Anorexia Nervosa: DSM-5 Flashcards Preview

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Flashcards in Anorexia Nervosa: DSM-5 Deck (19):

Eating Disorders, General

Most common: anorexia nervosa, bulimia nervosa, and binge-eating disorder

BMI is the most common way to judge/evaluate the presence of these disorders

Similarities between anorexia nervosa and bulimia nervosa
o An intense fear of gaining weight and a pursuit to be thin despite the consequences
• Often leading to illness, organ failure, or even death
o Grappling with perfection and control despite actual weight

3 general body types
o From skinny to heavy: ectomorphic, mesomorphic, endormorphic


Anorexia Nervosa

Restriction of energy intake relative to requirements, leading to a significantly low body weight
*"significantly low weight" is defined as a weight that is less than minimally normal
**for children and adolescents = less than minimally expected

Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly lower 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


Anorexia Nervosa: Restricting Type

Weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise

During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior


Anorexia Nervosa: Binge-eating/purging type

During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior

*Self-induced vomiting
*Misuse of laxatives, diuretics, or enemas

Some individuals with the subtype do not binge eat but do regularly purge after the consumption of small amounts of food

Binge-eating/purging type demonstrates higher rates of impulsivity and are more likely to abuse alcohol and other drugs

*crossover between subtypes is not uncommon – therefore subtype description should be used to describe current symptoms rather than longitudinal course


Anorexia Nervosa: Diagnostic Features

Persistent energy intake restriction

Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain

Disturbance in self-perceived weight or shape

Often, individuals brought professional attention by family members after marked weight loss has occurred

This individual seek help on their own, it is usually because of distress over the somatic and psychological sequalae of starvation


Anorexia Nervosa:  Fear of Gaining Weight

The intense fear of becoming fat is usually not alleviated by weight loss

Concern about weight gain may increase even as weight falls


Anorexia Nervosa: Experience of Body Weight

Distortion of the experience and significance of body weight and shape (Criterion C)

Some individuals feel globally overweight

Others realize that they are thin but are still concerned that certain body parts, particularly the abdomen buttocks and thighs are "too fat"


Anorexia Nervosa Associated Features: Physiological

Nutritional compromise affects most major organ systems and can produce a variety of disturbances

Physiological disturbances:
*Vital sign abnormalities

Most of the physiological disturbances associated with malnutrition are reversible, but some such as loss of bone mineral density are often not completely reversible


Anorexia Nervosa Associated Features: Depressive signs and symptoms

Depressive mood

social withdrawal



diminished interest in sex

*These features may be secondary to physiological consequences of semi-starvation, but they may also be sufficiently severe to warrant an additional diagnosis of MDD


Anorexia Nervosa Associated Features: Other Features

]concern about eating in public

feelings of ineffectiveness

strong desire to control one's environment

inflexible thinking

limited social spontaneity

overly restrained emotional expression


Anorexia Nervosa Associated Features: OCD Features

Obsessive-compulsive features, both related and unrelated to food, are often prominent

Most individuals are preoccupied with thoughts of food

Some collect recipes airport food

Obsessions or compulsions related to food may be exacerbated by undernutrition

When exhibiting obsessions and compulsions not related to food, body shape, overweight, and additional diagnosis of OCD may be warranted


Anorexia Nervosa: Prevalence


Less is known about males, but anorexia nervosa is far less common, 10:1 in clinical populations


Anorexia Nervosa: Onset

Commonly begins during adolescence are young adulthood

Rarely begins before puberty or after age 40, but cases of both early and late onset have been described

Onset is often associated with a stressful life event, such as leaving home for college


Anorexia Nervosa: Course

Course and outcome are highly variable

Older individuals are more likely to have a longer duration of illness, and the clinical presentation may include more signs and symptoms of a long-standing disorder

Clinician should not exclude anorexia nervosa from the differential diagnosis solely on the basis of older age


Anorexia Nervosa Risk Factors: Temperamental

Individuals develop anxiety disorders or display of sessional traits in childhood are at increased risk of developing anorexia nervosa


Anorexia Nervosa Risk Factors: Environmental

Associated with cultures and settings in which fitness is valued

Occupations and avocations encourage thickness, such as modeling and elite athletics, are also associated with increased risk


Anorexia Nervosa Risk Factors: Genetic

Increased risk among first-degree biological relatives

Increased risk of bipolar and depressive disorders among first-degree relatives


Anorexia Nervosa: Suicide Risk


12 per 100,00 per year


Anorexia Nervosa: Comorbidity

Bipolar, depressive, and anxiety disorders

Many report the presence of either an anxiety disorder symptoms prior to the onset of their eating disorder

OCD is described in some individuals, especially those with restricting type

Alcohol use disorder and other substance use disorders may also be comorbid, especially among those with the binge-eating/purging type