SLK Chapter 8
Erin Polyblank
CHAPTER 8- DISORDERS OF
NEUROVEGETATIVE FUNCTION: FEEDING
EATING AND SLEEP-WAKE DISORDERS
FEEDING AND EATING DISORDERS
Persistent disturbances to eating, and associated behaviours, cause
significant impairments in both bodily and psychological health.
o Maladaptive pattern of eating, and related behaviours, are central to the
diagnosis of feeding and eating disorders.
DSM-5 recognises three feeding and three eating disorders:
1. Pica.
2. Rumination disorder.
3. Avoidant restrictive food intake disorder.
4. Anorexia nervosa.
5. Bulimia nervosa.
6. Binge-eating disorder.
Obesity is not considered an eating disorder as it is believed not be a mental
disorder.
SCOPE AND SEVERITY OF EATING DISORDERS
It is not uncommon for people deficient in one or another nutrient to crave
strange foods, and even to eat non-foodstuffs such as sand or clay.
o This behaviour is known as pica and, although a natural phenomenon, it
could form the basis of the feeding disorder pica, which we will briefly
describe along with rumination disorder and avoidant-restrictive food
intake disorder.
Pica is characterised by persistently eating one or more non-nutritive, non-
food substances for a least a month.
o Non-food materials ingested in pica include ice, starch, clay, chalk, paint,
paper, soap, string, soil, faeces and hair.
o The ingestion of hair is well known in medicine as it may cause intestinal
obstruction due to the clogging of the hair into a ball through repeated
intestinal movements.
Known as a trichobezoar.
1
,SLK Chapter 8
Erin Polyblank
o Both males and females are affected by Pica.
o It occurs mostly during childhood but can appear at any time.
o Diagnosing pica in pregnancy is only appropriate if eating non-nutritive or
non-food material proves physically dangerous.
Where the consumption of clays, chalks and other non-nutritive or non-
food materials is culturally or religiously sanctioned, the practice
cannot be regarded as pica.
o Pica is encountered more frequently in people with intellectual impairment
and often occurs along with other behavioural disturbances.
Rumination disorder is characterised by repeated regurgitation of food after
feeding or eating.
o Without apparent retching, nausea or disgust at the practice, a person with
rumination disorder brings up previously swallowed food - often partially
digested - into the oral cavity to rechew.
o The behaviour tends to be more common in people with mental retar-
dation, although a degree of rumination is not unusual in infants, where it
usually presents between three and 12 months.
o Lack of stimulation, parental neglect and other early stressors are likely to
be factors in its development.
o Social isolation may complicate its course in older children and adults who,
realising the social disapproval and disgust with which the behaviour is
met, avoid eating with others.
o Physical illnesses such as gastro-oesophageal reflux, oesophageal
strictures, problems with oesophageal motility, pyloric stenosis and
problems with gastric emptying must be excluded diagnostically.
o Bulimia nervosa and anorexia nervosa with purging behaviour are other
principal differential diagnoses.
Avoidant/restrictive food intake disorder is a replacement and extension of
the DSM-IV feeding disorder of infancy and childhood.
o The avoidance of food and restriction of its intake characterise this
condition.
o Some children appear particularly averse to certain sensory qualities of
foods appearance, smell and texture as well as taste.
o People with autism with heightened sensory awareness may display similar
attitudes towards foods.
2
,SLK Chapter 8
Erin Polyblank
o Autistic spectrum disorders, along with attention deficit hyperactivity
disorder (ADHD), obsessive-compulsive disorder (OCD) and anxiety
disorders, may increase ones risk of avoidant/restrictive food intake
disorder.
Bulimia Nervosa: An eating disorder involving recurrent episodes of
uncontrolled excessive (binge) eating followed by compensatory actions to
reduce the caloric, or energy, impact of the food or to rid the body of the food
itself (Eg. Deliberate vomiting, laxative abuse and excessive exercise)
Anorexia Nervosa: An eating disorder characterised by recurrent food-
refusal, leading to dangerously low body weight and an extremely distorted
body image.
o Anorexia nervosa has the highest mortality rate of any psychological
disorder.
Binge-eating disorder (BED): A pattern of eating that involves distress-
inducing binges that aren’t followed by purging behaviours.
The characteristic of these disorders is an overwhelming drive to attain and
maintain a low weight and be thin.
Avoidant/restrictive food intake disorder (ARFID): An eating disorder
where people limit their food intake not because they are concerned with
their weight or body, but because they are not interested in eating or food or
because they avoid certain sensory characteristics or consequences of food
or eating.
ANOREXIA NERVOSA
Individuals often lose so much weight that they put their lives in considerable
danger.
Both bulimia and anorexia are characterised by a morbid fear of gaining
weight and losing control and overeating.
o The difference is whether the individual loses a significant amount of
weight.
Anorexics are proud of their diets and extreme control.
Bulimics are ashamed of both their eating issues and their lack of
control.
CLINICAL DESCRIPTION
3
, SLK Chapter 8
Erin Polyblank
Anorexia nervosa is less common than bulimia, but significant overlap exists.
o Eg. Many individuals with bulimia have a history of anorexia; that is, they
once used fasting to reduce their body weight below desirable levels.
People with anorexia have an intense fear of obesity and relentlessly pursue
thinness.
Anorexia nervosa most commonly begins in an adolescent who is overweight
or who perceives themselves to be.
o They then start a diet that escalates into an obsessive preoccupation with
being thin.
o Dramatic weight loss is achieved through severe caloric restriction or by
combining caloric restriction and purging.
2 subtypes of anorexia nervosa:
1. Restricting type: Individuals diet to limit calorie intake.
2. Binge eating/purging type: They rely on purging.
- Binge-eating-purging anorexics binge on relatively small amounts of
food and purge more consistently, in some cases each time they eat.
Subtyping may not be useful in predicting the future course of the disorder
but rather may reflect a certain phase or stage of anorexia, a finding
confirmed in a more recent study.
o The DSM 5 criteria specify that subtyping refers only to the last three
months.
Individuals with anorexia are not satisfied with their weight loss.
o Maintaining the same weight from one to the next or gaining any weight is
likely to cause intense panic, anxiety, and depression.
The DSM 5 criteria specify only significantly low body weight 15% below that
expected, one study suggests that BMI averages close to 15.8 by the time
treatment is sought.
After seeing numerous doctors, patients with anorexia nervosa become adept
at voicing what others expect to hear.
o They may agree they are underweight - but they do not really believe it
themselves.
o Usually, pressure from somebody in the family leads to the initial visit.
Diagnostic criteria for anorexia nervosa:
a. Restriction of energy intake relative to requirements, leading to a
significantly low body weight in the context of age, sex, developmental
4
Erin Polyblank
CHAPTER 8- DISORDERS OF
NEUROVEGETATIVE FUNCTION: FEEDING
EATING AND SLEEP-WAKE DISORDERS
FEEDING AND EATING DISORDERS
Persistent disturbances to eating, and associated behaviours, cause
significant impairments in both bodily and psychological health.
o Maladaptive pattern of eating, and related behaviours, are central to the
diagnosis of feeding and eating disorders.
DSM-5 recognises three feeding and three eating disorders:
1. Pica.
2. Rumination disorder.
3. Avoidant restrictive food intake disorder.
4. Anorexia nervosa.
5. Bulimia nervosa.
6. Binge-eating disorder.
Obesity is not considered an eating disorder as it is believed not be a mental
disorder.
SCOPE AND SEVERITY OF EATING DISORDERS
It is not uncommon for people deficient in one or another nutrient to crave
strange foods, and even to eat non-foodstuffs such as sand or clay.
o This behaviour is known as pica and, although a natural phenomenon, it
could form the basis of the feeding disorder pica, which we will briefly
describe along with rumination disorder and avoidant-restrictive food
intake disorder.
Pica is characterised by persistently eating one or more non-nutritive, non-
food substances for a least a month.
o Non-food materials ingested in pica include ice, starch, clay, chalk, paint,
paper, soap, string, soil, faeces and hair.
o The ingestion of hair is well known in medicine as it may cause intestinal
obstruction due to the clogging of the hair into a ball through repeated
intestinal movements.
Known as a trichobezoar.
1
,SLK Chapter 8
Erin Polyblank
o Both males and females are affected by Pica.
o It occurs mostly during childhood but can appear at any time.
o Diagnosing pica in pregnancy is only appropriate if eating non-nutritive or
non-food material proves physically dangerous.
Where the consumption of clays, chalks and other non-nutritive or non-
food materials is culturally or religiously sanctioned, the practice
cannot be regarded as pica.
o Pica is encountered more frequently in people with intellectual impairment
and often occurs along with other behavioural disturbances.
