Feeding and Eating Disorders Comprehensive Notes
DESCRIPTION OF THE DISORDERS
Eating disorders fall under a category of overlapping syndromes characterized by eating dysregulation.
This discussion centers on three primary disorders as per DSM-5:
Anorexia Nervosa (AN)
Bulimia Nervosa (BN)
Binge-Eating Disorder (BED)
Other feeding disorders like pica and rumination disorder, which are more prevalent in children, are beyond this scope.
Eating disorders constitute serious mental illnesses affected by both genetic and environmental factors.
CLINICAL PICTURE
Anorexia Nervosa (AN)
Most visible eating disorder marked by an inability to maintain a normal healthy body weight.
Individuals may exhibit:
Extreme weight loss and emaciation.
The perception of being overweight even when they are underweight.
The presence of harmful weight-loss behaviors such as purging and excessive exercise.
Diagnostic Criteria (DSM-5):
Low body weight in relation to age, sex, and health.
Intense fear of gaining weight.
Three-part criterion for diagnosis:
Disturbed experience of body weight/shape.
Undue influence of body weight/shape on self-evaluation.
Lack of recognition of the seriousness of low body weight.
Subtypes:
Restricting subtype: Low weight achieved solely through energy restriction.
Binge-eating/purging subtype: Eating binges accompanied by purging behaviors.
Bulimia Nervosa (BN)
Defined by recurrent binge-eating episodes (large food amounts in short time).
Binge episodes accompanied by:
Sense of loss of control.
Inappropriate compensatory behaviors (purging, laxatives, excessive exercise).
Diagnostic criteria:
Binge-eating and compensatory behaviors occur at least once a week for three months.
Must have a BMI above 18.5 kg/m² (not meeting AN criteria).
Gender Bias:
Typically more common in women, but diagnostic criteria may lead to under-detection in men.
Binge-Eating Disorder (BED)
Recognized in DSM-5 as a stand-alone disorder.
Characterized by:
Regular binge-eating episodes without compensatory behavior.
At least three of the following:
Eating rapidly.
Eating until uncomfortably full.
Eating large amounts when not hungry.
Eating alone due to embarrassment.
Feeling disgusted or guilty after eating.
No weight range restrictions; diagnosed only if AN or BN criteria are not met.
Other Specified Feeding or Eating Disorders (OSFED)
New category in DSM-5 replacing EDNOS, capturing atypical forms of eating disorders.
Includes atypical AN, BN & BED of low frequency, and purging disorder without binge eating.
Symptoms and severity comparable to AN and BN.
DIAGNOSTIC CONSIDERATIONS
DSM-5 allows for specifiers of:
Partial remission: Criteria met previously but current weight normalized.
Full remission: No criteria met for a sustained period.
Severity Specifiers (based on BMI):
Mild: BMI ≥ 17 kg/m²
Moderate: 16–16.99 kg/m²
Severe: 15–15.99 kg/m²
Extreme: <15 kg/m²
Personality traits often seen include:
For AN: Perfectionism, obsessionality, anxiety, low self-esteem.
For BN: Novelty-seeking, impulsivity, low self-directedness.
EPIDEMIOLOGY
Lifetime prevalence estimates are approximately:
AN: 0.8–1.7% in women, 0.1% in men.
BN: 0.08–2.6% in women, 0.1% in men.
BED: 2.3–3% in women, 0.7% in men.
Increased awareness shows potentially rising incidents, particularly among children and older adults.
PSYCHOLOGICAL AND BIOLOGICAL ASSESSMENT
Assessment goals include:
Accurate symptom characterization.
Differential diagnosis.
Treatment guidance.
Techniques:
Structured and semi-structured interviews (EDE, IDED).
Self-report measures for tracking change (EDI, EDE-Q).
MEDICAL ASSESSMENT
Critical for identifying medical complications related to eating disorders (e.g., electrolyte imbalances, sudden cardiac death).
Comprehensive initial assessments recommended for low-weight individuals include:
Blood count and electrolyte battery.
Electrocardiograms and DEXA scans.
ETIOLOGICAL CONSIDERATIONS
Etiology remains complex with both genetic and environmental factors contributing:
Genetic: Predispositions affecting vulnerability to environmental triggers.
Environmental: Sociocultural pressures, negative self-image, childhood adversities.
Common risk factors include sex (female), race, childhood gastrointestinal issues, and psychiatric comorbidities.
The three primary eating disorders discussed are Anorexia Nervosa (AN), Bulimia Nervosa (BN), and Binge-Eating Disorder (BED). Here is a breakdown of their differences:
Anorexia Nervosa (AN):
Characterized by an inability to maintain a healthy body weight, extreme weight loss, and an intense fear of gaining weight.
Individuals may have distorted body image, believing they are overweight even when underweight.
Common behaviors include harmful weight-management techniques such as purging and excessive exercise.
Subtypes: Restricting subtype (weight loss solely through energy restriction) and binge-eating/purging subtype (binge eating followed by purging).
Bulimia Nervosa (BN):
Defined by recurrent binge-eating episodes along with inappropriate compensatory behaviors to prevent weight gain (e.g., purging, excessive exercise).
Individuals experience a sense of loss of control during binge episodes.
Diagnostic criteria include binge eating and compensatory behaviors at least once a week for three months and a BMI above 18.5 kg/m².
Binge-Eating Disorder (BED):
Characterized by regular binge-eating episodes without compensatory behaviors.
Individuals often experience feelings of disgust or guilt after eating, and the eating occurs in the absence of hunger.
There are no weight restrictions for diagnosis, and it's only diagnosed if AN or BN criteria are not met.
Compensatory behaviors are actions taken by individuals with eating disorders to prevent weight gain after binge eating episodes or to offset their eating habits. These behaviors can include:
Purging: Techniques such as vomiting or excessive use of laxatives to eliminate food from the body.
Excessive Exercise: Engaging in high levels of physical activity following meals to burn calories.
Fasting: Skipping meals or restricting food intake to compensate for overeating.
Diuretics or Other Medications: Using substances to promote weight loss or fluid elimination.
These behaviors are often linked to feelings of loss of control during eating episodes and are commonly associated with disorders like Bulimia Nervosa (BN) and Binge-Eating Disorder (BED).