W2-Eating disorders: Assessment and diagnosis

Cards (50)

  • Eating Disorders
    Serious mental health conditions characterized by abnormal eating behaviors and attitudes that negatively impact physical and mental health
  • Eating disorders have increased over the past several decades
  • Eating disorders have serious health consequences
  • Eating disorders have low recovery rates
  • Eating disorders have higher mortality rates than other psychiatric disorders
  • 90% of people with eating disorders are women
    1. 3% of women will have an eating disorder in their lifetime
  • Most eating disorders begin in adolescence or young adulthood
  • Eating disorders can lead to cardiac issues
  • Types of Eating Disorders

    • Pica
    • Rumination Disorder
    • Avoidant/Restrictive Food Intake Disorder
    • Anorexia Nervosa
    • Bulimia Nervosa
    • Binge-Eating Disorder
    • Other Specified Feeding or Eating Disorder
    • Unspecified Feeding or Eating Disorder
  • Pica
    Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month
  • Rumination Disorder
    Repeated regurgitation of food over a period of at least 1 month
  • Avoidant/Restrictive Food Intake Disorder (ARFID)

    Eating or feeding disturbance characterized by persistent failure to meet appropriate nutritional and/or energy needs, associated with significant weight loss, nutritional deficiency, dependence on enteral feeding or oral supplements, or marked interference with psychosocial functioning
  • ARFID is not better explained by lack of available food or a culturally sanctioned practice, does not occur exclusively during another eating disorder, and is not attributable to another mental disorder or medical condition
  • Anorexia Nervosa (AN)
    Restriction of energy intake leading to markedly low body weight, intense fear of gaining weight or becoming fat, and disturbances in the way one's body weight or shape is experienced
  • Anorexia Nervosa Subtypes
    • Restricting
    • Binge eating/purging
  • Anorexia Nervosa Specifiers
    • In partial remission
    • In full remission
    • Current severity (based on BMI)
  • Anorexia Nervosa Behaviors
    Eating disorder "rules", significantly reduced quantity and variety of food, calorie/fat counting, ritualistic eating, obsessive interest in food
  • Orthorexia
    Obsession with eating "pure", "perfect", "clean" foods, leading to significant social, occupational, and/or nutritional problems
  • Bulimia Nervosa (BN)

    Recurrent episodes of binge eating (eating an abnormally large amount of food w/in a short amount of time with a sense of lack of control) followed by inappropriate compensatory behaviors like self-induced vomiting, misuse of laxatives/diuretics, fasting, or excessive exercise
  • Bulimia Nervosa Specifiers
    • In partial remission
    • In full remission
    • Severity (based on average number of binge/purge episodes per week)
  • Bulimia Nervosa Behaviors
    Eating rapidly, secret eating, excessive/secretive exercise, prioritizing compensatory behaviors over other activities, emotional dysregulation
  • Other Specified Feeding or Eating Disorder

    Includes conditions like atypical anorexia nervosa, purging disorder, and low-frequency/limited duration bulimia nervosa or binge-eating disorder
  • Unspecified Feeding or Eating Disorder

    Eating disorders that do not meet the full criteria for any of the specific feeding and eating disorder diagnoses
  • Other Specified Feeding or Eating Disorder (OSFED) is more than 50% of all diagnosed eating disorders, has rates of death similar to Anorexia Nervosa, and 50% of patients are admitted to tertiary care
  • Examples of OSFED
    • Atypical Anorexia Nervosa
    • Purging Disorder
    • Low-frequency and/or limited duration Bulimia Nervosa or Binge-Eating Disorder
  • Unspecified Feeding or Eating Disorder (UFED) is used when the clinician chooses not to specify the reason that the criteria are not met for a specific disorder, or when there is insufficient information to make a more specific diagnosis
  • Psychiatric Comorbidities
    • Affective disorders (depression, bipolar)
    • Anxiety disorders (OCD, social anxiety, GAD, PTSD)
    • Personality disorders (Borderline Personality Disorder)
    • Substance abuse
    • Suicidality
  • Comorbidity prevalence: 15-50% of Anorexia Nervosa Restrictive type have major depressive disorder (compared to ~17% in general population), 46-80% of Anorexia Nervosa Binge-Purge type have major depressive disorder, 50-65% of Bulimia Nervosa have major depressive disorder, 30-60% of eating disorder sufferers are victims of rape or childhood abuse, 37% of Anorexia Nervosa patients had comorbid OCD vs. 3% of Bulimia Nervosa patients, 54% of patients with Borderline Personality Disorder have some eating disorder
  • Suicide rates: 20% of Anorexia Nervosa patients attempt suicide, up to 4% complete suicide; 35% of Bulimia Nervosa patients attempt suicide, but actual suicide rates are no higher than non-Bulimia Nervosa population
  • Medical Consequences of Eating Disorders
    • Amenorrhea (loss of menses)
    • Stomach pain/Constipation
    • Fatigue
    • Cold intolerance
    • Light-headedness
    • Signs of emotional/cognitive blunting
  • Other Medical Consequences
    • CNS (brain changes)
    • Cardiovascular: (cardiac dysfunction, arrhythmias, prolonged QT interval, bradycardia, hypovolemia/hypotension)
    • Renal/Metabolic (kidney): (electrolyte disturbances - hypokalemia, hypoglycemia)
    • Musculoskeletal
    • Reproductive
    • Endocrine/metabolic
    • Gastrointestinal
    • Oroparyngeal
    • Severe Malnutrition - <75% ideal body weight
    • Rapid weight loss despite interventions
    • Intractible binge-purge episodes
  • Factors to Consider:
    Factors that may contribute to the development of eating disorders include diets gone awry, as many people diet in our culture but relatively few develop Anorexia, Bulimia. Binge-eating disorder is most common.
  • Neurochemistry of ED's:
    Patients with Bulimia Nervosa appear to have lower levels of serotonin, and acute tryptophan depletion increases depressive mood and mood lability in both ill and recovered bulimics. Patients w/ BN tend to respond well to antidepressants (SSRIs)
  • Neurochemistry Cont'd:
    Patients with Anorexia Nervosa appear to be hyperserotonergic.
    Hypothesis: at baseline, AN patients have higher than normal levels of serotonin activity, which contributes to the premorbid anxiety and obsessionality frequently observed in these patients.
    During the acute phase of illness, patients w/ AN have lower serotonin activity due to dietary-induced reduction of the amino acid tryptophan thus decreasing their anxiety.
  • Emotion dysregulation:
    Individuals who engage in restrictive eating appear more over-controlled, anhedonic, and constricted, while those who engage in binging and purging appear more under-controlled, volatile, and emotionally labile. Some evidence that ED behaviors help control emotions.
  • Assessment Measures
    • Eating Disorders Examination (EDE)
    • Eating Disorders Inventory (EDI)
    • Binge Rating Form
    • Mood, trait, and affect questionnaires
  • Assessment Information Gathered
    • History of eating patterns, body image concerns, and life events
    • Previous treatment for eating disorder, substance use, and/or mood disorder
    • Presenting problem or reason seeking treatment
  • Assessment: thorough understanding of ED history
    • Daily caloric intake
    • Daily fluid intake
    • Menstrual history (females)
    • Lifetime highest and lowest weight
    • Significant recent weight loss or gain
  • Comorbidities Assessed
    • Mood disorder concerns
    • Anxiety (panic attacks, OCD traits)
    • Physical or sexual traumas
    • Previous psychiatric hospitalizations
    • Family history of mental illness