Week 1: Eating Disorders
READINGS:
DSM 5
Report the criteria of all eating disorders described in the DSM-
5 :anorexia nervosa
Report in-depth knowledge of all aspects of anorexia nervosa
Subtypes Anorexia:
most individual who binge eat also purge
not binge eat but misuse laxatives or vomit → still purge
Diagnostic Features:
3 essential features:
energy intake restriction/
fear gain weight/ behavior interfere
self perception distrubance or lack see seriousness
Criterion A= weight significant low (under 17 or with history 18,5)
concern about weight gain not less when further loose weight → not
recognize fear but behavior
weight gain perceived as failure self control + often not see seriousness
malnourish
→ lack insight or deny problem
Associated Features Supporting Diagnosis:
semi-starvation and dangerous purge → life threat
physiological = amenhorrea
most reversible with nutritional rehabilitation
loss bone mineral density not reversible
many depressive features becaise of malnourishment
obsessive compulsive features:
preoccupied thought of food (OCD )
others:
concern eat in public
feel ineffective
desire control environment
inflexible think
limited social spontaneity
restrained emotional expression
binge eating purging type:
higher level impulsiveness
higher alcohol/ substance misuse
excessive level physical activity
start before onset of disorder
misuse medication
Risk and Diagnostic Factors:
Temperamental:
develop anxiety disorder
,obsessional traits in childhood
Environmental
thinness is valued/ encouraged in occupations (model)
Genetic and physiological
increased risk relatives
bipolar and depressive increased risk for binge eat purging type
Culture Related Diagnostic Issues:
most prevalent in post industrialized high income
mental health service in Latin American, Asian less → ascertainment bias
Asia:
“fat phobia” = intense fear gain in Asia high
gastrointestinal discomfort
Diagnostic Markers:
Heramotology
Leukopenia = loss of all cell types
apparent lymphcytosis
mild anemia
thromobytopenia
Serum chemistry
dehydration
hypercholesterol
hepatic enzyme elevated
little magnesium, zinc, phosphor
laxative abuse → mild metabolic acidosis
Endocrine
female = low estrogen level
male = low testosterone
Electrocardiography
Bone mass
risk for fracture is high
Electroencephalography
Resting energy expenditure.
significant reduction
Physical signs and symptoms
menarche delayed
amenhorrea as result starvation
lethargy, cold intolerance
languo= fine hair
Differential Diagnosis:
medical conditions
no disturbance in how experience body
acute weight loss can result in recurrence
Major depressive disorder
severe weight loss can occur but no desire for weight loss
Schizophrenia
no body image disturbance
have odd eating behavior
Substance use disorder
low weight due to poor intake of nutrition
,substance use may be persistent behavior to interfere with weight gain
Social anxiety disorder (social phobia),
obsessive-compulsive disorder, and body dysmorphic disorder
emberassed eat in public (social phobia)
preoccupied with effect in body (body dysmorphia)
social fears not limited to eating disorder
Bulimia nervosa: if weight remains above a normal level
avoidant/ restrictive food intake disorder → no fear gain weight,
become fat or distorted body image
Cormorbidities:
bipolar, depressive, anxiety
OCD especially in restrictive type
binge eat purge disorder → alcohol use disorder /substance
Prevalence anorexia Nervosa:
0.4% in young women
more common in women than men with 10: 1 ratio
Development and Course:
Anorexia Nervosa:
during adolescence/ young adulthood
rarely before puberty or after age 40
associated with stressful life event
often period change eating behavior before start
younger individuals:
atypical features → deny fear
older individuals:
longer duration illness
recovery:
some fully
some fluctuating weight gain + relapse
chronic course over years
remission within 5 years
5% death and elevated risk
avoidant/restrictive food intake disorder
significant weight loss
no fear gain weight
no disturbance in how see body
Bulimia nervosa:
recurrent episode binge eat
engage in behavior to avoid weight gain for 3 months
overly concerned body and weight
maintain body weight
in depth knowledge: bulimia nervosa,
Diagnostic Features:
Context in which Eating occur → identify whether food is really excessive
discrete period of time → limited (usually less than 2hr)
continued snacking small amount through day is no binge
