5. alimentaire Flashcards
Pica
Diagnostic Criteria
Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month. The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual. The eating behavior is not part of a culturally supported or socially normative practice. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.
Coding note: The ICD-10-CM codes for pica are F98.3 in children and F50.89 in adults.
Specify if:
In remission: After full criteria for pica were previously met, the criteria have not been met for a sustained period of time.
Rumination Disorder
Diagnostic Criteria (F98.21)
Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out. The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis). The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder. If the symptoms occur in the context of another mental disorder (e.g., intellectual developmental disorder [intellectual disability] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.
Specify if:
In remission: After full criteria for rumination disorder were previously met, the criteria have not been met for a sustained period of time.
Avoidant/Restrictive Food Intake Disorder
Diagnostic Criteria (F50.82)
An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) associated with one (or more) of the following:
Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
Significant nutritional deficiency.
Dependence on enteral feeding or oral nutritional supplements.
Marked interference with psychosocial functioning.
The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
Specify if:
In remission: After full criteria for avoidant/restrictive food intake disorder were previously met, the criteria have not been met for a sustained period of time.
Anorexia Nervosa
Diagnostic Criteria
Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Coding note: The ICD-10-CM code depends on the subtype (see below).
Specify whether:
F50.01 Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise. F50.02 Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge-eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).
Specify if:
In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A (low body weight) has not been met for a sustained period, but either Criterion B (intense fear of gaining weight or becoming fat or behavior that interferes with weight gain) or Criterion C (disturbances in self-perception of weight and shape) is still met. In full remission: After full criteria for anorexia nervosa were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based, for adults, on current body mass index (BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges below are derived from World Health Organization categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision.
Mild: BMI ≥ 17 kg/m2. Moderate: BMI 16–16.99 kg/m2. Severe: BMI 15–15.99 kg/m2. Extreme: BMI < 15 kg/m2.
Bulimia Nervosa
Diagnostic Criteria (F50.2)
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
Self-evaluation is unduly influenced by body shape and weight.
The disturbance does not occur exclusively during episodes of anorexia nervosa.
Specify if:
In partial remission: After full criteria for bulimia nervosa were previously met, some, but not all, of the criteria have been met for a sustained period of time. In full remission: After full criteria for bulimia nervosa were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based on the frequency of inappropriate compensatory behaviors (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week. Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week. Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week. Extreme: An average of 14 or more episodes of inappropriate compensatory behaviors per week.
Binge-Eating Disorder
Diagnostic Criteria (F50.81)
Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most people would eat in a similar period of time under similar circumstances.
A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
The binge-eating episodes are associated with three (or more) of the following:
Eating much more rapidly than normal.
Eating until feeling uncomfortably full.
Eating large amounts of food when not feeling physically hungry.
Eating alone because of feeling embarrassed by how much one is eating.
Feeling disgusted with oneself, depressed, or very guilty afterward.
Marked distress regarding binge eating is present.
The binge eating occurs, on average, at least once a week for 3 months.
The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.
Specify if:
In partial remission: After full criteria for binge-eating disorder were previously met, binge eating occurs at an average frequency of less than one episode per week for a sustained period of time. In full remission: After full criteria for binge-eating disorder were previously met, none of the criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based on the frequency of episodes of binge eating (see below). The level of severity may be increased to reflect other symptoms and the degree of functional disability.
Mild: 1–3 binge-eating episodes per week. Moderate: 4–7 binge-eating episodes per week. Severe: 8–13 binge-eating episodes per week. Extreme: 14 or more binge-eating episodes per week.
Other Specified Feeding or Eating Disorder
This category applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. The other specified feeding or eating disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific feeding and eating disorder. This is done by recording “other specified feeding or eating disorder” followed by the specific reason (e.g., “bulimia nervosa of low frequency”).
Examples of presentations that can be specified using the “other specified” designation include the following:
Atypical anorexia nervosa: All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range. Individuals with atypical anorexia nervosa may experience many of the physiological complications associated with anorexia nervosa(Moskowitz and Weiselberg 2017; Peebles et al. 2010; Sawyer et al, 2016). Bulimia nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months. Binge-eating disorder (of low frequency and/or limited duration): All of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than 3 months. Purging disorder: Recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating. Night eating syndrome: Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical condition or to an effect of medication.
Unspecified Feeding or Eating Disorder
This category applies to presentations in which symptoms characteristic of a feeding and eating disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the feeding and eating disorders diagnostic class. The unspecified feeding or eating disorder category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific feeding and eating disorder and includes presentations in which there is insufficient information to make a more specific diagnosis (e.g., in emergency room settings).
Prévalence (parmi les femmes d’âge scolaire)
Anorexie
´ Clinique = 0,5 et 1 %
´ Sous - clinique = jusqu’à 5 %
´ Boulimie
´ Clinique = 1 et 3 %
´ Sous - clinique = 4 % et +
– à – % des adolescentes se trouvent trop grosses
´– % des femmes et —% des hommes avec un poids normal
souhaitent maigrir (Ledoux et Rivard, 2000)
´ – à – % patientes développent TCA avant 12 ans
´– % développent un TCA après 25 ans
´ Les + jeunes = symptômes anorexie (<— ans)
´ Les + vieilles = symptômes boulimie (—– ans)
´ – % mortalité chez les TCA,– fois plus élevé que le taux de
mortalité jeunes femmes normales
´ Comorbidité avec autres troubles psychiatriques = –à– %
50 à 70 % des adolescentes se trouvent trop grosses
´ 47 % des femmes et 9,5 % des hommes avec un poids normal
souhaitent maigrir (Ledoux et Rivard, 2000)
´ 10 à 12 % patientes développent TCA avant 12 ans
´ 5 % développent un TCA après 25 ans
´ Les + jeunes = symptômes anorexie (< 12 ans)
´ Les + vieilles = symptômes boulimie (17-21 ans)
´ 10 % mortalité chez les TCA, 12 fois plus élevé que le taux de
mortalité jeunes femmes normales
´ Comorbidité avec autres troubles psychiatriques = 40 à 50 %
Conséquences médicales
´ Neurophysiologiques
´ Réduction sérotonine.
´ Médicales
´ Débalancement des électrolytes pouvant conduire à des problèmes cardiaques,
intestinaux ou rénaux, à de l’oedème et à des étourdissements
´ Problèmes oesophagiens et dentaires dus aux vomissements fréquents
´ Crampes, diarrhée, constipation, saignements gastro-intestinaux et anémie dus à l’abus de
laxatifs
´ Altération de la fonction rénale
´ Réduction de la densité osseuse menée à de l’ostéoporose
´ Psychologiques
´ Difficultés de concentration, la dépression, l’anxiété et l’abus de substances
Causes : modèle multidimensionnel
´ Prédispositions biologiques
´ Facteurs sociaux, environnementaux, familiaux
´ Facteurs psychologiques - individuels
´ Restriction
Prédispositions génétiques
´ Taux de concordance chez les jumeaux
n Anorexie
Jumeaux monozygotiques : 50 %
Jumeaux dizygotiques : 5 %
n Boulimie
Jumeaux monozygotiques : 23 %
Jumeaux dizygotiques : 9 %
Vulnérabilité sérotoninergique
´ Associée à plusieurs traits (impulsivité, instabilité de
l’humeur, compulsivité, anxiété)
´ La sérotonine est liée à la restriction
´ Trois semaines de diète modérée diminuent significativement
l’activité sérotoninergique
´ Restriction = se mettre à risque
´ Chez les personnes vulnérables, le risque de déclencher un
TCA est plus important
Facteurs socioculturels et environnementaux
Médias et modèles de minceur
´ Occupation
´ Deuils, pertes, séparation
´ Négligence, abus physique,
sexuel et psychologique
´ Influence des pairs
