Problem 1: Eating disorders 1:
Part 1: DSM & personality:
Reading 1: DSM-5 (APA):
• Mutually exclusive disorders (can only have one):
o Rumination, avoidant/restrictive, anorexia, bulimia, binge-eating
o All have different treatments
• In remission = when meet criteria but not sustained over time
• PICA:
o Eating non-food substances (e.g. clay) – for at least 1 month
o Inappropriate to developmental level of person (e.g. not a child – min 2 years)
o Not part of a culturally/socially supported practice
o If present on top of other psych or medical condition -> severe enough for more
attention
• Unclear prevalence – increased risk in severe intellectual disability
o Can happen during pregnancy
o Develops -> most common during childhood - !! not linked to cultural ritual
o If done to lose weight (e.g. eat paper to suppress hunger) anorexia
o Comorbidity -> autism; intellectual disability; schizophrenia; OCD…
• RUMINATION DISORDER:
o Regurgitation of food (vomit) – can be re-chewed/swallowed/spit – at least 1 month
o Not attributable to medical condition
o Doesn’t happen with anorexia, bulimia, binge-eating, avoidant/restrictive
o If occur in context of other mental disorder -> severe enough to need more attention
• Unclear prevalence – often higher in intellectually disabled
o Self-soothing/stimulating in some infants or people with intellectual disabilities
• AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER:
o Eating disturbance (lack of interest/avoidance) – failure to meet energy/nutrition
(1 or more) Sig weight loss (growth delay in kids) – nutritional deficiency –
dependence on enteral feeding or oral supplements – interference with
psychosocial functioning
o Not explained by lack of available food or cultural practice
o Doesn’t happen with bulimia or anorexia + no disturbance in own body shape
o Not explained by medical or mental disorder – if occur in context of other mental
disorder -> severe enough to need more attention
• No prevalence given – higher risk with anxiety, OCD, autism, ADHD – equal gender
o Can come from extreme sensitivities to smell, color, shape of food
o Lack of interest -> often start in infancy – can continue into adulthood
• ANOREXIA NERVOSA:
o Restriction of energy intake – leads to sig low body weight (= less than min normal)
o Intense fear of gaining weight – behavior to avoid weight gain
o Disturbed experience of own body’s weight/shape – lack of recognition of low weight
• Restriction type = weight loss mainly through diet & exercise – during last 3 months
o Binge-eating/purging type = binge & purging behavior – during last 3 months
o In partial remission -> criteria A isn’t sustainly met – B or C is
1
, In full remission -> all criteria met but not sustained
• Level of severity based on BMI (for kids -> also look at height)
o Concern of weight gain can increase with weight loss
o Some realize they are underweight but still think some parts are too big
• Prevalence = 0.4% in young females – female to male ration = 10:1
o Often begins in adolescence /young adulthood – link to stressful life event (e.g.
leaving home for college) – common remission within 5 years
Crude mortality rate = 5%
• Risk factors -> anxiety, obsessive behavior – cultural norms of thinness (e.g. model) –
hereditary – brain differences compared to healthy control
• Common outcomes -> hematology; serum chemistry; endocrine; electrocardiography; bone
mass…
• Differential diagnosis -> weight loss can occur from other conditions
o MDD – schizophrenia – substance use disorder – social anxiety – OCD – body
dysmorphia – bulimia – avoidant/restrictive food intake
• BULIMIA NERVOSA:
o Recurrent binge eating episodes (= large amount of food in small period of time +
lack of control during the episode)
o Inappropriate compensatory behavior to prevent weight gain (laxatives, vomit, fast)
o Both occur at least once a week for 3 months
o Self-evaluation influenced by body shape & weight
o Doesn’t only occur during episodes of anorexia
• Mild = 1-3 episodes of compensatory behavior per week
o Moderate = 4-7 episodes per week
o Severe = 8-13 episodes per week
o Extreme = 14 or more episodes per week
o Partial remission -> all criteria is met – some but not all for a sustained period of time
o Full remission -> all criteria is met – none for a sustained period of time
• Typically, in normal or overweight BMI range
o Risk of amenorrhea (menstrual irregularities)
• Prevalence = 1-1.5% in young females – highest in young adults – female to male ratio = 10:1
o Often begins in adolescence/young adulthood
o Binging common after dieting
o Crude mortality rate = 2%
• Common to cross-over to anorexia -> often end up back in bulimia
• Risk factors -> weight concern; low self-esteem; depression; social anxiety