loss control = inability stop eating once started
no absolute ignorance → stop when someone enter → shame
, stop when feel uncomfortably full
eat food tend to otherwise avoid
negative self evaluation as delayed consequence
vomit (as compensation)→ relief fullness and no need to fear gain weight
some cases vomiting is goal itself → eventually able to vomit at will
diabetes→ omit insulin
shape and weight important → determine self worth
Associated Features Supporting Diagnosis:
typical within normal weight or overweight
between eating binges typically restrict
frequent use laative → may become dependent to stimulate bowel
Prevalence:
1-1.5% → peak in older adolescence and young adulthood
10: 1 female male ratio
Development and course:
young adulthood
multiple stressful life events
disturbed eating persist several years→ symptom diminish
period of remission longer than 1 year = better outcome
treatment predict outcome → diagnostic crossover to anorexia in minority
→10%-15%
often to binge eating disorder or back bulimia
Risk and Prognostic Factors:
Temperamental: weight concern, low self esteem , depressive
symptoms, social anxiety
Environmental: internalization thin body ideal, childhood sexual and
physical abuse
Genetic and physiological : childhood obestiy and early pubertal
maturation & family history
Course modifiers: severity of comorbidities
Culture Related Diagnostic Issues:
most industrialized countries
Gender Related Diagnostic Issues:
males far less likely to seek treatment
Diagnostic Markers:
abnormalities as a consequence of purging
→ fluid and electrolyte abnormalities
→ loss of gastric acid through vomiting
physical examination of mouth = indication (loss of dental enamel)
salivary glands notably enlarged
Suicide risk & Functional consequences of bulimia nervosa :
elevated suicide but only minority sever impaired in role (2%)
Differential Diagnosis:
Anorexia nervosa binge eat purge type:
only during episodes of anorexia
weight is normal for bulimia and only if not meet other anorexia criteria
Binge eating disorder:
no inappropriate compensation
Kleine- Levin syndrome:
READINGS:
DSM 5
Report the criteria of all eating disorders described in the DSM-
5 :anorexia nervosa
Report in-depth knowledge of all aspects of anorexia nervosa
Subtypes Anorexia:
most individual who binge eat also purge
not binge eat but misuse laxatives or vomit → still purge
Diagnostic Features:
3 essential features:
energy intake restriction/
fear gain weight/ behavior interfere
self perception distrubance or lack see seriousness
Criterion A= weight significant low (under 17 or with history 18,5)
concern about weight gain not less when further loose weight → not
recognize fear but behavior
weight gain perceived as failure self control + often not see seriousness
malnourish
→ lack insight or deny problem
Associated Features Supporting Diagnosis:
semi-starvation and dangerous purge → life threat
physiological = amenhorrea
most reversible with nutritional rehabilitation
loss bone mineral density not reversible
many depressive features becaise of malnourishment
obsessive compulsive features:
preoccupied thought of food (OCD )
others:
concern eat in public
feel ineffective
desire control environment
inflexible think
limited social spontaneity
restrained emotional expression
binge eating purging type:
higher level impulsiveness
higher alcohol/ substance misuse
excessive level physical activity
start before onset of disorder
misuse medication
Risk and Diagnostic Factors:
Temperamental:
develop anxiety disorder
,obsessional traits in childhood
Environmental
thinness is valued/ encouraged in occupations (model)
Genetic and physiological
increased risk relatives
bipolar and depressive increased risk for binge eat purging type
Culture Related Diagnostic Issues:
most prevalent in post industrialized high income
mental health service in Latin American, Asian less → ascertainment bias
Asia:
“fat phobia” = intense fear gain in Asia high
gastrointestinal discomfort
Diagnostic Markers:
Heramotology
Leukopenia = loss of all cell types
apparent lymphcytosis
mild anemia
thromobytopenia
Serum chemistry
dehydration
hypercholesterol
hepatic enzyme elevated
little magnesium, zinc, phosphor
laxative abuse → mild metabolic acidosis
Endocrine
female = low estrogen level
male = low testosterone
Electrocardiography
Bone mass
risk for fracture is high
Electroencephalography
Resting energy expenditure.
