eating disorders Flashcards
which mental disorder has the highest mortality?
anorexia
what type of disorder is AN?
Restrictive or binge eating/purging type
AN subtypes
Restricting type:
No recurrent binge eating nor purging behaviors for the last 3 months
Binge eating/purging type:
Recurrent binge-eating and/or purging behaviors
Anorexia severity classifications
BMI 17 and +: mild
BMI 16 -16.99: moderate
BMI 15-15.99: severe
BMI less than 15: extreme
AN prognosis
Near 2/3 of patients normalize wt
AN prognosis: adults vs teens
Patients with illness onset before 17 y.o. achieve a better outcome than adult onset. Higher rate of full recovery and lower mortality rate in adolescents than in adults
Prepubertal onset confers a more difficult course.
In adults, time to complete remission is 5 to 6 years
Commonly observed dietary patterns in AN
Gradual decrease of food intake Removal of high energy food Gradual decrease of portion sizes Limited to bulky nutrient-poor foods Rigid schedule of eating Limited food choices/amount of calories Fat avoidance Food avoidance related to digestive symptoms Vegetarianism and veganism Fluid avoidance or excessive fluid intake
What are the characteristics of binge eating episodes?
Both of the following has to be present:
- Eating in a discrete amount of time (within a 2 hour period) large amounts of food.
- Sense of lack of control over eating during an episode.
behavioural characteristics of bulimia nervosa
Obsessive thoughts focused on restricting and bulimia
Excessive concerns about weight and shape
Body weight fluctuations
Inability to accurately identify and express feelings
Chaotic relationships and interactions
Impulsivity
Anxiety
Labile mood
Bulimia nervosa severity cut-offs
Speific severity based on average number of compensatory behavior episodes per week
- Mild 1-3
- Moderate 4-7
- Severe 8-13
- Extreme 14 or more
Binge eating disorder characteristics
Recurrent episodes of binge eating. An episode of binge eating is
characterized by both of the following:
1. The binge-eating episodes are associated with three (or more) of the
following:
- eating much more rapidly
- until feeling uncomfortably full
- not feeling physically hungry
- eating alone
- feeling disgusted with oneself, depressed, or very guilty afterwards
2. NOT associated with the recurrent use of inappropriate compensatory behavior (for example, purging)
how often do binges occur with binge eating disorder
at least 1x/week for 3 months
severity cut-offs for binge eating disorder
Specific severity based on average number of binge-eating episodes per week Mild: 1-3 Moderate: 4-7 Severe: 8-13 Extreme: 14 or more
weight changes during binge eating and abstinence
No short term weight loss when reaching abstinence
Commonly observed dietary patterns in Bulimia and BED
Dieting history Removal of meals fasting Avoidance of high energy dense food Carbohydrates phobia Binge-eating forbidden food usually found in binge content
Other Specified Feeding or Eating Disorder (OSFED)
- Atypical anorexia nervosa: Weight within or above the average range for age and height
- Bulimia nervosa of low frequency and/or limited duration
- Binge-eating disorder of low frequency and/or limited duration
- Purging disorder: Persistent purging w/o binge-eating
- Night eating syndrome: excessive consumption of food following an evening meal or after waking from sleep in the night, which causes extreme psychological distress and interferes with daily functioning.
ARFID presentations for diagnosis
Avoidant Restrictive Food Intake Disorder (ARFID)
- 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) as manifested by persistent failure to meet appropriate nutritional and/or energy needs 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 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
when is ARFID more commonly seen?
in childhood
is ARFID characterized by body weight/size concern?
no