o Idealization of thin body – childhood sexual/physical abuse
o Childhood obesity – early maturation – hereditary
• Differential diagnosis -> anorexia binge eating/purging subtype (check diagnostic criteria)
o Binge eating (without compensatory behavior) – Kleine-Levin syndrome (no
overconcern with body shape) – MDD – borderline personality (check criteria)
• BINGE-EATING DISORDER:
o Recurrent episode of binge eating (= large amount of food in small period of time +
lack of control during the episode)
o (3 or more) Eating faster than normal – until uncomfortably full – eating a lot when
not hungry – eating alone because of embarrassment – feel disgusted by self,
depressed, or guilty after
o Marked distress
2
, o At least once a week for 3 months
o No compensatory behavior – doesn’t happen during bulimia or anorexia
• Mild to severe levels (same as bulimia)
o Partial remission -> meet criteria – binge happens less than once a week
o Full remission -> met criteria in past – none have been met for sustained time
• Prevalence = 1.6% in females & 0.8% on males US adults
o Often begins in adolescence/young adulthood -> precedes dieting
o Uncommon cross-over
• Risk factors -> hereditary
• Differential diagnosis -> bulimia (added purging; lower recovery) – obesity (over-evaluation
of body + binging) – bipolar & depression (no focus on body) – borderline personality
• Comorbidity -> bipolar – depression – anxiety – substance use
• OTHER SPECIFIED FEEDING OR EATING DISORDER:
o Atypical anorexia nervosa -> all criteria are met but weight is within or above norm
o Bulimia nervosa of low frequency and/or limited duration -> all criteria are met but
for less than once a week and/or less than 3 months
o Binge-eating disorder of low frequency and/or limited duration -> all criteria are
met but for less than once a week and/or less than 3 months
o Purging disorder -> purging behavior to influence weight in absence of binging
o Night eating syndrome -> eating after awakening or excessive food consumption
after evening meal – sig distress – awareness/recall of it
• UNSPECIFIED FEEDING OR EATING DISORDER:
o Symptoms linked to eating/feeding that cause significant distress/impairment
Can be used in situations with little info (e.g. in emergency room) or if not all
criteria met for any of previous disorders
3
, Reading 2: Cassin (2005) – Personality & eating disorders: a decade in review:
• SUMMARY:
o Aim: review literature explaining the link between personality & ED
Prevalence of personality disorders (PD) in AN; BN; BED
o (AN = anorexia – BN = bulimia – BED = binge-eating disorder)
o AN + BN perfectionism + obsessive compulsiveness + neuroticism + negative
emotionality + harm avoidance + low self-directedness + low cooperativeness
Traits linked to avoidance PD
AN = high constraint & persistence + low novelty seeking
BN = high impulsivity + sensation/novelty seeking + traits linked to borderline
o PD rates of 0-58% in AN & BN (!!! Self-report -> overestimation of prevalence)
• INTRODUCTION:
o Review by Vitousek (1994) -> discuss problems on assessing EDs + recommendation
to improve research in this area
o Purposes of preset review:
Update our understanding of the link between personality & EDs
Incorporate BED (only recently defined)
Look at comorbidity between PDs & EDs (utility of questionnaires)
o Different methods used in studies -> self-report of personality traits + omnibus self-
report + self-report measure of PDs + diagnostic interviews of PDs
• PERSONALITY TRAITS & EATING DISORDERS:
o Self-report measures – mainly correlational (!! Interpret with caution about causality)
• Perfectionism:
o = Tendency to set & perdue unrealistically high standards – despite aversive
consequences
Multidimensional conceptualizations -> adaptive & maladaptive
o ED higher neurotic perfectionism – similar normal perfectionism
o Multidimensional Perfectionism Scale (Hewitt) = 3 dimensions -> (1) self-oriented;
(2) other-oriented; (3) socially prescribed perfectionism
1 + 3 = linked to AN, BN, BED – overall all high (unrealistic expectations )
o Multidimensional Perfectionism Scale (Forst) = concern over mistakes; doubts about
actions; personal standards; parental expectations; parental criticism
ED = high doubt on quality of their performance + react negatively to
mistakes (= failure to them)
o Can predict AN + correlated to AN, BN, BED (also after recovery)
Specifically linked to disordered eating or maladjustment?
• Obsessive-compulsive traits:
o E.g. doubting, checking, need for symmetry/exactness
o More common in EDs – present after recovery
Childhood obsessive traits can predict EDs ( risk of recall bias)
• Impulsivity:
o = Lack of forethought & failure to contemplate risks & consequences before acting
AN = lower – BN = higher (maybe just before episode?)
