Conditions: Chp 15

Bulimia Nervosa (2)

Compensatory behaviors occur such as vomiting, misuse of laxative and diuretics, fasting, and/or excessive exercise. Unlike those with anorexia nervosa, individuals with bulimia nervosa tend to be of normal weight or slightly overweight. An individual with bulimia nervosa presents with self-evaluation that is "overly influenced by body shape and weight". The ICD-9-CM code for bulimia nervosa is 307.51 and the ICD-10-CM code is F50.2.

Bulimia Nervosa

A 12-month prevalence of bulimia nervosa among young females is reported at 1% to 1.5%. Prevalence is highest among young adults since it peaks in older adolescence and early adulthood. There is approximately a "10:1 ratio of females versus males". Like anorexia nervosa, comorbid psychological conditions such as anxiety and depression may also be present in individuals with bulimia nervosa.

Impact on Occupational Performance (3)

A client-centered approach to occupational therapy intervention for individuals with eating and feeding disorders entails finding meaning and purpose in life. It can also focus on self-esteem because it is a critical contributor to recovery from eating disorders and an important part of the treatment process.

Bulimia Nervosa

Bulimia nervosa features episodic and recurring binge eating and purging of food to avoid weight gain. Behaviors such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications to avoid weight gain are hallmarks of bulimia nervosa. Fasting or excessive exercise to compensate for high caloric intake is common in individuals with bulimia nervosa as well as anorexia nervosa. Like anorexia nervosa, a distorted perception of body image (shape and weight) is common for individuals with bulimia nervosa.

Bulimia Nervosa

Bulimia nervosa is diagnosed when an individual engages in binge eating and compensatory purging behaviors at least one time per week for 3 months and does not occur exclusively during episodes of anorexia nervosa. Eating occurs within a discrete amount of time (e.g., 1 hour). Food intake is significantly larger than what would be typically expected, and the individual experiences a sense of loss of control of the eating

Course and Prognosis (5)

Coexisting obsessive-compulsive characteristics add to the chronicity of both anorexia nervosa and bulimia nervosa. The prognosis for binge eating disorder is more favorable than for bulimia nervosa. The remission rate is >50%

Feeding disorder

In infancy or early childhood is a child's refusal to eat certain food groups, textures, solids or liquids for a period of at least one month, which causes the child to not gain enough weight, grow naturally, or cause any developmental delays.

Rumination (2)

Rumination does not occur exclusively within the context of anorexia nervosa, bulimia nervosa, binge eating disorder, or avoidant/restrictive food intake disorder. The ICD-9-CM code for rumination is 307.53, and the ICD-10-CM code is F98.21.

Binge Eating Disorder

The 12-month prevalence of binge eating disorder in the United States adult population is 1.6% female and 0.8% male. It is more prevalent among individuals seeking weight loss treatment than in the general population and is equally as prevalent among white females as ethnic minorities.

Diagnosis: Anorexia Nervosa (2)

The ICD-9-CM (International Statistical Classification of Diseases and Related Health Problems) code for anorexia nervosa is 307.1. The ICD-10-CM codes vary based on subtype; restricting type is F50.01 and binge eating/purging type is F50.02.

Etiology (7)

The cause of rumination is not understood. Rumination is commonly believed to be behavioral, that is, a learned disorder that allows for voluntary relaxation of the diaphragm that leads to belching and regurgitation of food.

Course and Prognosis (2)

The complex nature and frequency of relapse of anorexia nervosa make its prognosis the bleakest among eating and feeding disorders. Over 20% of individuals with anorexia nervosa continue to present with the condition at long-term follow-up. Vomiting and purgative abuse have been shown to lead to the worst prognosis, while excessive exercise and dieting does not necessarily portend poor prognosis.

Diagnosis: Anorexia Nervosa

The diagnostic criteria for anorexia nervosa include "restriction of caloric intake relative to body requirements that leads to significantly low body weight in relationship to age, sex, developmental trajectory, and physical health status". Suicide rate is high for individuals with anorexia and is reported at 12 per 100,000 annually.

