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Eating Complete Summary - 3.5 Eating, Sex and Sleep
Summary of all literature for week 1 (Eating) for course 3.5 Eating, Sex and Sleep Received the grade 8.6! Includes DSM-5 criteria for eating disorders
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3.5 Basic Human Needs:Eating, Sex and Sleep
Week 1
Eating
,DSM-5 Criteria → Anorexia Nervosa
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.
Subtype ● 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).
Remission ● 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.
Severity ● Mild: BMI > 17
● Moderate: BMI 16-16.99
● Severe: BMI 15-15.99
● Extreme BMI < 15
Subtypes
● Most with binge-purge type who binge also purge through self-induced methods, some
individuals with this subtype purge after small consumption of food
● Crossover between subtypes is common so should be used for current symptoms, not
longitudinal course
Diagnostic features
● Three essential features: persistent energy intake restriction, intense fear of gaining
weight or persistent behavior that interferes with weight gain, disturbance in
self-perceived weight or shape
, ● In children may be failure to make expected weight gain or developmental trajectory
instead of weight loss
● BMI of 18.5 is the normal lower limit for adults
● BMI-for-age is used for children (percentiles) → other guidelines can also be used
● Sometimes global thoughts of being too fat, sometimes specific body parts
● Many ways to measure and evaluate the body size
● Self esteem is highly dependent on the perceptions of body shape or weight
● Weight loss often viewed as impressive achievement & sign of self discipline (weight
gain = loss of self-control)
● Some may acknowledge being thin but do not acknowledge medical implications
● Often brought to medical attention by family members, if it is done alone, often caused
by somatic & psychological issues stemming from the disorder
Associated features supporting diagnosis
● Affects most major organs → can cause many disturbances
● Physiological disturbances → amenorrhea, vital sign abnormalities, loss of bone mineral
density (cannot be reversed with nutrition)
● Psychological symptoms → depressed mood, social withdrawal, irritability, insomnia,
diminished interest in sex (sometimes enough for additional MDD diagnosis)
● Obsessive compulsive features are often prominent, often preoccupied with thoughts of
food (sometimes additional OCD diagnosis)
● Some show excessive levels of physical activity, often precede onset of disorder
● Medications may be misused to achieve weight loss
Prevalence
● Young females 12 month prevalence = 0.4%
● Far less common in males (10:1 ratio)
Development & course
● Common to begin during adolescence & young adulthood, rarely before puberty or after
age 40
● Onset often associated with stressful life event
● Younger individuals may have more atypical symptoms
● Older individuals have longer illness duration and more symptoms typical of long
standing disorder
● Often there is a period of changed eating behavior before the full criteria of the disorder
are met
● Some recover after 1 episode, some fluctuate in weight, others more chronic
● Hospitalization may be required, lower remission for those hospitalized
● Most experience remission within 5 years of presentation
● Mortality rate = 5% per decade (often medical complications or suicide)
Risk & prognostic factors
● Temperamental → obsessional traits in childhood
, ● Environmental → cultural & historical valuations of thinness play a role, occupations
that encourage thinness are a risk
● Genetic & physiological → increased risk among first degree relatives with anorexia,
bipolar & depressive disorder family members, especially binge-purging type, brain
abnormalities have been found
Culture related diagnostic issues
● Most prevalent in post-industrialized, high-income countries
● Incidence in low/middle income countries is uncertain → lower utilization of services
● Cultural contexts → fat phobia more common in asia
Diagnostic markers
● Hematology → leukopenia (loss of all cell types), lymphocytosis, mild anemia,
thrombocytopenia, bleeding problems (rare)
● Serum chemistry → dehydration, hypercholesterolemia, elevated hepatic enzyme levels,
hypomagnesemia, phosphate, zinc, amylase, metabolic alkalosis, hypochloremia,
hypokalemia, metabolic acidosis
● Endocrine → thyroxine (T4) usually low-normal range, triiodothyronine (T3) decrease,
reverse T3 elevated, female lower estrogen, male lower testosterone
● Electrocardiography → sinus bradycardia is common, arrhythmias noted, significant QTc
prolongation
● Bone mass → low bone mineral density, high risk of fracture
● Electroencephalography → diffuse abnormalities
● Resting energy expenditure → significant reduction in resting energy expenditure
● Physical signs & symptoms → many attributable to starvation, amenorrhea, constipation,
abdominal pain, cold intolerance, lethargy, excess energy, emaciation, hypertension,
hypothermia, bradycardia, lanugo (fine body hair), peripheral edema, bleeding diathesis,
yellowing of the skin, hypertrophy of salivary glands, enamel erosion
Suicide risk
● Elevated, 12 per 100.000, should be evaluated
Functional consequences
● Some may remain active in social & professional functioning and other may experience
social isolation & failure to fulfill potential
Differential diagnosis
● Medical conditions → serious weight loss may occur, but do not manifest in fear about
weight gain or body shape, acute weight loss associated with a medical condition can
occasionally be followed by onset or recurrence of anorexia (initially masked by
condition)
● MDD → severe weight loss can occur but often not a desire for weight loss or fear
● Schizophrenia → exhibit odd eating behavior & sometimes weight loss, but rarely fear
of gaining weight & body image disturbance
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