Eating Disorders

1. In addition to anorexia nervosa (AN) and bulimia nervosa (BN), what additional diagnostic categories were added in the DSM-V and why?

  • Expanded the scope of ED diagnosis because more than half of the individuals presenting eating concerns did not meet the criteria for AN or BN

  • BED (binge eating disorder) was added 

  • AN and BN criteria was modified to be more inclusive 

  • Other Specified Feeding or Eating Disorder (OSFED) was added which identifies variants of AN, BN, and BED, but includes syndromes called purging disorder and night eating syndrome 

  • OFSED category also includes other disorders: pica (eating of non-nutritional substances, rumination disorder

2. What are the central tenets of Fairburn’s transdiagnostic theory of eating disorders?

Identified the centrality of overvaluation of eating, shape, and weight and their control across the range of eating pathology. 

  • Variations in eating symptomatology are all expressions of this overvaluation and the mechanisms of this core belief must be targeted during treatment


3. What is the primary symptom that distinguishes individuals diagnosed with AN from those diagnosed with BN or binge eating disorder (BED)?

Restriction of intake leading to a significantly low weight that is less and minimally normal or (in children and adolescents) less than minimally expected. 


4. Although restrictive behaviors can take many forms, which one is seen as most prominent in AN and what are some examples?

- Intentional dieting that will result in a low body weight is the hallmark of AN. 

  • Hours spent calculating calories and planning meals

  • Converting to vegetarianism in the context of dieting 

  • List of permissible foods becomes smaller until the individual only eats the exact same thing every day

5. Patients with AN tend to overestimate their body size relative to their true body size. From what process is this likely the result and how is this relevant to treatment avoidance?


Results from a consistent and persistent overfocus on the body as a whole or specific parts of the body (e.g. thighs, buttocks, cheeks) in an attempt to assess the efforts to lose weight or fat. Overtime, this hyperfocus on the body can lead to severe distortions such as inability to evaluate the consequences of being severely underweight, and this denial of malnutrition is a major source of treatment avoidance and represents a significant psychological hazard for successful weight restoration. 

6.What are some of the physical consequences of malnutrition?

  • Malnutrition affects most organs, the body's response system is to conserve energy by cutting back on all essential functions 

    • Blood flow to peripheries is decreased leading to cold extremities

    • Skin becomes dry, hair falls out, 

    • Menstruation stops or becomes irregular, fertility impaired, 

    • Presence of lanugo hair (to keep the body warm)

    • Calcium loss in the bones (leading to osteoporosis)

    • Younger patients will have their growth stopped or hindered 

    • Low heart rate, blood pressure, can result in death

    • Shrinkage of the brain

  1. On what critical symptom does the diagnosis of BN center? What is the difference between an objective binge episode and a subjective binge episode?

**boulimos means ravenous hunger in Greek 

The critical symptom of bulimia nervosa (BN) is centered around the presence of recurrent binge eating episodes 

  • Objective binge episode (OBE): eating more than what most people would eat in a  similar situation and discrete period of time (e.g. 2 hours), hence “objective” since they are eating objectively more than on average in the situation, with a sense of loss of control over eating 

  • Subjective binge episode: an individual eating a normal or little amount of food but a loss of control is endorsed, hence subjective because to the individual this shows a loss of control within them even if they eat a normal amount of food

!!So the difference between these episodes is the factor of control, an individual who experiences a subjective binge eating episode may feel that they are losing their control even when eating a normal amount of food. 

**Note: OBEs and compensatory behaviors are required to occur at least once per week for three months for a diagnosis of BN–DSM V (this number used to be twice per week for six months in the DSM IV, and this change can now allow for more recent onset and less severe cases to be diagnosed)


8.When are binges most likely to occur and what are some common triggers for a binge?

Binges are most likely to occur when an individual is alone, and evenings are especially high risk times. The behaviors are followed by feelings of guilt, shame, and embarrassment. 

Triggers for binging and purging: positive and negative emotions, lapses in self-awareness, interpersonal stressors, the presence of tempting food, feeling that a dieting rule has been broken, body-image dissatisfaction, and skipping meals or getting extremely hungry.

9.What are some physical consequences of continued binging/purging?

  • Development of fluid or electrolyte abnormalities which can lead to..

    • Potentially fatal arrhythmias

    • Esophageal complications 

    • Gastrointestinal (GI) symptoms 

    • Renal (urinary) system problems 

    • Menstrual irregularities 

    • Thyroid dysfunction 

  • Laxative abuse (another form of purging) can lead to..

    • Loss of normal colonic function (cathartic colon syndrome)

    • Reflex constipation

  • Vomiting (purging) can lead to

    • Enamel erosion 

    • Gum disease 

    • Enlarged parotid glands (chipmunk-like cheeks)


10.What differentiates BED from BN?

People with BED don't compensate for their binge eating (they don't purge like someone with bulimia would.

11.What does interoceptive awareness have to do with eating disorders?

Interoceptive awareness is the ability to identify internal sensations (e.g. hunger and satiety cues), including both physiological and emotional states. 

  • Women who have EDs have poor interoceptive awareness, and this can predict the onset of eating disorder symptoms 


12.What factors may associate with a person’s adoption of the “thin ideal”?

  • Individuals who immigrate to a western culture 

  • Living in urban areas rather than rural

  • ^^risks for an ED

  • Media exposure 

  • Family (e.g. comments on weight, teasing about weight, modeling of restrictive eating) 

  • Childhood abuse (physical or sexual)


13.The family environment may foster eating disorders in that they fail to teach

appropriate behaviors around eating; what other characteristics are common in families of eating disordered patients?

  • Parental obesity is a risk factor for binge eating disorder 

    • Parents who are overnight might exert pressure on children to be thin in order to prevent them from developing weight problems

  • People w/EDs come from households that are more chaotic, conflicted, and critical

14. What do genetic studies indicate with respect to genetic influences on eating disorders and gender differences? What does this findings suggest about the particular biological factors that might be implicated in the development of eating disorders in girls?

  • Genetic influences for an ED emerge at puberty, and the magnitude of them remain until young adulthood 

  • Ovarian hormones in girls (estrogen and progesterone) that become activated during puberty as well as those that drive pubertal development (breast development, increased adiposity or body fat) may be responsible