• Sensation seeking:
o = Need for varied/novel/complex sensations & experiences + willingness to take
physical & social risks
More common with EDs with binging & purging behaviors (BN; BED; ANB)
4
Part 1: DSM & personality:
Reading 1: DSM-5 (APA):
• Mutually exclusive disorders (can only have one):
o Rumination, avoidant/restrictive, anorexia, bulimia, binge-eating
o All have different treatments
• In remission = when meet criteria but not sustained over time
• PICA:
o Eating non-food substances (e.g. clay) – for at least 1 month
o Inappropriate to developmental level of person (e.g. not a child – min 2 years)
o Not part of a culturally/socially supported practice
o If present on top of other psych or medical condition -> severe enough for more
attention
• Unclear prevalence – increased risk in severe intellectual disability
o Can happen during pregnancy
o Develops -> most common during childhood - !! not linked to cultural ritual
o If done to lose weight (e.g. eat paper to suppress hunger) anorexia
o Comorbidity -> autism; intellectual disability; schizophrenia; OCD…
• RUMINATION DISORDER:
o Regurgitation of food (vomit) – can be re-chewed/swallowed/spit – at least 1 month
o Not attributable to medical condition
o Doesn’t happen with anorexia, bulimia, binge-eating, avoidant/restrictive
o If occur in context of other mental disorder -> severe enough to need more attention
• Unclear prevalence – often higher in intellectually disabled
o Self-soothing/stimulating in some infants or people with intellectual disabilities
• AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER:
o Eating disturbance (lack of interest/avoidance) – failure to meet energy/nutrition
(1 or more) Sig weight loss (growth delay in kids) – nutritional deficiency –
dependence on enteral feeding or oral supplements – interference with
psychosocial functioning
o Not explained by lack of available food or cultural practice
o Doesn’t happen with bulimia or anorexia + no disturbance in own body shape
o Not explained by medical or mental disorder – if occur in context of other mental
disorder -> severe enough to need more attention
• No prevalence given – higher risk with anxiety, OCD, autism, ADHD – equal gender
o Can come from extreme sensitivities to smell, color, shape of food
o Lack of interest -> often start in infancy – can continue into adulthood
• ANOREXIA NERVOSA:
o Restriction of energy intake – leads to sig low body weight (= less than min normal)
o Intense fear of gaining weight – behavior to avoid weight gain
o Disturbed experience of own body’s weight/shape – lack of recognition of low weight
• Restriction type = weight loss mainly through diet & exercise – during last 3 months
o Binge-eating/purging type = binge & purging behavior – during last 3 months
o In partial remission -> criteria A isn’t sustainly met – B or C is
1
, In full remission -> all criteria met but not sustained
• Level of severity based on BMI (for kids -> also look at height)
o Concern of weight gain can increase with weight loss
o Some realize they are underweight but still think some parts are too big
• Prevalence = 0.4% in young females – female to male ration = 10:1
o Often begins in adolescence /young adulthood – link to stressful life event (e.g.
leaving home for college) – common remission within 5 years
Crude mortality rate = 5%
• Risk factors -> anxiety, obsessive behavior – cultural norms of thinness (e.g. model) –
hereditary – brain differences compared to healthy control
• Common outcomes -> hematology; serum chemistry; endocrine; electrocardiography; bone
mass…
• Differential diagnosis -> weight loss can occur from other conditions
o MDD – schizophrenia – substance use disorder – social anxiety – OCD – body
dysmorphia – bulimia – avoidant/restrictive food intake
• BULIMIA NERVOSA:
o Recurrent binge eating episodes (= large amount of food in small period of time +
lack of control during the episode)
o Inappropriate compensatory behavior to prevent weight gain (laxatives, vomit, fast)
o Both occur at least once a week for 3 months
o Self-evaluation influenced by body shape & weight
o Doesn’t only occur during episodes of anorexia
• Mild = 1-3 episodes of compensatory behavior per week
o Moderate = 4-7 episodes per week
o Severe = 8-13 episodes per week
o Extreme = 14 or more episodes per week
o Partial remission -> all criteria is met – some but not all for a sustained period of time
o Full remission -> all criteria is met – none for a sustained period of time
• Typically, in normal or overweight BMI range
o Risk of amenorrhea (menstrual irregularities)
• Prevalence = 1-1.5% in young females – highest in young adults – female to male ratio = 10:1
o Often begins in adolescence/young adulthood
o Binging common after dieting
o Crude mortality rate = 2%
• Common to cross-over to anorexia -> often end up back in bulimia
• Risk factors -> weight concern; low self-esteem; depression; social anxiety
o Idealization of thin body – childhood sexual/physical abuse
