FEEDING AND EATING DISORDERS

WHAT ARE EATING DISORDERS (ED)?

 MENTAL DISORDER
 INSUFFICIENT OR EXCESSIVE FOOD INTAKE THAT CAUSES PHYSICAL AND MENTAL IMPAIRMENT
 ASSOC WITH THOUGHTS, ATTITIUDE AND EMOTIONS
 PTS CAN APPEAR UNDERWEIGHT, OVERWEIGHT OR NORMAL
WHAT ARE THE TYPES OF ED?
 ANOREXIA NERVOSA
MORE ASSOCIATED WITH YOUNG
 BULIMIA NERVOSA
ADULTHOOD
 BINGE-EATING

WHAT IS ANOREXIA NERVOSA (AN)?

 A) CANNOT MAINTAIN NORMAL BODY WEIGHT, B) HAVE A FEAR OF WEIGHT GAIN THOUGH
UNDERWEIGHT AND C) DISTORTED BODY PERCEPTION (ALWAYS BELIEVING THEY ARE FAT)
HOW DO YOU SPECIFY AN?
 CURRENT SEVERITY BASED ON BMI:
 MILD: BMI ≥17 KG/M2
 MODERATE: BMI 16–16.99 KG/M2
 SEVERE: BMI 15–15.99 KG/M2
 EXTREME: BMI<15 KG/M2
 RESTRICTING TYPE VS BINGE-EATING/PURGING TYPE:
 DURING THE LAST 3 MONTHS, THE INDIVIDUAL HAS:
 NOT ENGAGED IN RECURRENT EPISODES OF BINGE EATING OR PURGING BEHAVIOR
(I.E., SELF-INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR
ENEMAS). THIS SUBTYPE DESCRIBES PRESENTATIONS IN WHICH WEIGHT LOSS IS
ACCOMPLISHED PRIMARILY THROUGH DIETING, FASTING, AND/OR EXCESSIVE
EXERCISE OR
 ENGAGED IN RECURRENT EPISODES OF BINGE EATING OR PURGING BEHAVIOR (I.E.,
SELF-INDUCED VOMITING OR THE MISUSE OF LAXATIVES, DIURETICS, OR ENEMAS)
 PARTIAL REMISSION VS FULL REMISSION:
 AFTER FULL CRITERIA FOR ANOREXIA NERVOSA WERE PREVIOUSLY MET:
 CRITERION A (LOW BODY WEIGHT) HAS NOT BEEN MET FOR A SUSTAINED PERIOD,
BUT EITHER CRITERION B (INTENSE FEAR OF GAINING WEIGHT OR BECOMING FAT OR
BEHAVIOR THAT INTERFERES WITH WEIGHT GAIN) OR CRITERION C (DISTURBANCES IN
SELF-PERCEPTION OF WEIGHT AND SHAPE) IS STILL MET OR
 NONE OF THE CRITERIA HAVE BEEN MET FOR A SUSTAINED PERIOD OF TIME
WHICH GENDER AND/OR AGE GROUP IS MORE ASSOCIATED WITH AN?
 PREPUBERTAL GIRLS AND IN BOYS; 10 - 20% MORE IN FEMALES THAN MALES
 MIDTEENS (14 - 18) WITH 5% IN THEIR EARLY 20s
WHAT ARE THE COMORDIB PSYCHIATRIC CONDITIONS ASSOC WITH AN?
 DEPRESSION
 SOCIAL PHOBIA
 OCD
 DEPRESSION, DRUG, ALCOHOL, PANIC DISORDER, MANIA/HYPOMANIA, ANXIETY DISORDER
WHAT ARE SOME CAUSES OF AN?
 DIMINISHED NOREPINEPHRINE TURNOVER AND ACTIVITY ARE SUGGESTED BY REDUCED 3-
METHOXY-4-HYDROXYPHENYLGLYCOL (3-M-4-HPG) LEVELS IN THE URINE AND THE
CEREBROSPINAL FLUID (CSF)
 FAMILIAL
 SOCIAL INFLUENCE
WHAT ARE THE TREATMENT THERAPIES?
 HOSPITALIZATION MAY BE NECESSARY IN EXTREME CASES
 COGNITIVE BEHAVIORAL (CBT) - TAUGHT TO MONITOR FOOD INTAKE, FEELINGS, BEHAVIOURS
 DYNAMIC PSYCHOTHERAPY - PSYCHOTHERAPISTS IS UNDERSTANDING TOWARDS THEIR
THOUGHTS AND FEELINGS EXPRESSED
 FAMILY THERAPY
 CYPROHEPTADINE (ANTIHISTAMINIC), AMITRIPTYLINE
WHAT ARE THE EFFECTS OF AN?
 BONES, MUSCLES, HAIR, AND NAILS BECOME WEAK AND BRITTLE
 DEVELOP LOW BLOOD PRESSURE, SLOWED BREATHING AND PULSE
 LETHARGIC, SLUGGISH, AND FATIGUED
 GASTROINTESTINAL SYSTEM FUNCTIONS ABNORMALLY
 HEART AND BRAIN DAMAGE
 MULTIPLE ORGAN FAILURE

WHAT IS BULIMIA NERVOSA (BM)?

