. * Using food as a mechanism to reduce stress and provide a temporary feeling of power and well-being. * Regularly bingeing on "junk" foods.

Effects of Anorexia Nervosa: * Low body temperature. * Bruising. * Low metabolic rate and cold intolerance. * Hair loss. * Fainting and fatigue. * Loss of heart tissue. * Lanugo (the growth of fine, downy hair). * Very little subcutaneous fat. * Amenorrhea (cessation of menstruation). * Low bone mass. * Muscle tears and stress fractures. * Iron-deficiency anemia.
Effects Shared by Anorexia and Bulimia Nervosa: * Blood potassium imbalance. * Irregular heart rate. * Dental decay. * Constipation. * Sleep disturbances. * Immune dysfunction. * Infertility.
Effects Specific to Bulimia Nervosa: * Swollen salivary glands. * Irritation of the esophagus. * Stomach ulcers. * Note: Bulimia may also lead to potassium imbalances, heart irregularities, tooth decay, constipation, sleep issues, immune issues, and infertility.
Effects of Binge Eating Disorder: * Hypertension (high blood pressure). * High cholesterol. * Osteoarthritis. * Fatty liver disease. * Atherosclerosis. * Type $2$ diabetes. * Specific types of cancer. * Sleep apnea.

The setting of care depends entirely upon the needs of the individual.
A multiple-area team approach is required to address the complexities of recovery: * Physical Health Goals: Restore body weight, normalize levels of electrolytes and hormones, and ensure the resumption of menstruation. * Nutritional Care: Correcting misconceptions about food and establishing good, normal eating patterns. * Psychological Needs: Addressing issues related to body image, food restriction, overexercise, purging, and binge eating. Medication is identified as useful in treating underlying mood and anxiety disorders.

Orthorexia: Defined as an unhealthy obsession with healthy eating. There is concern that this obsession can transition into disordered eating.
Prevention Strategies: * Encourage children to eat only when they are hungry. * Discourage restrictive dieting and the skipping of meals. * Provide accurate information about the normal physical changes that occur during puberty. * Correct prevailing myths regarding nutrition, body weight, and weight loss. * Carefully phrase recommendations regarding weight. * Encourage an active respect for diversity in body shapes and sizes.

Standard Screening Questions: * Do you make yourself sick because you feel uncomfortably full? * Do you worry you have lost control over how much you eat? * Have you recently lost more than $15\,\text{pounds}$ in a $3\text{-month}$ period? * Do you believe yourself to be fat when others say you are too thin? * Would you say that food dominates your life?
Renfrew Risk Quizzes: * Key questions include: "Do you have a healthy relationship with food?" and "Do you respect your body?"