o Childhood obesity – early maturation – hereditary
• Differential diagnosis -> anorexia binge eating/purging subtype (check diagnostic criteria)
o Binge eating (without compensatory behavior) – Kleine-Levin syndrome (no
overconcern with body shape) – MDD – borderline personality (check criteria)
• BINGE-EATING DISORDER:
o Recurrent episode of binge eating (= large amount of food in small period of time +
lack of control during the episode)
o (3 or more) Eating faster than normal – until uncomfortably full – eating a lot when
not hungry – eating alone because of embarrassment – feel disgusted by self,
depressed, or guilty after
o Marked distress
2
, o At least once a week for 3 months
o No compensatory behavior – doesn’t happen during bulimia or anorexia
• Mild to severe levels (same as bulimia)
o Partial remission -> meet criteria – binge happens less than once a week
o Full remission -> met criteria in past – none have been met for sustained time
• Prevalence = 1.6% in females & 0.8% on males US adults
o Often begins in adolescence/young adulthood -> precedes dieting
o Uncommon cross-over
• Risk factors -> hereditary
• Differential diagnosis -> bulimia (added purging; lower recovery) – obesity (over-evaluation
of body + binging) – bipolar & depression (no focus on body) – borderline personality
• Comorbidity -> bipolar – depression – anxiety – substance use
• OTHER SPECIFIED FEEDING OR EATING DISORDER:
o Atypical anorexia nervosa -> all criteria are met but weight is within or above norm
o Bulimia nervosa of low frequency and/or limited duration -> all criteria are met but
for less than once a week and/or less than 3 months
o Binge-eating disorder of low frequency and/or limited duration -> all criteria are
met but for less than once a week and/or less than 3 months
o Purging disorder -> purging behavior to influence weight in absence of binging
o Night eating syndrome -> eating after awakening or excessive food consumption
after evening meal – sig distress – awareness/recall of it
• UNSPECIFIED FEEDING OR EATING DISORDER:
o Symptoms linked to eating/feeding that cause significant distress/impairment
Can be used in situations with little info (e.g. in emergency room) or if not all
criteria met for any of previous disorders
3
, Reading 2: Cassin (2005) – Personality & eating disorders: a decade in review:
• SUMMARY:
o Aim: review literature explaining the link between personality & ED
Prevalence of personality disorders (PD) in AN; BN; BED
o (AN = anorexia – BN = bulimia – BED = binge-eating disorder)
o AN + BN perfectionism + obsessive compulsiveness + neuroticism + negative
emotionality + harm avoidance + low self-directedness + low cooperativeness
Traits linked to avoidance PD
AN = high constraint & persistence + low novelty seeking
BN = high impulsivity + sensation/novelty seeking + traits linked to borderline
o PD rates of 0-58% in AN & BN (!!! Self-report -> overestimation of prevalence)
• INTRODUCTION:
o Review by Vitousek (1994) -> discuss problems on assessing EDs + recommendation
to improve research in this area
o Purposes of preset review:
Update our understanding of the link between personality & EDs
Incorporate BED (only recently defined)
Look at comorbidity between PDs & EDs (utility of questionnaires)
o Different methods used in studies -> self-report of personality traits + omnibus self-
report + self-report measure of PDs + diagnostic interviews of PDs
• PERSONALITY TRAITS & EATING DISORDERS:
o Self-report measures – mainly correlational (!! Interpret with caution about causality)
• Perfectionism:
o = Tendency to set & perdue unrealistically high standards – despite aversive
consequences
Multidimensional conceptualizations -> adaptive & maladaptive
o ED higher neurotic perfectionism – similar normal perfectionism
o Multidimensional Perfectionism Scale (Hewitt) = 3 dimensions -> (1) self-oriented;
(2) other-oriented; (3) socially prescribed perfectionism
1 + 3 = linked to AN, BN, BED – overall all high (unrealistic expectations )
o Multidimensional Perfectionism Scale (Forst) = concern over mistakes; doubts about
actions; personal standards; parental expectations; parental criticism
ED = high doubt on quality of their performance + react negatively to
mistakes (= failure to them)
o Can predict AN + correlated to AN, BN, BED (also after recovery)
Specifically linked to disordered eating or maladjustment?
• Obsessive-compulsive traits:
o E.g. doubting, checking, need for symmetry/exactness
o More common in EDs – present after recovery
Childhood obsessive traits can predict EDs ( risk of recall bias)
• Impulsivity:
o = Lack of forethought & failure to contemplate risks & consequences before acting
AN = lower – BN = higher (maybe just before episode?)
• Sensation seeking:
o = Need for varied/novel/complex sensations & experiences + willingness to take
physical & social risks
More common with EDs with binging & purging behaviors (BN; BED; ANB)
4
