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LECTURE: FEEDING AND EATING DISORDERSYoung and younger people be diagnosed with this disorderUsed to be called eating disorders in earlier versions of DSM but now they have feeding and eating to combine in some childhood disorders related to abnormal eatingFeeding and Eating Disorders: DSM-5Anorexia Nervosa – believe they are over weight and will starveBulimia Nervosa – binges and purges the food by vomiting or excessive exercise, etcBinge Eating Disorder – similar to bulimia but you don’t have the vomiting or exercise. Over weight, obese individualsChildhood disorders: involve injection of substances+Pica+rumination disorder+avoidant/restrictive food intake disorderFeeding and Eating Disorders: DSM-5Pica: young child/young adolescent eat nonnutritive, non food substances which is inappropriate to the developmental level of individualEx eating paint chipsRumination disorder: person regurgitates the food that they eat for atl east one monthEven sweet foods, comfort foodAvoidant/restrictive food intake disorder: lack of interest in eating. Someone who is not focused on foodSome people eat to live, or live to eat but these people don’t even think about eating and don’t want to eatAvoidance based on sensory part of food such as smell of peas or the way that yogurt curdlesTHESE ARE ALL BEHAVIORIAL!Most of them can be treated with behavioral therapyA child who has either one of these three is not going to be at an increased risk of developing anorexia, bulimia, or binge eatingAnorexia Nervosa: DSM-5Restriction of food/liquid (energy) intakeSignificantly low body weight in context to physical healthThey get very low body weight because they are starving themselves and are eating very little amount of foodThey look skin and boneTend to wear baggy clothes, turtle necks to hide itBehavior or person limiting caloric intake to become grossly underweightIf you fall below 85% of what BMI suggests then you would meet the criteria for significant body weightPerceptional disturbance: intense fear of gaining weight or becoming fatPerception of themselves that they are grossly over weightAnorexia Nervosa Severity: DSM:5//21-25 is normal healthyMild: BMI >= 17 kg/m2 – 20/21 kg/m2Underweight but not causing physical damage yetModerate: BMI 16-16.99 kg/m2Severe: BMI 15-15.99 kg/m2Extreme: BMI <15 kg/m2Your metabolic rate changes, cardiovascular problems in severe and extreme rangeThey have atrial fibrillation and look like much older person who has clogged arteriesTypes of Anorexia NervosaRestrictive TypeBinge-Eating/Purging TypeRestricting Type: DSM-5Classic type: person literally starves themselves and consumes very little amounts of food. Do things like how long will I get today just by eating a granola barUses a laxative -> forcing body to defecate what they eatDon’t engage in binge-purge cycleThink that others are trying to get them to gain weight.Ex. When family member thinks they look thin they want to cook them a meal or take them outDeny they have a problem at allWill keep their weight down by not eating or through excessive exerciseMost COMMON typeBinge-Eating/Purging TypeUse vomiting, misuse laxative to purge themselves of what they have consumedVomit until blood comes outMake elaborate choleric charts of what they took in and what they need to rid their body ofVery low weightTrouble controlling impulsesProblems with drugs/alcohol or self mutilation (cutting, scarring, burning)This type has the more chronic courseOne substance that is abused is ipecac -> will automatically cause you to vomitEpidemiology of anorexia nervosaMaybe more biologically drivenGender difference: 90-95% of people diagnosed are women. Men do suffer but more often in women than menBegins in adolescence between 15 – 19 years of age. Not uncommon to see kids even in single digits restricting dietDeath rate is 15%When person doesn’t eat the amount of calories its supposed to, it will take its toll on your bodySlow heart rate, heart failure, heart attacksTreatment: First is to get the person fed and then psychotherapyBulimia Nervosa: DSM-5Recurrent episodes of binge eating: doing it quiet regularlyBinge: eating in a discrete period of time (2 hours for example) and amount of food that is larger than what most people would eatChoose to eat high fat, high sugar, caloric food or will turn to sugar packets, large amount of milk, eat all the cereal, eat sticks of butter, all the ice cream in the fridgeLacks control and cannot stop that binge ***Fasting so person may binge and not eat for a while or engage in excessive exercise for 6 hours or 8 hoursOccurs at least once a week for three monthsLook at themselves and see themselves as overweight and need to lose weight. Not as extreme as what you see in anorexiaThey feel horrible doing it and feel guilty about what they have done and try to reduce the guilt by purgingThe frequency in which they purge that determines the severity:Mild: 1-3 episodes per weekModerate: 4-7 episodes per weekSevere: 8-13 episodes per weekExtreme: 14 or more episodes per weekMost of this is done in secrecy so they will not get discovered.Types of Bulimia NervosaPurging typeNon purging typeExercise fad in late 70s and early 80sSomeone who has binge but uses exercise or fasting for daysDifferential DiagnosisBinge – purge type anorexia differences from purge type of bulimia in three ways:1. 85% (15%) below where healthy BMI is supposed to bevast majority of people with bulimia look normal or slightly above body weight2. women will lose menstrual cycle. Lower the weight goes, the most disruption in menstrual cycles3. someone who has anorexia will not binge at that level or degree of food. Person is subsisting on 500 calories a day, a binge to them is having 2 extra slices of pizza. Volume is much lower than what you see in bulimia but still engage in extreme type of purgingPeople will bulimia tend to be more impulsive than anorexiaSexual promiscuity, stealing, etcEpidemiology of Bulimia NervosaMuch more common in women than menBulimia range extends to 15-29 years of ageNot a high death rate but high levels of anxiety and depressionSee things like electrolyte imbalance when person purgesWon’t feel wellReferrals from dentists who see a wearing of enamel in their teeth due to stomach acid from purgingAN/BN SimilaritiesFear of becoming obsessDrive to become thin-> addition to become thinAnxiety, depression, obsessiveness, perfectionistsHeighted risk of suicide attemptsSubstance

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