Feeding and Eating Disorders

Which of the feeding and eating disorders have greater prevalence in females?

Anorexia nervosa and bulimia nervosa and, to a leer extent, binge-eating disorder are more prevalent in females.

Which two of the feeding and eating disorders require body image disturbances or an overemphasis on weight and shape on self-evaluation?

Anorexia nervosa and bulimia nervosa require body image disturbance or an overemphasis on weight and shape on self-evaluation.

Which feeding and eating disorder has onset from early to late adolescence and is often preceded by an overly anxious and harm-avoidant temperament?

Anorexia nervosa has onset from early to late adolescence and is often preceded by an overly anxious and harm-avoidant temperament.

How is avoidant/restrictive food intake disorder different from a gastrointestinal problem?

Avoidant/restrictive food intake disorder can be diagnosed in the presence of a gastrointestinal disorder, but the disturbance of intake must be beyond what is directly accountable by the medical condition. Furthermore, some individuals may have lingering difficulties eating foods despite management of physical symptoms.

Feeding and Eating Disorders

Feeding and Eating Disorders focus on abnormal behaviors concerning the consumption of food that lead to significant physical health impairment and psychosocial functioning impairment.

What is the best way to differentiate anorexia nervosa from avoidant/restrictive food intake disorder?

Individuals with anorexia nervosa also place undue emphasis on weight and shape and have disturbance in their body image.

What two characteristics are necessary for an eating episode to be considered binge eating?

Binge eating involves a large amount of food and a feeling of loss of control.

When can both anorexia nervosa and obsessive-compulsive disorder be diagnosed?

When diagnostic criteria for anorexia nervosa have been met, yet significant obsessions and compulsions not related to food or body image are also present, an additional diagnosis of obsessive-compulsive disorder is considered.

Avoidant/Restrictive Food Intake Disorder

is characterized by a persistent failure to meet nutritional or energy needs as evidenced by one or more of the following: significant weight loss or failure to achieve expected weight; nutritional deficiency; dependence on nutritional supplements; or marked interference with psychosocial functioning. There are three subtypes of eating patterns for this disorder: (1) individuals who do not eat enough or show little interest in eating, (2) individuals who accept only a limited diet due to sensory features, or (3) individuals who refuse food related to previous aversive experiences. The disorder affects males and females equally in infancy and childhood. It has the potential to interfere with physical development, caregiver stress, and problems with family functioning. Although less common, the disorder can begin in adolescence or in pregnant women due to sensory sensivities (usually of short duration). The behaviors are not culturally approved.

Which of the feeding and eating disorders can be diagnosed in addition to the others within the category?

Pica can be diagnosed in addition to the other feeding and eating disorders.

What is the duration of time that symptoms must be present to meet diagnostic criteria for pica and rumination disorder?

Symptoms must be present for 1 month to meet diagnostic criteria for pica and rumination disorder.

Billy is a six-year-old boy who lives in a crowded two-bedroom apartment with his mother and multiple family members. The family is from a lower socioeconomic part of the city where there are "food deserts" and limited economic resources to purchase nutritional foods. The apartment is old and in poor repair. His grandmother has noticed that for the past six weeks, Billy peels off the walls and eats dirt from the sidewalk. She is concerned that Billy will get sick if he continues this behavior. His grandmother told the school nurse what Billy was doing and she referred Billy to the school counselor. Billy's behavior may be an indication of what disorder? A. Pica B. Avoidant/Restrictive Food Intake Disorder C. Rumination Disorder D. Feeding Disorder of Infancy or Childhood

The correct answer is "A" - Pica. Billy has been eating nonnuritive substances for at least a month that are not developmentally appropriate. "B" - Avoidant/Restrictive Food Intake Disorder is not correct. There is no evidence that Billy is avoiding other foods. "C" - Rumination Disorder is also incorrect. Billy does not regurgitate, spit out or re-chew his food. "D" - Feeding Disorder of Infancy or Childhood is not correct. This was a DSM-IV diagnosis and no longer used.

Jonathan is a 25-year-old male who was evaluated at an eating disorder clinic. He has lost 50 pounds in the past three months, dropping from 185 to 130 pounds on a 6'1" medium frame body. Jonathan complained he was still fat. Jonathan began dieting three months ago when his wife told him he was "a fatty" and implied she might consider annulling their nine-month marriage. This absolutely terrified him so he began to diet. Initially he at only a scrambled egg for breakfast, a diet soda for lunch, and a salad with shrimp or chicken for dinner. After he lost 10 pounds in the first week, he decided if he at less then he would lose weight more quickly, so he stopped eating dinner. When this was not working as he expected, he induced vomiting after meals. Jonathan is now "obsessed" with food. He studied what foods have the lowest calorie content and eats only those foods. He cannot bear feeling full after eating and worries that he still hasn't lost enough weight when he looks in the mirror. He has never engaged in vomiting, using laxatives, diuretics, weight loss medication, or exercise. Jonathan is suffering from? A. Binge-Eating Disorder B. Anorexia Nervosa, restricting type C. Bulimia Nervosa, extreme D. Unspecified Eating Disorder

