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3.5 Eating Sex and Other Needs -- Literature Summary
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Notes for all DSM-5 disorders and articles/book chapters. Written during 2019-20 study year.
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Week 1: Eating disorders – symptomologyAmerican Psychiatric Association (2013). Diagnostic and statistical manual of
mental disorders (5th ed.).
Notes from the Professor
Check the full DSM 5 (not just the brief summary) for criteria + prevalence + etiology.
● You will need to know the basics (criteria, differential diagnosis) for all eating disorders,
● You will need to know everything (criteria, diagnostic markers, prevalence, etc.) for AN, BN, and BED.
Feeding and eating disorders - intro
● Feeding and eating disorders characterised by a persistent disturbance of eating or
eating-related behaviour that results in altered consumption or absorption of food and
that significantly impairs physical health or psychosocial functioning
● Diagnosis for all disorders (except Pica) is mutually exclusive despite a number of
common psychological and behavioural features, the disorders differ substantially in
clinical course, outcome and treatment needs
o However, diagnosis of Pica may be assigned in the presence of any other feeding
and eating disorder
● Some disorders report eating-related symptoms resembling those endorsed by individuals
with substance use disorders (eg- cravings and compulsive patterns of use)
o May involve same neural systems (regulatory self-control and reward), but the
contributions of these shared/distinct factors remain insufficiently understood
● Obesity (excess body fat) is not included a mental order (because many genetic,
behavioural, physiological and environmental factors contribute)
PICA
Diagnostic criteria
● Non-food substances vary with age but can include paper, soap, hair, string etc
● Eating of nonnutritive, nonfood substances may occur during the course of other mental
disorders (e.g., autism, schizophrenia) → additional diagnosis of pica can thus be given
(unlike with other eating disorders)
Differential ● Anorexia nervosa
diagnosis o Some presentations of AN involve ingestion of nonfood substances (eg- paper
tissues) as attempt to control appetite
o In these cases, if eating of nonfood substances is primarily used as a means of weight
control, then AN should be the primary diagnosis
● Facititous disorder
o Some individuals nay ingest foreign objects as part of the pattern of falsification of
physical symptoms
o In such instances, there is an element of deception that is consistent with deliberate
induction of injury or disease
● Non-suicidal self injury behaviours
Some individuals may swallow potentially harmful items (e.g., pins, needles, knives) in the
context of maladaptiv behaviour patterns assoc with personality disorders or nonsuicidal self-
injury
, o
RUMINATION DISORDER
Diagnostic criteria
● Previously swallowed food that may be partially digested is brought up into the mouth
without apparent nausea, involuntary retching or disgust
● Food may be re-chewed and then ejected from the mouth or re-swallowed
Differential ● Gastrointestinal disorders: must rule out other conditions characterised by GI reflux or
diagnosis vomiting through appropriate physical examinations and laboratory tests
● Anorexia nervosa and bulimia nervosa: individuals with AN and BN may also engage in
regurgitation with subsequent spitting out of food as a means of disposing of ingested calories
because of concerns about weight gain
AVOIDANT/RESITRICTIVE FOOD INTAKE DISORDER
Diagnostic criteria ● Avoidance or restriction of food intake manifested by clinically significant failure to meet
requirements for nutrition or insufficient energy intake through oral intake of food.
Differential Appetite loss preceding restricted intake is a nonspecific symptom that can accompany a number
diagnosis of mental diagnoses.
Avoidant/restrictive food intake disorder can be diagnosed concurrently with the disorders below
if all criteria are met, and the eating disturbance requires specific clinical attention.