Medical/Surgical Management (5)

Typical treatment for avoidant/restrictive food intake disorder includes psychological or behavioral interventions, nutritional counseling, and medical monitoring. Avoidant/restrictive food intake disorder can be managed clinically using food or drink supplements high in calories and fat or via enteric feeding.

Pica

is a dangerous form of self-injurious behavior. It is described as a perverted appetite for nonnutritive, nonfood substances such as clay, soil, laundry starch, hair, chalk, crayons, and ashes.

Cognitive-behavioral therapy

(CBT) is the most common psychological intervention for adults and family-based therapy (FBT) for children, youth, and adolescents. Both are evidence-based treatment approaches for individuals with eating disorders. These highly structured interventions have been shown to be more effective than less structured psychological treatment approaches. If psychotherapy services are not available or are ineffective, the next treatment option for those with eating disorders (anorexia nervosa or bulimia nervosa) may be the use of medications such as antidepressants or mood stabilizers.

Signs and Symptoms: Psychopathology

-Anxiety -Depression -Body image disturbance -Preoccupation with body weight and shape -Overevaluation of shape and weight to determine self-worth -Minimizing or denying symptom severity -Disturbance in way body is experienced -Intense fear of weight gai, despite being significantly underweight

Signs and Symptoms: Restrictive Behaviors

-Cutting back on food consumption -Strict rules about eating (when, where, caloric intake) -Long term fasting (>8hours) -Ritualized behaviors (shopping, preparation, consumption, cutting food into tiny pieces, ingesting hot food, ritualized order of eating) -Little variety in foods -Avoiding social eating -Social competitiveness (who can eat less) -Self-mutilation

Signs and Symptoms: Physical (2)

-Diminished bone density -Osteoporosis -Muscle loss -Dehydration -Syncope -Dry skin -Lanugo (downy body hair) -Electrolyte imbalance -Gastric issues

Signs and Symptoms: Binge eating

-Eating excessive amount of food in discrete about of time based on situation (objective) -Food intake not excessive in light of context but determined to be large by individual (subjective) -Eating quickly -Eating until uncomfortably full -Eating in isolation because of feeling embarrassed -Eating large amounts when not hungry -Shame and self-disgust from eating

Signs and Symptoms: Physical (3)

-Esophageal inflammation and rupture -Tooth decay -Pancreaitis -Ulcers -Irregular bowel movements

Signs and Symptoms: Psychopathology (2)

-Impaired concentration -Emotionally labile -Irritation -Apathy -Personality changes -Poor insight and judgment -Social withdrawal -Decreased libido

Signs and Symptoms: Fluid intake

-Limited (<1 quart per day) -Excessive (>1.5 quarts per day) -Increased tea and coffee consumption

Signs and Symptoms: Purgative behavior

-Misuse of diet pills, diuretics, laxatives -Excessive exercise -Self-induced vomiting or spitting

Signs and Symptoms: Fixations

-Obsessive fascination with recipes and reading cookbooks -Increased use of spices, salt, and gum chewing -Intensive, unrelenting, compulsive

Signs and Symptoms: Cognitive perceptual

-Poor concentration -Denies hunger or fatigue -Preoccupation with diet and exercise -Calorie counting -Loss of memory -Poor concentration

Signs and Symptoms: Body avoidance

-Refusing to weigh self -Refusing to look at self in mirror -Wearing bulky clothes -Self-mutilation -Refusing to touch self

Signs and Symptoms: Body checking

-Repeated weighing -Pinching or measuring body parts -Repeated checking of protrusion of body bones (i.e., hips) -Obsessive checking that clothes fit -Mirror gazing -Comparing self with others

Signs and Symptoms: Physical

-Weight loss or failure of growth, e.g., disruption of menses -Reductions in waking erections (men) -Reduced libido -Hair loss -Nail biting -Sensitivity to cold -Weakness and fatigue -Low blood pressure -Bradycardia

Description and Definition (2)

According to the DSM-5, feeding and eating disorders include anorexia nervosa, bulimia nervosa, binge eating, pica, rumination, and avoidant/restrictive food intake disorder. Eating disorders (particularly anorexia nervosa, bulimia nervosa, and binge eating disorder are among the most common health concerns in young people, particularly female adolescents and young women, but to a lesser extent, men are also impacted. Most adults seeking treatment for eating disorders are in their 20s or 30s, having dealt with their issues for on average 8 years.