 CHARACTERIZED BY EPISODES OF BINGE EATING (GIVING INTO HUNGER PANGS) FOLLOWED BY
PHYSICAL DISCOMFORT—FOR EXAMPLE, ABDOMINAL PAIN OR NAUSEA—TERMINATES THE
BINGE EATING, WHICH IS OFTEN FOLLOWED BY FEELINGS OF GUILT, DEPRESSION, OR SELF-
DISGUST COMBINED WITH INAPPROPRIATE WAYS OF STOPPING WEIGHT GAIN (PURGING BY
MEANS OF VOMIITNG, LAXATIVES, DIURETICS
 MAINTAIN NORMAL WEIGHT
 AT LEAST ONE EPISODE WEEKLY FOR 3 MONTHS
WHAT ARE THE TREATMENTS FOR BM?
 FLUOXETINE (SSRI), IMIPRAMIDE, TRAZODONE, DESIPRAMINE
 CBT - FIRST LINE TREATMENT; TRY TO STOP LIFESTYLE AND ENCOURAGE HEALTHY EATING
HABITS AND HEALTHY SELF-PERCEPTION
WHAT ARE THE EFFECTS OF BM?
 IPECAC SYRUP HAS TOXIC EFFECTS
 DENTAL DECAY (BILE FROM STOMACH CONTENTS)
 LAXATIVES, DIURETICS, AND DIET PILLS ALSO HAVE TOXIC EFFECTS OVER TIME
 GASTROINTESTINAL DAMAGE MAY BE PERMANENT

WHAT IS BINGE-EATING DISORDER?

WHAT ARE FEEDING DISORDERS?

 INVOLVES A CHILD’S OR AN ADULT’S REFUSAL TO EAT CERTAIN FOOD GROUPS, TEXTURES,
SOLIDS, OR LIQUIDS FOR A PERIOD OF AT LEAST ONE MONTH, WHICH CAUSES THEM TO NOT
GAIN OR MAINTAIN ENOUGH WEIGHT OR GROW NATURALLY
WHAT ARE THE TYPES OF FD?
 PICA
 ARFID MORE ASSOC WITH INFANCY AND
 RUMINATION DISORDER EARLY CHILDHOOD

WHAT IS PICA?
 PERSISTENT EATING OF NONNUTRITIVE SUBSTANCES
 EXCEPT IN AUTISM SPECTRUM DISORDER AND INTELLECTUAL DISABILITY, PICA OFTEN REMITS BY
ADOLESCENCE
 PICA-LIKE SYMPTOMS EXPERIENCED IN PREGNANCY ARE LIMITED TO PREGNANCY
WHAT ARE SOME MEDICAL CONDITIONS ASSOC WITH PICA?
 POISONING EX LEAD POISONING DUE TO INGESTION OF LEAD CONTAINING PAINT CHIPS
 INTESTINAL INFECTIONS
 INTESTINAL OBSTRUCTIONS
 GEOPHAGY - EATING OF CLAY OR DIRT
 AMYLOPHAGIA - EATING OF STARCH
 CRAVINGS OF DIRT AND ICE SIGNIFY IRON OR ZINC DEFICIENCY
WHAT ARE THE CRITERIAS FOR PICA?
 PERSISTENT EATING OF NONNUTRITIVE, NONFOOD SUBSTANCES OVER A PERIOD OF AT LEAST 1
MONTH (MINIMUM AGE OF 2 YEARS)
 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 (E.G.,
INTELLECTUAL DISABILITY [INTELLECTUAL DEVELOPMENTAL DISORDER], AUTISM SPECTRUM
DISORDER, SCHIZOPHRENIA) OR MEDICAL CONDITION (INCLUDING PREGNANCY), IT IS
SUFFICIENTLY SEVERE TO WARRANT ADDITIONAL CLINICAL ATTENTION
 SPECIFY IF:
 IN REMISSION: AFTER FULL CRITERIA FOR PICA WERE PREVIOUSLY MET, THE CRITERIA HAVE
NOT BEEN MET FOR A SUSTAINED PERIOD OF TIME
WHAT ARE THE TREATMENT OPTIONS FOR PICA?
 MOST TREATMENT IS AIMED AT EDUCATION AND BEHAVIOUR MODIFICATION

WHAT ARE AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (ARFID)?