,● Other medical conditions (eg- GI disease, food allergies)
o If the disturbance of food intake is beyond that directly account for by physical
symptoms assoc with medical condition
o If it persists following resolution of medical condition
● Specific neurological, structural or congential disorders and conditions assoc with
feeding difficulties
o Can be diagnosed along with other feeding difficulties assoc with feeding conditions
as long as all diagnositic critera are met
● Reactive attachment disorder
o Some degree of withdrawl is characteristic of reactive attachment disorder and can
lead to a disturbance in the caregiver-child relationship that can affect feeding and
the child’s intake
o Should be diagnosed concurrently only id all criteria are met for both disorders and
the feeding disturbance is a primary focus for the intervention
● Autism spectrum disorder
o Rigid eating can often occur; avoidant intake only if criteria met for both disordders
and when the eating disturbance requires specific treatment
● Specific phobia, SAD and other anxiety disorders
o Specific phobia of situations that may lead to choking or vomiting – can result in
food avoidance (but this is the secondary to the focus on fear of choking or
vomiting). Avoidant intake disorder when food avoidance is primary focus
o In SAD, when individual may present with a fear of being observed by others while
eating, which can also occur in avoidant/restrictive food intake disorder
● AN
o Food avoidance and low weight are common symptoms
o Avoidant intake disorder DO NOT show fear of gaining weight or becoming fat,
behaviour that interferes with weight gain and specific disturbances in perception of
body shape/weight (but AN do)
● OCD
o Avoidance or restriction of intake in relation to preoccupations with food or
ritualized eating behaviour
o Diagnosed concurrently if all criteria met for both and if aberrant eating is major
aspect of clinical presentation required specific intervention
● Major depressive disorder
o Usually appetite loss and related reduction of intake abate with resolution of mood
problems
o Avoidant intake disorder should only be used concurrently if full critera are met for
both disorders and when the eating disrubance requires specific treatment
● Schizophrenia
o Odd eating behaviours; often avoidance of specific foods because of delusional
beliefs (eg- negative consequences from eating specific foods)
o Avoidant intake disorder should only be used concurrently if full critera are met for
both disorders and when the eating disrubance requires specific treatment
● Factitious disorder
o Must check if the person is not just intentionally describing dramtically restrictive
diets
, ANOREXIA NERVOSA
Diagnostic
criteria
Subtypes ● Most individauls with binge eating/purging type of anorexia who binge eat also purge through
self-induced vomiting or the misuse of laxatives, diuretics or enemas
● Some individuals with this subtype do not binge eat but do regularly purge after consumption of
small amounts of food
● Crossover between subtypes is not uncommon; subtype description should be used to describe
current symptoms rather than longitundial course
Diagnostic ● Criteron A
features o Requires that individual’s weight be significantly low (i.e., less that minimally normal, or
less that minimally expected in children and adolescents)
o Weight assessement can be challenging because normal weight range differs among
individuals → thus, BMI is useful measure (see Severity in criteria)
o BMI-for-age useful for children and adolescents, however not definitive because of
differening developmental trajectories among youth
o Summary: Criteron A should be determined to be met based on numerical guidelines, as
well as individual’s body build, weight history and any physiological disturbances.
● Criteron B
o Intense fear of becoming fat is usually not allieviated by weight loss
o In fact, concern about weight gain may increase even as wieght falls
o Younger individauls with AN (as well as some adults) may not recognise or acknowledge a
fear of weight gain
▪ In the absence of other explanations for low weight Criteron B may be established
from:
● clinican inference from collateral hisotry,
● observational data,
● physical and laborotory findings or
● longitudinal course (either indicating a fear of weight gain or supporting
persistent behaviours that prevent it)
● Criteron C
o Some individauls feel globally overweight
o Others realize that they are thin but still concerned about certain body parts are “too fat”
(eg- stomach, buttocks and thighs)
o Variety of techniques to evaluate their body size or weight → eg- frequent weighing,
obsessive measuring of body parts, and persistent use of a mirror to checl for percieved
areas of “fat”
o Self-esteem of individuals with AN highly dependent on their peceptions of body shape
and weight
▪ Weight loss viewed as impressive achievement and sign of extraordinary self-
discipline
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