Description and Definition

Activities that contribute to health and occupational performance include eating a balanced diet, engaging in meaningful leisure pursuits, exercising in moderation, and participating in fulfilling social relationships. Food restricting or purging behaviors "prevent clients from engaging in activities that contribute to health" (Costa, 2009, p. 13). Many people experience internal conflict with regard to eating at some point in their lives, but not to the point at which it threatens good health and occupational performance.

Course and Prognosis

Although eating disorders have the highest mortality rate of any mental disorder, like diagnostic rates, the mortality rate of eating disorders varies depending on studies and reports. Part of the reason why there is a large variance in the reported number of deaths caused by eating disorders is that those with an eating disorder may ultimately die of heart failure, organ failure, malnutrition, or suicide. Often, the medical complications of death are reported instead of the eating disorder that compromised a person's health.

Etiology (8)

Although not for certain, avoidant/restrictive food intake disorder may be caused by mechanical oral motor factors such as low tone or coordination, tactile defensiveness, previous history of choking, and/or a conditioned response to gastrointestinal issues that preclude food intake. These issues combined with an individual's medical history and, for children, caregiver response to these issues and subsequent learned behaviors may exacerbate avoidant/restrictive food intake disorder.

Binge Eating Disorder

Binge eating disorder was first described in the medical literature in 1952 (Walsh, 2011). Binge eating disorder is a condition in which there are both recurrent episodes of excessive eating within a discrete period of time and a perceived sense of lack of control over the eating. Most individuals with binge eating disorder tend to be "overweight, obese, and middle-aged"

Avoidant/Restrictive Food Intake Disorder (2)

An avoidant/restrictive food intake disorder cannot be associated with an individual's self-perception of his/her body weight or shape, associated with a concurrent medical condition such as food allergy or intolerance, or better explained by psychiatric conditions such as schizophrenia, in which an individual might have delusions about the safety of his or her food, cultural practices, or with the presence of another eating disorder. The ICD-9-CM code for avoidant/restrictive food intake disorder is 307.59 and the ICD-10-CM code is F50.8.

Impact on Occupational Performance (6)

An occupational therapy practitioner needs to be aware of this persistent drive and work with the individual to reevaluate the value of such behavior. It becomes, in essence, helping the client find balance between engaging in moderate exercise and engagement in other meaningful work and leisure activities. This entails client-centered intervention to engage in meaningful active recreation that stops before becoming excessive, to increase socialization, to set limits, and to reduce anxiety and depression.

Anorexia Nervosa

Anorexia nervosa is described as the oldest recorded eating disorder, with accounts of it dating back to the 19th century. Anorexia nervosa presents as a profound refusal to maintain a normal body weight at 85% of expected weight, excessive concern with and distorted body image, and failure to recognize that there is a problem.

Anorexia Nervosa

Anorexia nervosa was previously thought to impact only young Caucasian women with upper socioeconomic status. It actually affects both men and women of all ages, races, and ethnicities across the world, but mostly younger Caucasian women. The prevalence rate is reported at a range between 0.3% and 1%. Comorbidity is the rule rather than the exception, with anxiety and depression the most common. It has been estimated that one-fifth of people with attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder have anorexia nervosa.

Description and Definition (4)

Anxiety, low self-esteem, obsessional thoughts and actions, feelings of low self-worth, and perfectionism are classic characteristics associated with eating disorders. Hypotension and bradycardia, constipation, GI issues, and long-term estrogen deficiency are common side effects of anorexia nervosa. Other serious long-term effects of anorexia nervosa and bulimia nervosa include reproductive issues, osteopenia and osteoporosis, impaired brain growth, and dental health.

Eating disorder

Any of a range of psychological disorders characterized by abnormal or disturbed eating habits (such as anorexia nervosa).

