feeding and eating disorders

Question 1

what is the prevalence?

Answer 1

4-6.5%
only 10 % receive treatment

Question 2

what is the comorbidity

Answer 2

• obsessive-compulsive disorder (20-60%) (every eating disorder)
• mood disorders
• maltreat and sexual abuse

Question 3

what kinds of evaluation is there?

Answer 3

• eating disorder diagnostic scale- EDDS
• eating disorder inventory- EDI-3
• figure rating scale- FRS

Question 4

what kinds of interventions is there?

Answer 4

• group:
  warning about side effects:
  For instance: people learn new methods of hiding food, throwing it away…
• family therapy
  discovering invisible rules
  “i feel like a little girl”
  “if i don’t eat, it’s my own decision”
  “food is one of the many things i can control”
  individual
• CBT (thoughts, emotions, behaviors)
  Christopher G Fairburn
• pharmacotherapy

Question 5

what kind of pharmacotherapy is there?

Answer 5

some substances can help for some cases
sertraline
appeared in 1991, after fluoxetine (1987)
trade names: lusral, zoloft, besitran
action: it’s a selective serotonin reuptake inhibitor (SSRI). Prescribed also for depressive disorder, OCD, social phobia, panic disorder
common side effects: diarrhea, nausea, sexual dysfunction, troubles with sleep

Question 6

what are some associations?

Answer 6

ADANER and NEDA (international, national eating disorder association)

Question 7

what kind of disorders is there?

Answer 7

• Anorexia nervosa
• bulimia nervosa
• binge-eating disorder- new
• Pica
• rumination disorder
• avoidant/ restrictive food intake disorder

Question 8

describe anorexia nervosa

Answer 8

• restriction of energy intake –> significantly low body weight in the context if age, sex etc
• significantly low: less than minimally normal/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

Question 9

Which 2 types of anorexia nervosa is there?

Answer 9

• restrictive type
• binge-eating/ purging type

Question 10

specify the severity of AN

Answer 10

• MILD: BMI > 17 kg/m2
• MODARATE: BMI > 16-16.99 kg/m2
• SEVERE: BMI 15-15.99 kg/m2
• EXTREME: BMI < 15 kg/m2

Question 11

name some cognitive and emotional symtoms

Answer 11

• fear of weight gain
• denial of having a disorder or of the danger associated with low body weight
• Exaggeration of the importance of body shape and weight in self-assessment or excessive interest in fashion
• misinterpretation of body sensations
• distortion of body image (weight or shape)

Question 12

name some behaviors of AN

Answer 12

• Food avoidance (refusing, hiding or throwing away food)
• Causing vomiting
• Laxative and diuretic abuse
• Excessive exercise
• Frequent weighing
• Avoidance of eating places
• Dressing in baggy clothes
• Lying and irascibility (can’t talk to them about food)

Question 13

name som physical symtoms for AN

Answer 13

*Self-induced weight loss starting 15% below normal
*Muscle and immune weakness
*Amenorrhea (loss of at least 3 menstrual cycles)
*Hypothermia
*Bradycardia
*Dermatological disorders: hair loss, dry skin, itching
*Endocrine changes, low phosphate level and electrolyte disturbances

Question 14

name some lab abnormalities for AN

Answer 14

Hematology
1. Anemia (decrease in the total amount of red blood cells).
2. Leukopenia (deficiency in the number of white blood cells or leukocytes).

Question 15

name some consequences of AN

Answer 15

• Death (6-15% of cases)
• Early menopause
• Infantile uterus
• Small hearts
• Osteoporosis
• Immunosuppression
• Alterations in hormonal cycles
• Dental lesions as a result of acidity from vomiting
• Gastrointestinal problems

Question 16

name som data of those who have AN

Answer 16

⚫ 0.1% men
⚫ 0.3-1% of females
⚫ Adolescents (40%)
⚫ Some Professions (models, dancers, athletes, etc.)
⚫ Mothers after childbirth
⚫ Elderly

Question 17

what did richard morton coin? AN

Answer 17

nervous consuption

Question 18

what did Ernest-Charles Lasègue coin? AN

Answer 18

“Anorexia Hysterique”

Question 19

who was the first to coin the term anorexia nervosa

Answer 19

William Gull

Question 20

what is bulimia nervosa?

Answer 20

• recurrent episodes of binge eating: A sense of lack of control over eating during the episode.
• recurrent inappropiate compensatory behaviors (to prevent weight gain): vomiting; misuse of laxatives, fasting; or excessive exercise.
• binge eating + compensatory both occurs at least 1/week for 3 months
• self-evaluations: influenced by body shape and weight
• not only during episodes of AN

Question 21

what is the binge-eating episodes associated (3 or more)

Answer 21

– 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.

Question 22

specify the severity of BN

Answer 22

• Mild = 1 - 3 episodes of inappropiate
  compensatory behaviors per week.
• Moderate = 4 - 7
• Severe = 8 - 13
• Extreme = > 14

Question 23

what is the prevalence with BN

Answer 23

• 1-3%
• 90% women

Question 24

what is the comorbidity for BN

Answer 24

• high risk of suicide 75%

Question 25

what is binge-eating disorder?

Answer 25

*Recurrent episodes of binge eating: – Eating, in a discrete period of time 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. * 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.

Question 26

specify the severity of BED

Answer 26

* Mild = 1- 3 binge-eating episodes per week * Moderate = 4 - 7 * Severe = 8 - 13 * Extreme = > 14

Question 27

what is pica?

Answer 27

* Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month. * The eating of nonnutritive, nonfood substances is inappropiate 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, it is sufficiently severe to warrant additional clinical attention.

Question 28

what are some typical substances for pica?

Answer 28

* Paper * Soap * Cloth * Hair * String * Wool * Soil * Chalk * Paint * Gum * Clay

Question 29

which groups are vulnerable for pica?

Answer 29

* Children * Mental disorders – Autism Spectrum Disorder – Psychotic Disorders – etc * Pregnant Women

Question 30

name some additional evaluation for pica

Answer 30

* Gastrointestinal complications * Poisoning * Infection * Nutritional deficiency

Question 31

what is rumination disorder?

Answer 31

* Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be rechewed, re-swallowed, or spit out. * The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition. * 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, they are sufficiently severe to warrant additional clinical attention.

Question 32

what is avoidant/ restrictive food intake disorder?

Answer 32

* 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.

Question 33

what is the prevalence for avoidant/ restrictive food intake disorder?

Answer 33

1-3%

Question 34

what is the comorbidity for avoidant/ restrictive food intake disorder?

Answer 34

* Developmental disability: 80% * Autistic spectrum * Fear of vomiting (emetophobia)

Question 35

what is additional evaluation for for avoidant/ restrictive food intake disorder?

Answer 35

* Excluded food – Whole food groops (fruits, etc) – Based on color – Very hot or very cold * Apparent lack of interest in eating or food * Concern about aversive consequences of eating