Week 1 (EATING)
Report the criteria of all eating disorders described in the DSM V (pica, rumination
disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia
nervosa, binge eating disorder, other specified feeding or eating disorder,
unspecified feeding or eating disorder)
Report in-depth knowledge of all aspects of anorexia nervosa, bulimia nervosa, and
binge eating disorder described in the DSM V
Identify the differences in the etiology and development of eating disorders in
children and adults
Identify the differences in the etiology and development of eating disorders in men
and women
Describe (evidence-based) treatments of anorexia nervosa, bulimia nervosa, and
binge eating disorder
Describe pros and cons of (evidence-based) treatments of anorexia nervosa, bulimia
nervosa, and binge eating disorder.
Learning goal 1 & 2:
DSM-5
(only know criteria for pica, rumination disorder, avoidant restrictive food intake disorder)
Pica
Diagnostic Criteria
A. Persistent eating of nonnutritive, nonfood substances over a period of at least 1
month.
B. The eating of nonnutritive, nonfood substances is inappropriate to the
developmental level of the individual.
C. The eating behavior is not part of a culturally supported or socially normative
practice.
D. If the eating behavior occurs in the context of another mental disorder (e.g.,
intellectual disability [intellectual developmental disorder], autism spectrum
disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently
severe to warrant additional clinical attention.
Rumination Disorder
Diagnostic Criteria 307.53 (F98.21)
A. Repeated regurgitation of food over a period of at least 1 month. Regurgitated food
may be re-chewed, re-swallowed, or spit out.
B. The repeated regurgitation is not attributable to an associated gastrointestinal or
other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).
C. The eating disturbance does not occur exclusively during the course of anorexia
nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake
disorder.
D. If the symptoms occur in the context of another mental disorder (e.g., intellectual
dis- ability [intellectual developmental disorder] or another neurodevelopmental
disorder), they are sufficiently severe to warrant additional clinical attention.
Specify if:
In remission: After full criteria for rumination disorder were previously met, the criteria have
not been met for a sustained period of time.
,Avoidant/Restrictive Food Intake Disorder
Diagnostic Criteria 307.59 (F50.8)
A. 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:
1. Significant weight loss (or failure to achieve expected weight gain or faltering
growth in children).
2. Significant nutritional deficiency.
3. Dependence on enteral feeding or oral nutritional supplements.
4. Marked interference with psychosocial functioning.
B. The disturbance is not better explained by lack of available food or by an associated
culturally sanctioned practice.
C. 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.
D. 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.
Specify if:
In remission: After full criteria for avoidant/restrictive food intake disorder were previously
met, the criteria have not been met for a sustained period of time.
Anorexia Nervosa
Diagnostic Criteria
A. Restriction of energy intake relative to requirements, leading to a significantly low
body weight in the context of age, sex, developmental trajectory, and physical
health. Significantly low weight is defined as a weight that is less than minimally
normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that
interferes with weight gain, even though at a significantly low weight.
C. 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.
Specify whether:
Restricting type: During the last 3 months, the individual has not engaged in recurrent
episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of
laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is
accomplished primarily through dieting, fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged in
recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the
misuse of laxatives, diuretics, or enemas).
Specify if:
,In partial remission: After full criteria for anorexia nervosa were previously met, Criterion A
(low body weight) has not been met for a sustained period, but either Criterion B (intense
fear of gaining weight or becoming fat or behavior that interferes with weight gain) or
Criterion C (disturbances in self-perception of weight and shape) is still met.
In full remission: After full criteria for anorexia nervosa were previously met, none of the
criteria have been met for a sustained period of time.
Specify current severity:
The minimum level of severity is based, for adults, on current body mass index (BMI) (see
below) or, for children and adolescents, on BMI percentile. The ranges below are derived
from World Health Organization categories for thinness in adults; for children and
adolescents, corresponding BMI percentiles should be used. The level of severity may be
increased to reflect clinical symptoms, the degree of functional disability, and the need for
supervision.
Mild: BMI ≥ 17 kg/m2
Moderate: BMI 16–16.99 kg/m2
Severe: BMI 15–15.99 kg/m2
Extreme: BMI < 15 kg/m2
For children, determining a BMI-for-age percentile is useful.
