Feeding and Eating Disorders

Question 1

Describe the difference between feeding and eating

Answer 1

Feeding implies a relationship aspect - being given food by another - whereas eating is more autonomous

Question 2

What percentage of parents with children below age 5 would say their child has a feeding difficulty?

Answer 2

40%

Question 3

Describe some factors involved in the progression from feeding to eating

Answer 3

Being able to select appropriate foods, being able to handle food (swallow, chew, use cutlery), sensory integration, managing social aspects of food, regulating food intake, effective interpretation of emotions (recognising when not feeling hungry means feeling upset), moving from dependence t self-care

Question 4

Describe how the progression from feeding to eating relates to obesity

Answer 4

One theory of obesity states that parents who are overly controlling of their child’s food intake lead to a child unable to recognise their own satiety cues, leading to issues with food regulation when they progress to controlling their own intake

Question 5

Why is food often used by children to signal unhappiness to parents?

Answer 5

Mealtimes can be one of the few times when the whole family sits down and interacts

Question 6

What is the difference between an eating disorder and disordered eating?

Answer 6

An eating disorder is a phenotype of behaviours, whereas disordered eating is a single behaviour

Question 7

What is rumination disorder?

Answer 7

Where an individual regurgitates and re-swallows food - this is widely seen as a self-soothing behaviour

Question 8

Which 2 population groups typically develop rumination disorder?

Answer 8

Those with disabilities and those who have experienced extreme trauma

Question 9

In which 3 population groups is disordered eating more common?

Answer 9

Those with intellectual disabilities, those with severe food allergies, and type 1 diabetics - all groups which encourage the obsessive checking of food

Question 10

What percentage of individuals with disordered eating have a comorbid medical condition?

Answer 10

80%

Question 11

What are eating disorders?

Answer 11

Mental health disorders n which people experience severe disturbances in their eating or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning

Question 12

How are eating disorders distinguished from feeding disorders?

Answer 12

They are caused by negative thoughts about weight and shape

Question 13

Give some examples of behaviours intended to control weight

Answer 13

Restricted eating, self-induced vomiting, excessive exercise, use of laxatives or diuretics, appetite suppressing medications (including caffeine and smoking)

Question 14

How can eating disorders affect physical health?

Answer 14

They can impair growth and development in childhood and cause amenorrhoea, osteoporosis, and affects on the brain

Question 15

Name the 7 eating disorders in DSM-V

Answer 15

Anorexia nervosa, bulimina nervosa, binge-eating disorder, atypical anorexia nervosa, atypical bulimia nervosa, purging disorder, night-eating syndrome

Question 16

Define atypical anorexia nervosa

Answer 16

Exhibiting anorexia nervosa-type behaviour and losing a lot of weight very quickly but still falling within the normal weight range; typically affects individuals who were severely overweight

Question 17

Define atypical bulimia nervosa

Answer 17

Exhibiting bulimia nervosa-type behaviour but not bingeing and purging often enough to meet criteria

Question 18

State the 3 main diagnostic criteria for anorexia nervosa in DSM-V

Answer 18

1) Persistent restriction of energy intake leading to significantly low bodyweight in the context of what is minimally expected for age, sex, developmental trajectory, and physical health
2) Intense fear of gaining weight or persistent behaviour that interferes with weight gain, despite being low weight
3) Disturbance in the way one’s body weight or shape is experienced or lack of recognition of the seriousness of current low body weight

Question 19

Define binge eating

Answer 19

Eating in a discrete period of time (e.g. 2 hours) an amount of food that is definitely larger than most people would eat during a similar period of time and similar circumstances, and a sense of lack of control over eating during the episode

Question 20

State the 5 main diagnostic criteria for bulimia nervosa in DSM-V

Answer 20

1) Recurrent episodes of binge eating
2) Recurrent inappropriate compensatory behaviour to prevent weight gain
3) Both binge eating and compensatory behaviours occur at least once a week for 3 months
4) Self-evaluation is unduly influenced by body shape and weight
5) Does not meet criteria for anorexia nervosa

Question 21

State the 5 main diagnostic criteria for binge-eating disorder in DSM-V

Answer 21

1) Recurrent episodes of binge eating
2) Binge-eating associated with eating more rapidly than normal, eating until feeling uncomfortably full, eating when not hungry, eating alone due to embarrassment, or feelings of guilt or shame afterwards
3) Marked distress over binge eating
4) Binge eating occurs once a week for 3 months
5) Does not meet criteria for anorexia or bulimia nervosa

Question 22

Is obesity an eating disorder?