significant reduction
Physical signs and symptoms
menarche delayed
amenhorrea as result starvation
lethargy, cold intolerance
languo= fine hair
Differential Diagnosis:
medical conditions
no disturbance in how experience body
acute weight loss can result in recurrence
Major depressive disorder
severe weight loss can occur but no desire for weight loss
Schizophrenia
no body image disturbance
have odd eating behavior
Substance use disorder
low weight due to poor intake of nutrition
,substance use may be persistent behavior to interfere with weight gain
Social anxiety disorder (social phobia),
obsessive-compulsive disorder, and body dysmorphic disorder
emberassed eat in public (social phobia)
preoccupied with effect in body (body dysmorphia)
social fears not limited to eating disorder
Bulimia nervosa: if weight remains above a normal level
avoidant/ restrictive food intake disorder → no fear gain weight,
become fat or distorted body image
Cormorbidities:
bipolar, depressive, anxiety
OCD especially in restrictive type
binge eat purge disorder → alcohol use disorder /substance
Prevalence anorexia Nervosa:
0.4% in young women
more common in women than men with 10: 1 ratio
Development and Course:
Anorexia Nervosa:
during adolescence/ young adulthood
rarely before puberty or after age 40
associated with stressful life event
often period change eating behavior before start
younger individuals:
atypical features → deny fear
older individuals:
longer duration illness
recovery:
some fully
some fluctuating weight gain + relapse
chronic course over years
remission within 5 years
5% death and elevated risk
avoidant/restrictive food intake disorder
significant weight loss
no fear gain weight
no disturbance in how see body
Bulimia nervosa:
recurrent episode binge eat
engage in behavior to avoid weight gain for 3 months
overly concerned body and weight
maintain body weight
in depth knowledge: bulimia nervosa,
Diagnostic Features:
Context in which Eating occur → identify whether food is really excessive
discrete period of time → limited (usually less than 2hr)
continued snacking small amount through day is no binge
loss control = inability stop eating once started
no absolute ignorance → stop when someone enter → shame
, stop when feel uncomfortably full
eat food tend to otherwise avoid
negative self evaluation as delayed consequence
vomit (as compensation)→ relief fullness and no need to fear gain weight
some cases vomiting is goal itself → eventually able to vomit at will
diabetes→ omit insulin
shape and weight important → determine self worth
Associated Features Supporting Diagnosis:
typical within normal weight or overweight
between eating binges typically restrict
frequent use laative → may become dependent to stimulate bowel
Prevalence:
1-1.5% → peak in older adolescence and young adulthood
10: 1 female male ratio
Development and course:
young adulthood
multiple stressful life events
disturbed eating persist several years→ symptom diminish
period of remission longer than 1 year = better outcome
treatment predict outcome → diagnostic crossover to anorexia in minority
→10%-15%
often to binge eating disorder or back bulimia
Risk and Prognostic Factors:
Temperamental: weight concern, low self esteem , depressive
symptoms, social anxiety
Environmental: internalization thin body ideal, childhood sexual and
physical abuse
Genetic and physiological : childhood obestiy and early pubertal
maturation & family history
Course modifiers: severity of comorbidities
Culture Related Diagnostic Issues:
most industrialized countries
Gender Related Diagnostic Issues:
males far less likely to seek treatment
Diagnostic Markers:
abnormalities as a consequence of purging
→ fluid and electrolyte abnormalities
→ loss of gastric acid through vomiting
physical examination of mouth = indication (loss of dental enamel)
salivary glands notably enlarged
Suicide risk & Functional consequences of bulimia nervosa :
elevated suicide but only minority sever impaired in role (2%)
Differential Diagnosis:
Anorexia nervosa binge eat purge type:
only during episodes of anorexia
weight is normal for bulimia and only if not meet other anorexia criteria
Binge eating disorder:
no inappropriate compensation
Kleine- Levin syndrome:
