Introduction to Eating Disorders

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Introduction to Eating Disorders
Anorexia Nervosa Clinical features and
prevalence. Bulimia Nervosa Clinical features
and prevalence.
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Anorexia Nervosa (AN)
Clinical Criteria (DSM IV) for AN

• 1) Refusal to maintain body weight (BW) at or
  above a minimally normal weight for age and
  height.
• BW lt 85 of normal
• BMI lt 17.5 kg/m2

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Body Mass Index
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Criteria for AN (cont.)
2) Intense fear of gaining weight or becoming
fat. 3) Disturbance of body image. 4)
Amenorrhea (primary or secondary).
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Subtypes of AN
Restricting Type Engages in caloric restriction
(dieting) and does not include binge eating or
purging.
Binge Eating/Purging Type Engages in binge
eating and purging behavior (vomiting, abuse of
laxatives, diuretics, enemas).
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Features of AN

• food fixations
• might prepare elaborate meals for others
• collect recipes
• obsession with caloric/macronutrient content of
  food
• may hoard, conceal, throw away food
• deny that they have an eating disorder
• often resistant to therapy
• socially withdrawn to help conceal their eating
  disorder

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Prevalence of AN

• prevalence 1 2 US population
• age of onset adolescence, often around
  puberty
• sexually dimorphic female gtgtgt male
• mortality rates 5 to 18
• typically, starvation leads to heart attack
  and/or organ failure
• psychological profile
• perfectionist
• dichotomous thinking
• pushed to succeed by family or self
• acceptance from others based on physical
  appearance

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Bulimia Nervosa (BN)
Clinical criteria (DSM IV) for BN
1) Recurrent episodes of binge eating. An
episode of binge eating is characterized by both
of the following a) eating, in a discrete
period of time (e.g., within any 2-h period) an
amount of food that is definitely larger than
most people would eat during a similar period of
time and under similar circumstances b) a
sense of lack of control over eating during the
episode (e.g., a feeling that one cannot stop
eating or control what or how much one is eating)
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Criteria for BN (cont.)

• 2) Recurrent inappropriate compensatory behavior
  in order to prevent weight gain, such as
  self-induced vomiting misuse of laxatives,
  diuretics, enemas, or other medications fasting
  excessive exercise.
• 3) The binge eating and inappropriate
  compensatory behaviors both occur, on average, at
  least twice a week for 3 months.
• 4) Self evaluation is unduly influenced by body
  shape and weight.
• 5) The disturbance does not occur exclusively
  during episodes of anorexia nervosa.

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Subtypes of BN
Purging Type During the current episode of
bulimia nervosa, the person has regularly engaged
is self-induced vomiting or the misuse of
laxatives, diuretics, and/or enemas.
Nonpurging Type During the current episode of
bulimia nervosa, the person has used other
inappropriate compensatory behaviors, such as
fasting and/or excessive exercise, but has not
regularly engaged in self-induced vomiting or the
misuse of laxatives, diuretics, or enemas.
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Features of BN

• caloric restriction often sets up a binge
• binge on forbidden foods that can be eaten
  rapidly
• ice cream, chocolate, chips, cookies
• unable to control the binge because they know
  they will purge
• secretive behavior
• purging is initially associated with relief
  (psychological physiological) but feelings of
  relief give way to guilt and shame

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Prevalence of BN

• prevalence 4 10 of US population
• age of onset adolescence to mid 30s
• sexually dimorphic female gtgt male
• psychological profile
• often recovered anorexics
• may abuse other drugs
• may engage in self abusive behavior

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