Feeding and Eating Disorders DSM 5 Anorexia Nervosa believe they are over weight and will starve Bulimia Nervosa binges and purges the food by vomiting or excessive LECTURE FEEDING AND EATING DISORDERS Young and younger people be diagnosed with this disorder Used 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 eating exercise etc vomiting or exercise Over weight obese individuals Feeding and Eating Disorders DSM 5 Pica young child young adolescent eat nonnutritive non food substances which is inappropriate to the developmental level of individual Childhood disorders involve injection of substances Pica rumination disorder avoidant restrictive food intake disorder Binge Eating Disorder similar to bulimia but you don t have the Ex eating paint chips Rumination disorder person regurgitates the food that they eat for atl east one month Even sweet foods comfort food Avoidant restrictive food intake disorder lack of interest in eating Someone who is not focused on food Some people eat to live or live to eat but these people don t even think about eating and don t want to eat Avoidance based on sensory part of food such as smell of peas or the way that yogurt curdles THESE ARE ALL BEHAVIORIAL Most of them can be treated with behavioral therapy A child who has either one of these three is not going to be at an increased risk of developing anorexia bulimia or binge eating and are eating very little amount of food Anorexia Nervosa DSM 5 Restriction of food liquid energy intake Significantly low body weight in context to physical health They get very low body weight because they are starving themselves They look skin and bone Tend to wear baggy clothes turtle necks to hide it Behavior or person limiting caloric intake to become grossly underweight criteria for significant body weight fat If you fall below 85 of what BMI suggests then you would meet the Perceptional disturbance intense fear of gaining weight or becoming Perception of themselves that they are grossly over weight Anorexia Nervosa Severity DSM 5 21 25 is normal healthy Mild BMI 17 kg m2 20 21 kg m2 Underweight but not causing physical damage yet Moderate BMI 16 16 99 kg m2 Severe BMI 15 15 99 kg m2 Extreme BMI 15 kg m2 Your metabolic rate changes cardiovascular problems in severe and extreme range They have atrial fibrillation and look like much older person who has clogged arteries Types of Anorexia Nervosa Restrictive Type Binge Eating Purging Type Restricting Type DSM 5 Classic 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 bar Uses a laxative forcing body to defecate what they eat Don t engage in binge purge cycle Think 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 out Deny they have a problem at all Will keep their weight down by not eating or through excessive Most COMMON type exercise consumed Binge Eating Purging Type Use vomiting misuse laxative to purge themselves of what they have Vomit until blood comes out Make elaborate choleric charts of what they took in and what they need to rid their body of Very low weight Trouble controlling impulses Problems with drugs alcohol or self mutilation cutting scarring This type has the more chronic course One substance that is abused is ipecac will automatically cause you burning to vomit Epidemiology of anorexia nervosa Maybe more biologically driven Gender difference 90 95 of people diagnosed are women Men do suffer but more often in women than men Begins in adolescence between 15 19 years of age Not uncommon to see kids even in single digits restricting diet Death rate is 15 When person doesn t eat the amount of calories its supposed to it will take its toll on your body Slow heart rate heart failure heart attacks Treatment First is to get the person fed and then psychotherapy Bulimia Nervosa DSM 5 Recurrent episodes of binge eating doing it quiet regularly Binge eating in a discrete period of time 2 hours for example and amount of food that is larger than what most people would eat Choose 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 fridge Lacks 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 hours Occurs at least once a week for three months Look at themselves and see themselves as overweight and need to lose weight Not as extreme as what you see in anorexia They feel horrible doing it and feel guilty about what they have done and try to reduce the guilt by purging The frequency in which they purge that determines the severity Mild 1 3 episodes per week Moderate 4 7 episodes per week Severe 8 13 episodes per week Extreme 14 or more episodes per week Most of this is done in secrecy so they will not get discovered Types of Bulimia Nervosa Purging type Non purging type Exercise fad in late 70s and early 80s Someone who has binge but uses exercise or fasting for days Differential Diagnosis three ways body weight Binge purge type anorexia differences from purge type of bulimia in 1 85 15 below where healthy BMI is supposed to be vast majority of people with bulimia look normal or slightly above 2 women will lose menstrual cycle Lower the weight goes the most disruption in menstrual cycles 3 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 purging People will bulimia tend to be more impulsive than anorexia Sexual promiscuity stealing etc Epidemiology of Bulimia Nervosa Much more common in women than men Bulimia range extends to 15 29 years of age Not a high death rate but high levels of anxiety and depression See things like electrolyte imbalance when person purges Won t feel well Referrals from dentists who see a wearing of enamel in their teeth due to stomach acid from purging AN BN Similarities Fear of becoming obsess Drive to become thin addition to become thin Anxiety depression obsessiveness perfectionists Heighted risk of suicide attempts Substance abuse Particularly in bulimia Disturbed