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3.5: Eating, Sex and Other Needs - Summary
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Tutorial 1Vignette 1: Why, Mandy?
DSM-V – Feeding and eating disorders.
Characterized by persistent disturbance of eating behavior that results in altered consumption
or absorption of food and that significantly impairs physical health or psychosocial
functioning.
Obesity is not a disorder.
Prevalence: females 0.4%, 10:1 female-to-male ratio.
Risk Factors:
,03
ANOREXIA
Temperamental risk
factors: anxiety disorders
and OCD.
Genetics: first degree
relatives
- Prevalence: 12 month 0.4, 10:1
female to male ratio, 5%
mortality rate
- Types: an-restrictive, an-binge
eating (have cycles of binging
and purging)
o Difference between AN-
binge purge and BN: low
body weight (AN)
- Environmental: occupations and
avocations that encourage
thinness, such as modeling or elite athletics.
- Genetic and physiological: first-degree relatives increased risk. Bipolar and depression.
Diagnostic markers: hematology, serum chemistry, endocrine, electrocardiography, bone mass,
electroencephalography, resting energy expenditure, physical signs (amenorrhea,
emaciation, hypotension, hypothermia, bradycardia, lanugo all usually due to
starvation)
Differential diagnosis medical conditions, MDD, SCZ, substance abuse, social anxiety
disorder, OCD, body dysmorphic disorder, bulimia, avoidant/restrictive food intake
disorder.
Comorbidity bipolar, MDD, anxiety disorder, OCD, alcohol, or other substance use disorders
(especially in the AN-binge.
BULUMIA: overconcern with weight and compensatory behaviors (exercising, vomiting,
laxatives)
Individuals with bulimia are usually within the normal weight or overweight
range.
Menstrual irregularity or amenorrhea occurs in females.
2
, Severity of BN: 1-3 episodes for week Mild, 4-7 moderate, 8-13 severe, 14>
extreme.
Prevalence females 1-1.5%, peaks in
older adolescence or young
adulthood. Less common in males
(10:1)
Development and course onset
before puberty or age of 40 is
uncommon. Multiple stressful life
events.
Risk factors:
- Temperamental: weight
concerns, low self-esteem,
depression, social anxiety
disorder, and overanxious
disorder of childhood at
increased risk.
- Environmental: internalization
of a thin body is a risk for
developing weight concerns.
Childhood sexual or physical
abuse.
- Genetic and physiological: childhood obesity and pubertal maturation.
- Course modifiers: severity of psychiatric comorbidity
Occurs more in industrialized countries. Ex. USA, Canada, European countries.
Diagnostic markers fluid and electrolyte abnormalities. Loss of gastric acid. Significant loss of
dental enamel.
Differential diagnosis anorexia, binge-eating, kleine-levin syndrome, MDD, BPD.
Comorbidity MDD, bipolar, anxiety, substance abuse, BPD.
______________________________________________________________________________
BINGE-EATING DISORDER
normal weight/overweight individuals
Prevalence females 1.6%, males 0.8%
Begins in adolescence or young adulthood but can also begin in later adulthood.
3
, Risk factors: biological seems to run in families.
More frequent in western countries but inside these countries there’s no difference between
ethnicity and the prevalence.
Associated with social role adjustment
problems, impaired health-related
quality of life, and life satisfaction,
increased medical mortality…
Differential diagnosis bulimia, obesity,
bipolar, MDD, BPD.
Comorbidity MDD, bipolar, anxiety, lesser
degree substance abuse.
important similarities and diffs
(pica, rumination, avoidance
disorders: no criteria for body
dysmorphia)
AN and BN HAVE, BED not (body
dysmorphia)
binge eating present in BN and BED,
but not AN, except subtype.
purging/vomiting is not present in
BED, but in BN and AN
diff bw AN and BN might be body weight.
BN patients do not show restricted energy intake or all these rules.
prevalence: BN is 1.5%, AN 0.4%, BED is 1.6%
4
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