Chapter 14: Feeding and Eating Disorders

Describe normal eating patterns

1. Eating until full/satiated 2. Prioritizing scheduled physical activity > sedentary 3. Balanced diet 4. 3 meals a day 5. Comfortable with food being social

Describe the diagnostic criteria for avoidant-restrictive food intake disorder (ARFID)

1. Lack of interest in eating or food that leads to A. Significant weight loss B. Significant nutritional deficiency C. Dependence on enteral feeding or oral nutritional supplements 2. There is no evidence of a disturbance in the way in which one's body weight or shape is experienced 3. The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder.

Describe the diagnostic criteria for bulimia nervosa

1. Recurrent episodes of binge eating followed by compensatory behavoiurs 2. Recurrent inappropriate compensatory behaviors 3. Binge eating with compensatory behaviors must occur at least 1x/week for at least 3 months 4. Self evaluation is unduly influenced by body shape and weight 5. Does not occur exclusively during episodes of Anorexia Nervosa

Describe the diagnostic criteria for binge-eating disorders

1. Recurrent episodes of binge eating. 2. Binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or very guilty afterward. 3. Marked distress regarding binge eating is present. 4. Binge eating occurs, on average, at least once a week for 3 months. 5. Binge eating is not associated with inappropriate compensatory behavior and does not occur exclusively during the course of bulimia nervosa or anorexia

Describe the diagnostic criteria for anorexia nervosa

1. Restrictive energy intake, resulting in significant weight loss, and/or low body weight 2. Intense fear of gaining weight or engaging in behaviours that prevent weight gain (i.e. restriction/purging) 3. Distorted body image or failure to recognize seriousness of current low weight

childhood obesity

A chronic medical condition characterized by an excessive accumulation of body fat relative to gender- and age-based norms.

Anosognosia

A condition in which a person with an illness seems unaware of the existence of his or her illness.

binge eating disorder (BED)

A disorder that involves periods of excessive eating with a feeling of a loss of control. It is similar to binge eating but without the compensatory behaviors and has become increasingly widespread during this age of abundant fast food and obesity.

pica

A form of eating disorder in which the infant or toddler persists in eating inedible, nonnutritive substances. This disorder is one of the more common and usually less serious eating disorders found among very young children.

disturbed eating attitudes

A person's belief that cultural standards for attractiveness, body image, and social acceptance are closely tied to the ability to control one's diet and weight gain.

anorexia nervosa

A severe eating disorder characterized by the refusal to maintain a minimally normal body weight, an intense fear of gaining weight, and a significant disturbance in the individual's perception and experiences of his or her own size

restricting type

A type of anorexia in which the individual uses dieting, fasting, or excessive exercise to lose or avoid gaining weight. During the current episode of anorexia, the person has not engaged in binge-eating or purging behavior.

Describe the characteristic features of individuals with AN

These individuals are anosognosic and ego-syntonic, comorbidities with anxiety disorders/depression/suicidality and related, highest mortality rate. Restrictive and binge/purge types.

Ego-syntonic

Those with anorexia see their illness as part of their personality

Describe the etiology of ARFID

Unknown, though speculation has been made Psychological; Anxiety disorders and anxious traits, depressive symptoms; Neglect, abuse, and developmental delays

set point

a comfortable range of body weight that the body tries to "defend" and maintain

drive for thinness

a motivational variable underlying dieting and body image, among young females in particular, whereby the individual believes that losing more weight is the answer to overcoming her troubles and achieving success

binge eating/purging type

a type of anorexia whereby the individual regularly engages in episodes of binge eating or purging or both

purging

behavior aimed at ridding the body of consumed food, including self-induced vomiting and the misuse of laxatives, diuretics, or enemas

Describe the importance of nutrition in adolescent development

Affects biological (i.e. for growth), psychological (i.e. for emotions), social (i.e. for peer relationships), and neurological development (i.e. for making neural connections).

bulimia nervosa

An eating disorder that involves recurrent episodes of binge-eating, followed by an effort to compensate by self-induced vomiting or other means of purging. Individuals with bulimia are also unduly influenced by body shape and weight and are obsessed with food.