Rumination disorder is characterised by repeated regurgitation of food after
feeding or eating.
o Without apparent retching, nausea or disgust at the practice, a person with
rumination disorder brings up previously swallowed food - often partially
digested - into the oral cavity to rechew.
o The behaviour tends to be more common in people with mental retar-
dation, although a degree of rumination is not unusual in infants, where it
usually presents between three and 12 months.
o Lack of stimulation, parental neglect and other early stressors are likely to
be factors in its development.
o Social isolation may complicate its course in older children and adults who,
realising the social disapproval and disgust with which the behaviour is
met, avoid eating with others.
o Physical illnesses such as gastro-oesophageal reflux, oesophageal
strictures, problems with oesophageal motility, pyloric stenosis and
problems with gastric emptying must be excluded diagnostically.
o Bulimia nervosa and anorexia nervosa with purging behaviour are other
principal differential diagnoses.
Avoidant/restrictive food intake disorder is a replacement and extension of
the DSM-IV feeding disorder of infancy and childhood.
o The avoidance of food and restriction of its intake characterise this
condition.
o Some children appear particularly averse to certain sensory qualities of
foods appearance, smell and texture as well as taste.
o People with autism with heightened sensory awareness may display similar
attitudes towards foods.
2
,SLK Chapter 8
Erin Polyblank
o Autistic spectrum disorders, along with attention deficit hyperactivity
disorder (ADHD), obsessive-compulsive disorder (OCD) and anxiety
disorders, may increase ones risk of avoidant/restrictive food intake
disorder.
Bulimia Nervosa: An eating disorder involving recurrent episodes of
uncontrolled excessive (binge) eating followed by compensatory actions to
reduce the caloric, or energy, impact of the food or to rid the body of the food
itself (Eg. Deliberate vomiting, laxative abuse and excessive exercise)
Anorexia Nervosa: An eating disorder characterised by recurrent food-
refusal, leading to dangerously low body weight and an extremely distorted
body image.
o Anorexia nervosa has the highest mortality rate of any psychological
disorder.
Binge-eating disorder (BED): A pattern of eating that involves distress-
inducing binges that aren’t followed by purging behaviours.
The characteristic of these disorders is an overwhelming drive to attain and
maintain a low weight and be thin.
Avoidant/restrictive food intake disorder (ARFID): An eating disorder
where people limit their food intake not because they are concerned with
their weight or body, but because they are not interested in eating or food or
because they avoid certain sensory characteristics or consequences of food
or eating.
ANOREXIA NERVOSA
Individuals often lose so much weight that they put their lives in considerable
danger.
Both bulimia and anorexia are characterised by a morbid fear of gaining
weight and losing control and overeating.
o The difference is whether the individual loses a significant amount of
weight.
Anorexics are proud of their diets and extreme control.
Bulimics are ashamed of both their eating issues and their lack of
control.
CLINICAL DESCRIPTION
3
, SLK Chapter 8
Erin Polyblank
Anorexia nervosa is less common than bulimia, but significant overlap exists.
o Eg. Many individuals with bulimia have a history of anorexia; that is, they
once used fasting to reduce their body weight below desirable levels.
People with anorexia have an intense fear of obesity and relentlessly pursue
thinness.
Anorexia nervosa most commonly begins in an adolescent who is overweight
or who perceives themselves to be.
o They then start a diet that escalates into an obsessive preoccupation with
being thin.
o Dramatic weight loss is achieved through severe caloric restriction or by
combining caloric restriction and purging.
2 subtypes of anorexia nervosa:
1. Restricting type: Individuals diet to limit calorie intake.
2. Binge eating/purging type: They rely on purging.
- Binge-eating-purging anorexics binge on relatively small amounts of
food and purge more consistently, in some cases each time they eat.
Subtyping may not be useful in predicting the future course of the disorder
but rather may reflect a certain phase or stage of anorexia, a finding
confirmed in a more recent study.
o The DSM 5 criteria specify that subtyping refers only to the last three
months.
Individuals with anorexia are not satisfied with their weight loss.
o Maintaining the same weight from one to the next or gaining any weight is
likely to cause intense panic, anxiety, and depression.
The DSM 5 criteria specify only significantly low body weight 15% below that
expected, one study suggests that BMI averages close to 15.8 by the time
treatment is sought.
After seeing numerous doctors, patients with anorexia nervosa become adept
at voicing what others expect to hear.
o They may agree they are underweight - but they do not really believe it
themselves.
o Usually, pressure from somebody in the family leads to the initial visit.
Diagnostic criteria for anorexia nervosa:
a. Restriction of energy intake relative to requirements, leading to a
significantly low body weight in the context of age, sex, developmental
4