Avoidant/Restrictive Food Intake Disorder

Avoidant/restrictive food intake disorder is a new diagnostic category in the DSM-5. It replaces and extends the category of Feeding Disorder of Infancy or Early Childhood in the DSM-IV. The reason for the change was to expand the category to make the disorder applicable across the life span and to make the diagnostic criteria more explicit. While typically seen in children and adolescents, avoidant/restrictive food intake disorder can also be diagnosed in adults. Avoidant/restrictive food intake disorder may present in a variety of ways; some individuals eat only a very narrow range of foods, while others restrict food intake in response to emotional crises, unpleasant experiences, or untoward feelings.

Avoidant/restrictive food intake disorder

Avoidant/restrictive food intake disorder may present in a variety of ways; some individuals eat only a very narrow range of foods, while others restrict food intake in response to emotional crises, unpleasant experiences, or untoward feelings. Food avoidance is not driven by cognitive misperceptions about weight or body shape, nor is it the result of lack of availability of food or a culturally sanctioned practice.

Binge Eating Disorder (2)

Binge eating disorder is not associated with inappropriate compensatory behaviors, nor does it occur exclusively during the course of anorexia nervosa or bulimia nervosa. The ICD-9-Cm code is 307.51, and the ICD-10-CM code is F50.8.

Binge Eating Disorder

Binge eating disorder refers to recurring episodes of eating quickly, with loss of control, and ingesting significantly more food in a discrete period of time (e.g., 1 hour) than most people would eat under similar circumstances regardless of hunger or satiety. It is associated with marked distress and occurs, on average, at least once a week over 3 months.

Impact on Occupational Performance (2)

Diminished engagement in purposeful occupation is noted and accompanied by unreasonably high self-expectations. It is not uncommon for an individual with an eating disorder to lose sight of what is (was) fun and important for him or her. Personal causation is at issue. Isolation is common. Roles that are lost may include friend, spouse, parent, worker, and hobbyist. This loss leads to a dearth of interpersonal connections and even, due to the obsessive inward nature of the disorders, lack of empathy for others.

Description and Definition (3)

Eating disorders are understood to arise from a combination of behavioral, biological, emotional, psychological, interpersonal, and social factors. While each of the feeding and eating disorders has different clinical presentations, these six disorders feature severe disturbances in eating behavior that clinically impede an individual's life. Life-threatening effects of eating disorders can be electrolyte imbalance, cardiac arrhythmias, and intercurrent infarction.

Impact on Occupational Performance (4)

Engagement in social and community activity bolsters self-esteem. Intervention can be directed at increasing socialization, a life function often lost when an individual is entrenched in an eating disorder. Motivational interviews may help a client with an eating disorder prepare to authentically engage in making adaptive behavioral changes. Occupational therapy can focus on enhancing self-efficacy and self-concept, identifying role deficits, and identifying positive role models.

Bulimia nervosa

Features episodic and recurring binge eating and purging of food to avoid weight gain. Behaviors such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications to avoid weight gain are hallmarks of bulimia nervosa. Fasting or excessive exercise to compensate for high caloric intake is common in individuals with bulimia nervosa as well as anorexia nervosa. Like anorexia nervosa, a distorted perception of body image (shape and weight) is common for individuals with bulimia nervosa.

Avoidant/Restrictive Food Intake Disorder (2)

Food avoidance is not driven by cognitive misperceptions about weight or body shape, nor is it the result of lack of availability of food or a culturally sanctioned practice. Those with avoidant/restrictive food intake disorder are more likely to have a coexisting medical condition such as autism spectrum disorder, attention deficit hyperactivity disorder, anxiety disorder, and obsessive-compulsive disorder than individuals with anorexia nervosa or bulimia nervosa.

Impact on Occupational Performance (5)

For instance, with anorexia nervosa and bulimia nervosa, exercise may become the focal point of a client's life—all day, every day. The occupational therapy practitioner must become skilled at understanding the client's desire and motivation to engage in an activity and the activity demands and associated contraindications. Striking a balance between autonomy and safety is paramount. Too much high-intensity activity will perpetuate undesired behaviors and weight loss.

Etiology (3)

For some individuals with bulimia nervosa and binge eating disorder, overeating may be considered a form of self-regulation. An explanation for this behavior is that when people are under stress, eating helps to balance the body's biochemistry; serotonin levels increase and cortisol decreases. From a sensory regulation perspective, people who are hyporesponsive to sensory input (tactile and proprioceptive) may be drawn to consuming large amounts of highly textured and flavored foods (or nonnutritive substances) in an effort to modulate.

Etiology (2)

Further, there is a relationship between general adversity (abuse, neglect) and increased risk of developing an eating disorder. Parallels are also noted between eating disorders and addictions; both have associated tendencies such as compulsive behaviors, diminished self-control, and engagement in repetitive behaviors despite knowing the negative consequences.

Medical/Surgical Management (4)

In the case of rumination, a muscle relaxant such as baclofen may be used to "reduce regurgitation and belching... and decrease how often the lower esophageal sphincter relaxes". For some eating disorders, particularly pica, applied behavioral analysis treatment techniques are often the preferred treatment method. When there is a concern regarding an individual's physical or emotional safety, especially in individuals with anorexia nervosa, inpatient hospitalization may be required. The goal of this hospitalization would be to reestablish a safe nutritional status and address emotional issues.

Medical/Surgical Management

Interpersonal challenges tend to worsen self-esteem. These challenges can be the catalyst to engage in atypical eating behaviors as a maladaptive way to gain self-control. Fully manifesting eating disorders tend to occur in the context of or are amplified by traumatic interpersonal events.

Family-based therapy

Is a home-based treatment approach that today remains the only treatment proven effective in controlled trials for anorexia nervosa in adolescents. FBT takes an agnostic view of cause of the eating disorder but instead places initial focus on refeeding and full weight restoration to promote recovery.

Anorexia nervosa

Is described as the oldest recorded eating disorder, with accounts of it dating back to the 19th century. Anorexia nervosa presents as a profound refusal to maintain a normal body weight at 85% of expected weight, excessive concern with and distorted body image, and failure to recognize that there is a problem

Rumination

Is the nonpurposeful regurgitation of recently ingested food from the stomach to the mouth, where it is either rechewed, reswallowed, or expelled.

Course and Prognosis (3)

It has been found that the outcome for adolescent onset is more positive than for adult onset. For younger individuals, a positive parent-child relationship has protective qualities to diminish poor outcomes for both anorexia nervosa and bulimia nervosa. (Herzog et al., 1999) and colleagues' longitudinal study of 246 patients with anorexia nervosa and bulimia found that 74% of individuals with bulimia nervosa achieved a full recovery compared to 33% of those with anorexia nervosa.

Avoidant/Restrictive Food Intake Disorder (3)

It has been suggested that there are five types of food refusal. They include: -Learning dependent food refusal -Medical complications-related food refusal -Selective food refusal -Fear-based food refusal -Appetite awareness and autonomy-based food refusal An individual with avoidant/restrictive food intake disorder is dependent on enteral feeding and/or oral nutritional supplements and may demonstrate notable interference with psychosocial function.

Anorexia Nervosa (2)

It is a relentless pursuit of thinness through diet and exercise with an accompanying intense and unremitting fear of gaining weight or becoming fat, despite being extremely thin. Food is always on the minds of those with anorexia nervosa. For example, a person might obsess about the number of calories, the fat content, or how many minutes of exercise it will take to burn off a desperately desired cookie.

Incidence and Prevalence

It is estimated that up to 24 million people of all ages and genders have anorexia, bulimia, or binge eating disorder in the United States with the highest incidence rate of anorexia nervosa and bulimia nervosa occurring between the age of 10 and 19 years.

Course and Prognosis (7)

Like pica, for individuals with developmental and intellectual disabilities, the prognosis for rumination tends to be poorer than for the general population. The prognosis for individuals with avoidant/resistant food intake has not been reported in the literature, but early treatment is very important. Left untreated, it may lead to anorexia nervosa or bulimia nervosa

Avoidant/Restrictive Food Intake Disorder

Nutritional insufficiency and weight loss resulting from excluding specific food groups or inadequate vitamin or mineral intake must occur for a diagnosis of avoidant/restrictive food intake disorder. There are no validated assessments to diagnose avoidant/restrictive food intake disorder. Assessment is typically via interview with the client (or family if child is young), weight and height measurement, and assessment of clinical intake.

Description and Definition (5)

On a more systemic level, eating disorders can threaten to take over the entire family system; the family becomes consumed by it and has limited community engagement. Mealtimes become war zones. For children and adolescents with eating disorders, constant prompting to eat can lead to created dependency.

Etiology (5)

One suggested cause of binge eating disorder may be a genetic mutation of the melanocortin 4 receptor gene, which makes a protein that stimulates hunger. A mutation in this gene may lead to reduced protein production so that the body (inaccurately) feels excessive hunger. Like anorexia nervosa and bulimia nervosa, binge eating disorder may also have psychological roots, for example, negative emotions, loneliness, and anger.

Rumination

Originally, it was thought that rumination occurred only in intellectually impaired children or adults, but recent research suggests that healthy individuals with no cognitive challenges can also be diagnosed with rumination syndrome. To that end, there have been no systematic incidence studies on rumination in humans.

Course and Prognosis (4)

Partial recovery occurred in 99% of individuals with bulimia nervosa and 83% of those with anorexia nervosa. Relapse rate was found to be approximately 33% for both anorexia nervosa and bulimia nervosa. Recovery from anorexia nervosa becomes more difficult the longer it persists, yet the opposite is true for bulimia nervosa.

Pica (2)

Pica can lead to death or life-threatening consequences due to choking or intestinal obstruction and may require surgery to remove inedible objects. It can also lead to poisoning, burns, and parasitic infections and cause significant harm to dental and digestive structures.

Pica

Pica has been observed in people across all cultures and age groups. In the United States, it appears to be more common among individuals living in the Southeast. Considered by some to be a learned behavior, it is more frequently noted in individuals with autism spectrum disorder, Prader-Willi syndrome, and psychological conditions such as stress and anxiety. It is difficult to determine the prevalence rate because people are reluctant to admit to engaging in pica and the definitions of pica vary because of varied cultural practices.

Pica

Pica is a dangerous form of self-injurious behavior. It is described as a perverted appetite for nonnutritive, nonfood substances such as clay, soil, laundry starch, hair, chalk, crayons, and ashes. The word pica is derived from the Latin for magpie, a species of bird that eats whatever it finds

Course and Prognosis (6)

Pica may stop spontaneously after several months or require dopamine-regulating medication to control the behaviors. It tends to be more persistent and leads to poorer prognosis in individuals with developmental disabilities than the general population. Rumination may also stop spontaneously or require psychotherapy or aversive conditioning.

Medical/Surgical Management (2)

Psychological therapies are the typical means for managing eating disorders. Self-help groups and family interventions are the main types of therapy intervention for individuals with eating disorders. Cognitive-behavioral therapy (CBT) is the most common psychological intervention for adults and family-based therapy (FBT) for children, youth, and adolescents. Both are evidence-based treatment approaches for individuals with eating disorders.

Rumination

Rumination is diagnosed via the Rome III criteria, which includes symptoms such as regurgitation and rechewing or expulsion of food, with no retching for at least 1 month, with onset at least 6 months prior to diagnosis. While most often diagnosed in children with intellectual disabilities, adult cases in the general population have been documented.

Rumination

Rumination is the nonpurposeful regurgitation of recently ingested food from the stomach to the mouth, where it is either rechewed, reswallowed, or expelled. It has been recognized in the medical literature for over 100 years. Regurgitation typically happens during or immediately following a feeding.

Binge Eating Disorder (2)

The difference between binge eating disorder and bulimia nervosa is that individuals with binge eating disorder do not engage in compensatory behaviors like purging or misuse of laxative and diet pills. A transition from restrictive eating to binge eating is common, but going from binge eating to severely restricted eating is less so.

