Essentials of Psychiatry in Primary Care: Behavioral Health in the Medical Setting >Other Disorders and

Issues in Primary Care

Robert C. Smith, Gerald G. Osborn, Francesca C. Dwamena, Dale D'Mello, Laura Freilich, Heather S. Laird-Fick+
Table 8-7.The Eating Disorders and Subtypes From DSM-5

Criteria Symptoms/Signs Medical Complications Medical Treatment

1. Nutrition
1. Amenorrhea
2. Electrolyte/water balance—includes
1. BMIb <18.5 2. Weakness 1. ECG: Bradycardia, low voltage,
refeeding syndrome with severe
2. Persistent energy intake restriction 3. Bloating and abdominal pain increase QTc and PR intervals, and
Anorexia nervosa phosphate depletion
3. Fear weight gain or becoming fat 4. Cold sensitivity ST-T wave changes
3. Arrhythmias and heart failure
4. Persistent behavior that interferes 5. Depression 2. Decreased magnesium, sodium,
•Restricting 4. Osteoporosis and fractures
with weight gain 6. Anxiety and phosphorus
•Binge eatinga and purging 5. Risk of infection
5. Self-perception of overweight or 7. Decreased libido 3. Hypoglycemia
6. Pancreatitis
misshapen 8. Hypotension, orthostatic 4. Sick thyroid syndrome
Often need hospitalization, especially
9. Childlike secondary sexual features
with BMI <17.0

1. Irregular menses
1. Normal weight 2. Depression
1. ECG: Bradycardia, low voltage, 1. Nutrition
2. Recurrent binge eating 3. Anxiety
increase QTc, U waves 2. Electrolyte correction
Bulimia nervosa 3. Inappropriate measures to prevent 4. Bloating and constipation
2. Decreased chloride and potassium 3. Dehydration
weight gain (purging; excessive 5. Sore throat
with metabolic alkalosis; decreased 4. Esophageal rupture and bleeding
•Purging exercise; laxatives; enemas; 6. Dyspepsia
magnesium and phosphate 5. Aspiration pneumonia
•Nonpurging diuretics; fasting) 7. Eroded tooth enamel
3. Increased pancreatic enzymes 6. Rib fracture and pneumothorax
4. Self-perception unduly focused on 8. Swollen parotid and submandibular
4. Mallory-Weiss syndrome 7. Post-binge pancreatitis
body shape/weight glands
9. Calluses of knuckles

1. Those expected with chronic

overweight: Coronary artery
1. Bloating and discomfort disease, hypertension, type 2
1. Overweight 2. Dyspepsia diabetes, elevated LDL and 1. Treatment of standard medical
Binge-eating disorder 2. Recurrent binge eating 3. Depression triglycerides, NASH conditions
3. There is no compensating behavior 4. Anxiety 2. Osteoarthritis 2. Gastric rupture
to lose weight 5. Overweight 3. Obstructive sleep apnea
4. Cholecystitis
5. Gastric dilation and rupture

DSM-5 = Diagnostic and Statistical Manual of Mental Disorders, 5th ed.; ECG = electrocardiogram; LDL = low-density lipoprotein; NASH = nonalcoholic steatohepatitis.
aBinge eating must occur at least once per week for 3 months and is defined as eating an amount of food larger than normal over 2 hours for which the patient experiences lack of control.
bBMI = body mass index (kg weight divided by height in meters2) where 18.5 is lower limit of normal.

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