The correct answer is "B" - Anorexia Nervosa, restricting type. Jonathan has an intense fear of gaining weight or being perceived as "fat". He has distorted body image and engages in food restriction. "A" - Bing Eating Disorder is not correct. Jonathan does not engage in binge episodes. "C" - Bulimia Nervosa extreme is incorrect, as he does not engage in binge-eating; therefore, does not meet the criteria for Bulimia. "D" - Unspecified Eating Disorder is also incorrect because Jonathan's symptoms are better explained by Anorexia Nervosa.

Tita is a 10-year-old girls who was taken to her pediatrician's office for conflicts with her mother related to eating behaviors. According to Tita's mother, Tita has been refusing to eat any food that her mother prepares for the past three months. Tita has lost approximately 10 pounds during that time that she "couldn't afford to lose". At 5 feet tall, she currently weighs 85 pounds and looks think. In talking with Tita, the pediatrician finds that Tita is not trying to lose weight nor does she feel that she is overweight. Instead she reports that she is not interested in eating because the food her mother cooks irritates her mouth. She gets particularly upset when her mother cooks any type of past dish, especially with tomato sauce. Tita reports that her mother cooks past at least four times a week. During the rest of the week, her mother cooks meat dishes, but Tita does not like how meat tastes either. Tita's mother reports there is always a power struggle around meal times, usually with mom yelling at Tita and Tita throwing a temper tantrum. The mother does not know what to do and is worried that Tita is not getting sufficient nutrition. Tita is most likely suffering from: A Anorexia Nervosa, restricting type B. Avoidant/Restrictive Food Intake Disorder C. Autism Spectrum Disorder D. Food Anxiety Disorder

The correct answer is "B" - Avoidant/Restrictive Food Intake Disorder. Tita is primarily disinterested in food consumption because of the sensory characteristics of food (especially pasta). She is losing weight and there is significant impairment in her relationship with her mother. "A" - Anorexia Nervosa, restricting type, is not correct because Tita has no self-image distortions or an intense fear of gaining weight which is characteristic of individuals with Anorexia Nervosa. "C" - Autism Spectrum Disorder is also incorrect. There is no evidence presented that Tita has ever met the criteria for Autism Spectrum Disorder. "D" - Food Anxiety Disorder is not corret. There is no DSM-5 diagnosis known as Food Anxiety Disorder

Greg is a 25-year-old male who was referred to a weight loss clinic by his primary care provider due to concerns regarding obesity. At 6 feet tall Greg already weighs 350 pounds. In discussing his concerns with Greg, his care provider discovers Greg is eating copious amounts of food four to seven times per week. Greg eats when he is not hungry and cannot stop Once he starts he realizes what he has been doing, is embarrassed and disgusted with himself. The behaviors have been going on for 18 moths. Prior to starting this behavior, Greg was of average weight for his height. Greg most likely diagnosis is: A. Bulimia Nervosa, moderate B. Unspecified Eating Disorder C. Binge-Eating Disorder, moderate D. Carbohydrate Overconsumption Disorder

The correct answer is "C" - Binge Eating Disorder. Greg's weight is considered obese. Greg is engaging in binge eating 4 to 7 times per week, feeling embarrassed and disgusted with his out-of-control eating. "A" - Bulimia Nervosa, moderate is not correct. Although Greg's bingeing behavior is consistent with Bulimia Nervosa, he does not engage in compensatory behavior. "B" - Unspecified Eating Disorder is incorrect. Greg's symptoms and behavior are better accounted for by. Binge Eating Disorder. "D" - Carbohydrate Overconsumption Disorder is not a DSM=5 diagnosis.