Impact on Occupational Performance

The effect of an eating disorder negatively influences occupational performance. Behaviors are obsessive and maladaptive. Eating disorders globally impact a person's ability and drive to perform adaptive occupations. While loss of occupational role is a key area of concern for all individuals with eating disorders, anorexia nervosa, in particular, can literally consume a person and lead to a singular focus on food to the exclusion of all else in daily life.

Etiology

The heritable characteristics of eating disorders are strong. Twin and family studies show the incidence rates to be between 50% and 83% (Treasure et al., 2010). Research also indicates that eating disorders represent a complex interaction of physiological, genetic, psychological, social-emotional, and cognitive factors. There is a strong link between coexisting mental health conditions such as depression and anxiety, borderline personality disorder, affective disorder, substance abuse (the latter two more closely associated with bulimia nervosa), and eating disorders.

Etiology (6)

The practice of pica has been reported as far back as 1800 BCE in regions of the Far and Middle East. Since the time of Hippocrates, it has been proposed that pica is a symptom of anemia, but it has never been proven. The question remains as to whether iron deficiency is a cause or effect of pica. No further etiology for pica has been reported in the medical or psychological literature.

Rumination (2)

The sensation associated with the regurgitation is felt as pressure, the need to belch, nausea, pain, or discomfort. Individuals with rumination typically describe the process as being effortless with no gagging or retching. Those with rumination understand that the food is undigested yet report that it tastes normal. Lacking social conventionality, rumination is often a very secretive behavior. It is not life threatening but can have medical and psychological ramifications for the individual and family.

Avoidant/Restrictive Food Intake Disorder

There has been limited study of the prevalence of avoidant/resistant food intake disorder. Studies have noted rates range from 1.4% to 5% for youth and adolescents treated at eating disorder facilities. Being a new category in the DSM-5, future prevalence study has been recommended.

Medical/Surgical Management (3)

These highly structured interventions have been shown to be more effective than less structured psychological treatment approaches. If psychotherapy services are not available or are ineffective, the next treatment option for those with eating disorders (anorexia nervosa or bulimia nervosa) may be the use of medications such as antidepressants or mood stabilizers.

Etiology (4)

This potential causation of eating disorders could apply to individuals with bulimia nervosa, binge eating disorder, and pica. Although there are similarities, there are also etiological characteristics specific to each eating disorder. A description of etiology specific to each eating and feeding disorder follows. The cause of anorexia nervosa is multifactorial and includes genetics, sociocultural, familial, and individual factors and/or experiencing an adverse event, personality, and psychological vulnerability.. Like anorexia nervosa, the cause of bulimia nervosa is most likely multifactorial and includes sociocultural, familial, and individual characteristics as well as psychological factors.

Pica

To be diagnosed with pica, the individual must have engaged in eating nonfood items for at least 1 month. The ICD-9-CM code for pica is 307.52, and the ICD-10-CM codes for childhood pica are F98.3 and F50.8 for adults.

Conclusion

To varying extents, all aspects of daily life are negatively impacted by an eating disorder. Meal preparation, grocery and clothes shopping, interpersonal relationships, work, and leisure all suffer. An important role that occupational therapy practitioners can perform when working with clients with eating disorders is to help them organize their lives in order to find a workable balance between engaging in daily skills that they need to do in order to achieve a sense of personal fulfillment. Eating disorders are serious mental health conditions that warrant careful and sensitive client-centered treatment from an interdisciplinary team of health practitioners.

Course and Prognosis (8)

Until clients are ready to make behavioral changes, they will not recover from an eating disorder. Recovery also depends on hope, healing, empowerment, and connection. Recovery from an eating disorder has been described as "when individuals with a history of an eating disorder appear indistinguishable from healthy controls". From an occupational therapy perspective, recovery is dependent upon achieving a balance between work, leisure, and self-care.

Incidence and Prevalence (2)

With only 35% of people with anorexia, bulimia, or binge eating disorder receiving specialized treatment, the incidence rate for these three eating disorders cannot be considered absolute. More specific information on incidence and prevalence by diagnosis follows.