Eating, Anxiety, OCD, etc,.

• Feeding and Eating Disorders


  Characterized by a persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning
• Pica is the persistent eating of nonnutritive, nonfood substances over a period of at least 1 month
• Pica


  • The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual
  • The eating behavior is not part of a culturally supported or socially normative practice
  • If the eating behavior occurs in the context of another mental disorder or medical condition, it is sufficiently severe to warrant additional clinical attention
• Rumination Disorder


  • Repeated regurgitation of food over a period of at least 1 month
  • The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition
  • The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder
  • If the symptoms occur in the context of another mental disorder, they are sufficiently severe to warrant additional clinical attention
• Avoidant/Restrictive Food Intake Disorder

  • An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs
  • The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice
  • The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one's body weight or shape is experienced
  • The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder
• Anorexia Nervosa


  • Restriction of energy intake relative to requirements, leading to a significantly low body weight
  • Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain
  • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
• Typical warning signs and symptoms of Anorexia Nervosa

  • Emotional/behavioral symptoms: dramatic weight loss, preoccupation with food, weight, calories, etc., frequent comments about feeling "fat," eating a restricted range of foods, making excuses to avoid mealtimes, not eating in public
  • Physical changes: dizziness, difficulty concentrating, feeling cold, sleep problems, thinning hair/hair loss, muscle weakness
• When the individual with Anorexia Nervosa loses weight, they view this as an impressive achievement and a sign of extraordinary discipline, while weight gain is seen as an unacceptable failure of self-control
• Bulimia Nervosa


  • Recurrent episodes of binge eating
  • Recurrent inappropriate compensatory behaviors in order to prevent weight gain
  • The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months
  • Self-evaluation is unduly influenced by body shape and weight
• Signs and symptoms of Bulimia Nervosa


  • Hiding food wrappers or containers after a bingeing episode, feeling uncomfortable eating in public, developing food rituals, limited diet, disappearing to the bathroom after eating a meal, drinking excessive amounts of water or non-caloric beverages
  • Weight fluctuations both up and down, difficulty concentrating, dizziness, sleep disturbance, possible dental problems due to purging post binge eating episode
• Diagnosis of Anorexia Nervosa


  If severe calorie restriction occurs alone
• Diagnosis of Bulimia Nervosa


  If severe calorie restriction occurs AND there is a binge-eating episode
• Binge-Eating Disorder


  • Recurrent episodes of binge eating
  • The binge-eating episodes are associated with three or more of the following: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or very guilty afterward
  • Marked distress regarding binge eating is present
  • The binge eating occurs, on average, at least once a week for 3 months
  • The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa
• Diagnosis of Binge-Eating Disorder


  If binge eating occurs alone
• Diagnosis of Bulimia Nervosa


  If binge eating occurs AND there are compensatory behaviors to prevent weight gain
• More women (0.3-0.4%) than men (0.1%) will be diagnosed with anorexia
• Anorexia nervosa is most prevalent in post industrialized, high-income countries such as the United States, Australia, New Zealand, Japan, and many European countries
• 1.0% of women and 0.1% of men will meet the diagnostic criteria for bulimia nervosa
• Binge-Eating Disorder is three times more common than anorexia and bulimia and is more common than breast cancer, HIV, and schizophrenia
• Biological factors in eating disorders

  • If an identical twin is diagnosed with anorexia, there is a 70% percent chance the other twin will develop anorexia
  • Disruption in the neuroendocrine system is common in those with eating disorders
  • The hypothalamus is responsible for regulating body functions, particularly hunger and thirst, and a disruption in the lateral or ventromedial hypothalamus could explain issues with calorie intake or overeating
• Personality characteristics in the etiology of eating disorders

  • Perfectionism magnifies normal body imperfections, leading an individual to go to extreme (i.e., restrictive) behaviors to remedy the flaw
  • Overall low self-esteem increases the risk for over-evaluation of body, which in turn, leads to negative eating behaviors that could lead to an eating disorder
• Treatment for Anorexia Nervosa

  1. Cognitive Behavioral Therapy: recording eating and emotional behaviors, addressing maladaptive thought patterns regarding negative body image

  2. Family-Based Therapy: 16-18 sessions, 3 phases - parents take charge of weight restoration, client's gradual control of overeating, and addressing developmental issues including fostering autonomy from parents
• Treatment for Bulimia Nervosa


  1. CBT: journaling

  2. Exposure and response prevention (write their thoughts and feelings in a journal at the kitchen table)
• Treatment for Binge-Eating Disorder


  1. CBT

  2. Interpersonal Therapy
• Anxiety Disorder


  The excessive fear and anxiety and related behavioral disturbances
• Separation Anxiety Disorder


  • The excessive fear or anxiety concerning separation from home or attachment figures
  • Symptoms include recurrent excessive distress when anticipating or experiencing separation, persistent worry about losing major attachment figures or about possible harm to them, persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation, persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings, repeated nightmares about separation
• Symptoms of Separation Anxiety Disorder

  • Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures
  • Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death
  • Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure
  • Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
  • Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
  • Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
  • Repeated nightmares involving the theme of separation
  • Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated
• The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults
• The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning
• The disturbance is not better explained by another mental disorder
• Bulimia Nervosa is an eating disorder where the person eats large amounts of food at once (binge) then tries to get rid of it through vomiting, laxatives, fasting, or excessive exercise.
• Bulimia Nervosa is an eating disorder where the person binges on large amounts of food followed by purging (vomiting) or excessive exercise.
• Anorexia Nervosa is an eating disorder that involves self-starvation due to distorted perceptions about one's own body size and shape.
• Anorexia Nervosa is an eating disorder where the person restricts their caloric intake to lose weight.
• Eating Disorders are characterized by extreme emotions, attitudes, and behaviors involving food intake or body weight/shape
• Eating Disorders are characterized by extreme emotions, attitudes, and behaviors surrounding food intake or body weight/shape
• Avoidant Personality Disorder is a personality disorder characterized by feelings of social isolation, low self-esteem, hypersensitivity to criticism, and fear of rejection.
• Avoidant Personality Disorder is characterized by social anxiety, fear of rejection, and difficulty forming close relationships with others.