 FORMERLY KNOWN AS FEEDING DISORDER OF INFANCY OR CHILDHOOD
 DISTURBANCE OF EATING OR FEEDING BEHAVIOR THAT TAKES THE FORM OF AVOIDING OR
RESTRICTING FOOD INTAKE AS EVIDENCED BY SUBSTANTIAL WEIGHT LOSS (OR, IN CHILDREN,
ABSENCE OF EXPECTED WEIGHT GAIN), NUTRITIONAL DEFICIENCY, DEPENDENCE ON A FEEDING
TUBE OR DIETARY SUPPLEMENTS, AND/OR SIGNIFICANT PSYCHOSOCIAL INTERFERENCE
WHAT ARE THE TREATMENT STEPS FOR ARFID?
 FOUR STAGES OF TREATMENT:
 RECORD - LET CHILDREN TO RECORD THRIE EATING BEHAVIOURS AND THEIR FEELINGS
 REWARD - TRY A FOOD THEY DISLIKE AND ARE REWARDED
 RELAX -
 REVIEW

WHAT IS RUMINATION DISORDER (RD)?

 REGULAR REGURGITATION OF FOOD THAT MAY BE RE-CHEWED, RE-SWALLOWED OR SPIT OUT
AND HAS OCCURED FOR AT LEAST ONE MONTH
 MUST NOT BE DUE TO A MEDICAL CONDITION
 THE BEHAVIOUR DOES NOT OCCUR EXCLUSIVELY IN THE COURSE OF ANOREXIA NERVOSA,
BULIMIA NERVOSA, BD OR AVOIDANT/RESTRICITVE FOOD INTAKE DISORDER
WHAT ARE THE COMMON DISTURBANCES FOR RD?
 DELAYED OR ABSENT DEVELOPMENT OF FEEDING AND EATING SKILLS,
 DIFFICULTY MANAGING OR TOLERATING FOOD OR DRINK
 RELUCTANCE TO EAT FOOD BASED ON TASTE, TEXTURE, AND OTHER SENSORY FACTORS,
 LACK OF APPETITE OR INTEREST IN FOOD
 THE USE OF FEEDING BEHAVIORS TO COMFORT, SELF-SOOTHE, OR SELF-STIMULATE
HOW IS RD TREATED?
 COMBINATION OF BREATHING EXERCISES (DIAPHRAGMATIC BREATHING TECHNIQUES) AND
HABIT REVERSAL
 CHILD IS TAUGHT WHEN IT IS APPROPRIATE TO DO SO

WHAT ARE ELIMINATION DISORDERS (ED)?

 CHARACTERIZED BY AGE-INAPPROPRIATE INCONTINENCE AND ARE GENERALLY DIAGNOSED IN
CHILDHOOD
WHAT ARE THE SUBCATEGORIES OF ED?
 ENURESIS
 ENCOPRESIS
WHAT IS ENURESIS?
 BED WETTING OR URINATION IN THEIR CLOTHING AFTER THE AGE OF WHEN THEY SHOULD BE
TOILET TRAINED
WHAT ARE THE CRITERIAS FOR ENURESIS?
 NOCTURNAL, DIURNAL OR BOTH
 MUST HAVE A DEVELOPMENTAL AND CHRONOLOGICAL AGE OF 5 YEARS
 MUST OCCUR TWICE A WEEK FOR AT LEAST 3 MONTHS OR MUST CAUSE DISTRESS AND
IMPAIRMENT IN FUNCTIONING
WHAT ARE THE TREATMENT OPTIONS FOR ENURESIS?
 RESTRICT FLUIDS BEFORE BED
 DESMOPRESSIN (SIDE EFFECT IS HEADACHE, STOMACHACHE), ANTIDIURETIC
 REBOXETINE, NOREPINEPHRINE REUPTAKE INHIBITOR
 PSYCHOTHERAPY
 BEHAVIOURAL THERAPY USING BUZZER AND ALARM APPARATUS TO WAKE UP CHILD TO
PREVENT VOIDING
WHAT IS ENCOPRESIS?
 CHILD WHO IS AT LEAST 4 YEARS OLD REPEATEDLY HAS BOWEL MOVEMENTS EITHER IN ITS
CLOTHES OR IN ANOTHER INAPPROPRIATE PLACE
WHAT ARE THE CRITERIAS FOR ENCOPRESIS?
 WITH CONSTIPATION AND OVERFLOW INCONTINENCE
 WITHOUT CONSTIPATION AND OVERFLOW INCONTINENCE
 A CHILD MUST HAVE A DEVELOPMENTAL OR CHRONOLOGICAL LEVEL OF AT LEAST 4 YEARS
WHAT IS THE TREATMENT FOR ENCOPRESIS?
 DAILY ORAL ADMINISTRATIONS OF LAXATIVE, PEG 1G/KG
 SURGICAL DISIMPACTION WITH GENERAL ANESTHESIA
 COGNITIVE-BEHAVIOURAL INTERVENTION TO HAVE BOWEL MOVEMENTS ON THE TOILET
 HAVE REGULAR TIMED INTERVALS ON THE TOILET