Louise is a 38-year-old single, female who went to the wedding of her friend's daughter out of state. She took an active role helping her friend prepare food in the kitchen the night before. At the wedding the next day there was a flurry of activity. Louise, being physically and emotionally exhausted from the day before, began to eat hoping it would make her feel better. She stuffed herself with crackers, breads, deli meat, and salads in large quantitites. She realized that she had not engaged in bingeing behavior for several months and was appalled at the amounts she was devouring. When the desserts were placed out for guests, Louise began attacking the desserts as if she would never eat again. The wedding precipitated a six-month relapse into binge eating of four time per week. On the day after she binged, Louise exercised five to six hours. Exercising helped Louise keep an appropriate weight. In fact, she was approximately three pounds overweight. It was the worst relapse since she began having problems with binges 13 years ago. Louise is likely exhibiting? A. Anorexia Nervosa, binge-eating/purging type B. Binge Eating Disorder, in partial remission C. Bulimia Nervosa, moderate D. Unspecified Eating Disorder

The correct answer is "C" - Bulimia Nervosa, moderate. Louise has been engaging in binge episodes for the past 13 years. These episodes are characterized as eating more than the average person would be expected to eat in discrete periods of time. She utilizes exercise to manage her weight after bingeing. Once she relapsed she was engaging in binge eating episodes 4 times per week. "A" - Anorexia Nervosa, binge-eating/purging type is incorrect as Louise does not meet the criteria for BMI. "B" - Binge Eating Disorder, in partial remission is not correct. Louise engages in compensatory behavior in conjunction with binge eating. "D" - Unspecified Eating Disorder is not correct, as Bulimia Nervosa better accounts for Louise's behvior.

List the order of precedence for diagnoses of the feeding and eating disorders (other than pica).

The following is the order of precedence for diagnoses of the feeding and eating disorders (other than pica): anorexia nervosa, bulimia nervosa, avoidant/restrictive food intake disorder, being-eating disorder, and rumination disorder.

Anorexia Nervosa

is characterized by an intense fear of gaining weight and a distorted body perception. There is distorted self-image and cognitive distortions (e.g., intense fear of becoming fat, negative self-evaluation based on perceived image, or refusal to acknowledge low body weight is a problem). The individual refused to maintain an appropriate body weight at or above a minimally normal level for the individual's age, gender, development and physical health. The disorder has significant medical consequences including mortality. The disorder is more common in females with an onset in early adolescence, although it can occur at any age. The criteria no longer include amenorrhea (not applicable to males, menopausal women, women using oral contraceptives, or pre-menarcheal girls). Specify type: Restricting Type: the individual has not engaged in binge eating or purging in the past 3 months; rather weight loss is achieved by excessive exercise, dieting, and fasting. Binge-Eating/Purging Type: the individual over the past 3 months has engaged in repeated episodes of being-eating or purging. Specify severity (based on BMI [body mass index[): (1) mild: BMI < or = 17; (2) moderate: BMI 16-16.99; (3) severe: BMI 15-15.99; (4) extreme: BMI < 15.

Binge-Eating Disorder

is characterized by recurrent binge eating over a short period of time. Binges consist of four features: (1) eating more rapidly than normal to the point of being uncomfortably full; (2) eating large amounts of food even when not hungry; (3) eating alone because of embrassment; and (4( feeling guilty or upset about the episode. The behavior must occur at least once a week for three months. There is no compensatory behavior utilized after the binge. The behavior occurs in private and includes food with dense caloric content. Individuals feel they cannot control their eating. The disorder is more common in males and has a later onset. Approximately one half of individuals with Binge-Eating Disorder are obese. They have an unstable weight history with frequent weight cycling.

Rumination Disorder

is characterized by repetitive instances of regurgitation, re-swallowing or spitting out food. The onset must have been preceded by a period of normal functioning and the behavior should not be the result of a medical condition. The symptoms have persisted for at least 1 month. In infants, the behavior must be the result of inadequate emotional interaction and the infants have learned to self-soothe through rumination. It is recommended that if a clinician suspects Rumination Disorder that the individual be evaluated by a medical provider first to determine if there is an underlying medical condition. The symptoms do not occur exclusively in the course of an eating disorder. The disorder is uncommon. It tends to affect boys more often than girls.

Bulimia Nervosa

is characterized by the eating of large amounts of food in a brief period of time (i.e., binge eating) and a subsequent feeling of having lost control of eating during a binge episode. The individual engages in recurrent efforts to compensate (e.g., self-induced vomiting, laxative abuse, diruretics, and strenuous exercise) for bingeing to avoid weight gain. The bingeing and purging occurs an average of 1 (mild) to 14 or ore times (extreme) a week over a 3-month period. The individual may binge to soothe emotional distress, as breakthrough eating when hunger becomes an issue while trying to restrict eating to maintain thinness, or an inability to sustain semi-starvation. Body image has an excessive impact on self-evalutation. Symptoms have been present for at least three months.

Pica

is typified by the age-inappropriate, persistent eating of at least one nonnutritive, nonfood substance (e.g., dirt, hair, insects, and paints) for at least a 1-month period that is developmentally inappropriate (i.e., older than age 2) and not culturally sanctioned. The individual does not display an evident aversion to food. The disorder can be diagnosed at any age. Pica may occur with another mental disorder, but it must be severe enough to require clinical intervention.