Subtypes
Most individuals with the binge-eating/purging type of anorexia nervosa who binge
eat also purge through self-induced vomiting or the misuse of laxatives, diuretics, or
enemas. Some individuals with this subtype of anorexia nervosa do not binge eat but
do regularly purge after the consumption of small amounts of food.
Crossover between the subtypes over the course of the disorder is not uncommon;
therefore, subtype description should be used to describe current symptoms rather
than longitudinal course.
Associated features supporting diagnosis
Semi-starvation of anorexia nervosa, and the purging behaviors sometimes
associated with it, can result in significant and potentially life-threatening medical
conditions.
Physiological disturbances, including amenorrhea and vital sign abnormalities, are
common.
When seriously underweight, many individuals with anorexia nervosa have
depressive signs and symptoms such as depressed mood, social withdrawal,
irritability, insomnia, and diminished interest in sex.
Obsessive-compulsive features, both related and unrelated to food, are often
prominent.
Other features sometimes associated with anorexia nervosa include concerns about
eating in public, feelings of ineffectiveness, a strong desire to control one’s
environment, inflexible thinking, limited social spontaneity, and overly restrained
emotional expression.
Compared with individuals with anorexia nervosa, restricting type, those with binge-
eating/purging type have higher rates of impulsivity and are more likely to abuse
alcohol and other drugs.
A subgroup of individuals with anorexia nervosa show excessive levels of physical
activity.
, Prevalence
The 12-month prevalence of anorexia nervosa among young females is approximately 0.4%.
Less is known about prevalence among males, but anorexia nervosa is far less common in
males than in females, with clinical populations generally reflecting approximately a 10:1
female-to-male ratio.
Development and course
Anorexia nervosa commonly begins during adolescence or young adulthood. It rarely
begins before puberty or after age 40, but cases of both early and late onset have
been described.
The onset of this disorder is often associated with a stressful life event, such as
leaving home for college.
Many individuals have a period of changed eating behavior prior to full criteria for
the disorder being met. Some individuals with anorexia nervosa recover fully after a
single episode, with some exhibiting a fluctuating pattern of weight gain followed by
relapse, and others experiencing a chronic course over many years.
Hospitalization may be required to restore weight and to address medical
complications.
The crude mortality rate (CMR) for anorexia nervosa is approximately 5% per
decade. Death most commonly results from medical complications associated with
the disorder itself or from suicide.
Risk and prognostic factors
Temperamental. Individuals who develop anxiety disorders or display obsessional
traits in childhood are at increased risk of developing anorexia nervosa.
Environmental. Historical and cross-cultural variability in the prevalence of anorexia
nervosa supports its association with cultures and settings in which thinness is
valued. Occupations and avocations that encourage thinness, such as modeling and
elite athletics, are also associated with increased risk.
Genetic and physiological. There is an increased risk of anorexia nervosa and bulimia
nervosa among first-degree biological relatives of individuals with the disorder.
Diagnostic markers
Hematology (leukopenia with apparent lymphocytosis, mild anemia, thrombocytopenia,
bleeding problems)
Serum chemistry (dehydration, hypercholesterolemia, elevated hepatic enzyme levels,
hypomagnesemia, hypozincemia, hypophosphatemia, hyperamylasemia)
Endocrine. Serum thyroxine (T4) levels are usually in the low-normal range; triiodothyronine
(T3) levels are decreased, while reverse T3 levels are elevated. Females have low serum
estrogen levels, whereas males have low levels of testosterone.
Electrocardiography. Sinus bradycardia is common, and, rarely, arrhythmias are noted.
Significant prolongation of the QTc interval is observed in some individuals.
Bone mass. Low bone mineral density, with specific areas of osteopenia or osteoporosis, is
often seen. The risk of fracture is significantly elevated.
Electroencephalography. Diffuse abnormalities, reflecting a metabolic encephalopathy, may
result from significant fluid and electrolyte disturbances.
Resting energy expenditure. There is often a significant reduction in resting energy
expenditure.
Physical signs and symptoms. Many of the physical signs and symptoms of anorexia nervosa
are attributable to starvation. Amenorrhea is commonly present and appears to be an