Answer 22

No

Question 23

Define avoidant-restrictive food intake disorder (ARFID)

Answer 23

An eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional or energy needs and associated with at least 1 of: significant weight loss or growth failure, significant nutritional deficiency, dependence on enteral feeding or supplements, or interference with psychosocial functioning

Question 24

How is ARFID different to anorexia nervosa?

Answer 24

There is no evidence of disturbance in the way one’s body weight or shape is experienced

Question 25

State the 3 main subtypes of avoidant-restrictive food intake disorder (ARFID) (Bryant-Waugh et al, 2010)

Answer 25

Restricted type, sensory type, and phobic type

Question 26

Describe the restricted subtype of ARFID

Answer 26

Not eating enough or showing little interest in feeding but with no restriction in food variety or texture. Also known as infantile anorexia

Question 27

Describe the phobic type of ARFID

Answer 27

Refusing food due to past aversive experience, e.g. choking or anaphylaxis. Also known as post-traumatic feeding disorder

Question 28

Describe the sensory type of ARFID and the main population group it affects

Answer 28

Accepting only a limited diet due to sensory fears, common in autism spectrum disorder

Question 29

State the incidence of anorexia nervosa in adolescents (Smink et al, 2016)

Answer 29

26.7 per 100,000

Question 30

State the incidence of anorexia nervosa in adolescent girls

Answer 30

50 per 100,000

Question 31

State the incidence of bulimia nervosa in adolescents (Smink et al, 2016)

Answer 31

25.8 per 100,000

Question 32

State the incidence of bulimia nervosa in adolescent girls

Answer 32

50 per 100,000

Question 33

What is the estimated prevalence of anorexia nervosa and bulimina nervosa?

Answer 33

1-2%

Question 34

What is the estimated lifetime prevalence of binge-eating disorder?

Answer 34

1.6%

Question 35

When is eating disorder incidence most common?

Answer 35

Age 13-25

Question 36

How long does it typically take for an individual with anorexia nervosa to reach care?

Answer 36

Within a year due to rapid escalation

Question 37

How long does it typically take for an individual with bulimia nervosa or binge-eating disorder to reach care?

Answer 37

4-5 years

Question 38

What percentage of patients in eating disorder clinics report having ARFID?

Answer 38

15%

Question 39

State some psychological or behavioural markers distinguishing an eating disorder from ARFID in clinic

Answer 39

Reluctance to attend, resisting weighing and examination, seeking help for physical symptoms instead of eating problems, covering body, paradoxical increased energy, secretiveness or evasiveness, anger or distress when asked about eating

Question 40

Name a validated screening measure for eating disorders

Answer 40

The SCOFF

Question 41

State the 5 questions in the SCOFF

Answer 41

Have you ever made yourself sick to lose weight?
Have you ever eaten a lot of food at once in a way that made you feel out of control or like you couldn’t stop?
Have you recently lost most than one stone?
Do you think you’re fat when others don’t?
Do you feel that food has taken over your life?

Question 42

How much heritability do eating disorders have, and why?

Answer 42

60-70% - due to genetics, the home food environment, and parents’ attitudes towards food

Question 43

What is the biggest risk factor for an eating disorder?

Answer 43

Being female

Question 44

State at least 3 predisposing factors to eating disorder development

Answer 44

Family history of an eating disorder, obesity, depression, or alcoholism; personal background of low self-esteem, perfectionism, or depression; adverse life events in childhood; family environment of concern about weight, shape, or eating

Question 45

State 3 triggers to starting an eating disorder

Answer 45

A recent stressor (e.g. comments about weight or shape, pressure to succeed in school, relationship problems), pressure from the media to be thin, appetite and weight loss in the context of an illness (happiness at lower weight or positive comments about lower weight)

Question 46

Describe the consequences of weight stigma

Answer 46

Binge eating, increased food consumption, avoidance of physical activity because of shame, avoidance of help-seeking, increased stress, weight gain, and impaired weight loss outcomes

Question 47

How does being labelled as fat in adolescence affect eating? (Hunger et al, 2018)

Answer 47

It predicts unhealthy weight control behaviours and disordered eating over the next 5 years - regardless of objective BMI and initial levels of disordered eating

Question 48

How much does dieting increase the risk of an eating disorder?

Answer 48

18x

Question 49

Describe how ‘starvation syndrome’ perpetuates anorexia nervosa

Answer 49

It can cause a loss of appetite, feelings of fullness, low mood, poor concentration, and a feeling of regaining control.

Question 50

Describe the effect of body confidence on weight management

Answer 50

It facilitates weight management - overweight individuals who are body confident have gained less weight after 5 years than those who are insecure about their weight