Describe the diagnostic criteria for atypical anorexia

Anorexia nervosa criteria (same seriousness and changes) except for weight; often prior overweight

avoidant/restrictive food intake disorder (ARFID)

Avoidance or restriction of food intake, leading to significant weight loss (or failure to maintain normal growth) and/or nutritional deficiency

compensatory behaviors

Behavior shown by persons suffering from bulimia nervosa to prevent weight gain following a binge episode. Compensatory behaviors include self-induced vomiting, fasting, exercising, and the misuse of diuretics, laxatives, enemas, or diet pills.

Describe the etiology of anorexia nervosa

Biology; twin Studies find heritability ranging from 30-75% Psychology; temperament/Personality: Perfectionistic, obsessive, and avoidant personality features; Cognitive rigidity: Bias towards detail information processing Environment/Culture; Pressure to be thin

Describe the etiology of bulimia nervosa

Biology; twin studies: 60-83% concordance, more often in first-degree relatives Psychology; impulsive personality, perfectionism, abuse, PTSD, body dissatisfaction, dieting, negative affect (i.e. guilt) Environment/Culture; pressure to be thin

Describe eating patterns suggestive of an eating disorder in adolescents?

Dieting -Eliminating/avoiding certain food groups via dieting/ skipping meals Change in Eating Setting or Time of Day Change in Amount of Food eaten -Binging, restricting Unusual and Unhealthy Behaviors -Increased frequency or time in the bathroom, excessive and/or obsessive exercise, body dissatisfaction, discarding food, purging

Identify the cardiovascular complications of eating disorders

Dizziness, Low blood pressure (hypotension), Low heart rate (bradycardia), Syncope (passing out), Heart arrhythmia

Describe the characteristic features of individuals with BN

Ego-dystonic, more likely to be comorbit than AN - but with same conditions, lower mortality rate, greater concern over body image, more impulsive/moody

ego-dystonic

Feeling of shame and guilt with binge episodes results in purging to alleviate that (negative feedback loop)

What are the benefits of family-based treatment?

Get better faster, longer, and stay better

Describe the recommended treatment model for eating disorders in adolescents

Has moved on from focus on child (old) to a a family-systems based treatment. This treatment focuses on the parents as resources, the siblings as support, and food as medicine - restoring healthy eating immediately.

Describe normal eating patterns throughout childhood

Infancy - mainly scheduled and detected by caregivers based on hunger cues of infant School-aged - development in preferences, autonomy in initiating eating and food choices, and still require guidance and supervision Adolescence - More autonomy in food choice, higher BMR - bodies are growing fast and so there is an increased hunger drive, more susceptible to peer and external (i.e.media) influences on eating patterns

Describe the etiology of binge eating disorder

Little is known Psychology; restrictive dieting, emotional eating, low SE, depressed mood, increased anxiety Environmental/Culture; pressure to be thin, poor social support

Describe the characteristic features of individuals with ARFID

More likely with autism spectrum, equally in males and females, more likely with food allergies, traumatic event involving food (i.e. choking) or other medical conditions. Selective, aversive, and low interest types.

Describe the characteristic features of individuals with BED

Most common, similar comorbidities, more impulsive/mood, no compensatory behaviour

Describe the 3 phases of the family based treatment

Phase I: Immediate Control -Rapid and complete weight restoration -Parents are in charge of meals and snacks -Limited physical activity Phase II: Gradual Change -Gradual return to child having age-appropriate independence during meals Phase III: Continue the Good -Maintaining above 95% of the goal weight -Cessation of eating disorder behaviors

metabolic rate

The degree to which an individual's glucose level is maintained within the normal range (in reference to diabetes mellitus)

failure to thrive (FTT)

disorder characterized by weight below the fifth percentile for age, and/or deceleration in the rate of weight gain from birth to the present of at least 2 standard deviations, using standard growth charts for comparison

binge

episode of overeating that involves both excessive amounts of food and a lack of control