Eating and Feeding Disorders

 An eating disorder is a serious mental illness,

characterized by eating, exercise and body weight
or shape becoming an unhealthy preoccupation of
someone.
 Eating disorders can take many different forms and
interfere with a person’s day to day life.
 The exact cause of eating disorders is unknown. As with
other mental illnesses, there may be many causes, such as:
 Genetics and biology. Certain people may have genes that
increase their risk of developing eating disorders. Biological
factors, such as changes in brain chemicals, may play a role
in eating disorders.
 Psychological and emotional health. People with eating
disorders may have psychological and emotional problems
that contribute to the disorder. They may have low self-
esteem, perfectionism, impulsive behavior and troubled
relationships.
 Teenage girls and young women are more
likely than teenage boys and young men to
have anorexia or bulimia, but males can have
eating disorders, too.
 Although eating disorders can occur across a
broad age range, they often develop in the
teens and early 20s.
 Certain factors may increase the risk of developing an eating
disorder, including:
 Family history. Eating disorders are significantly more likely
to occur in people who have parents or siblings who've had
an eating disorder.
 Other mental health disorders. People with an eating
disorder often have a history of an anxiety disorder,
depression or obsessive-compulsive disorder.
 Stress. Whether it's heading off to college, moving, landing a
new job, or a family or relationship issue, change can bring
stress, which may increase risk of an eating disorder.
 Dieting and starvation. Dieting is a risk factor for
developing an eating disorder. Starvation affects the
brain and influences mood changes, rigidity in thinking,
anxiety and reduction in appetite.
 There is strong evidence that many of the symptoms of
an eating disorder are actually symptoms of starvation.
 Starvation and weight loss may change the way the
brain works in vulnerable individuals, which may
perpetuate restrictive eating behaviors and make it
difficult to return to normal eating habits.
 The Diagnostic and Statistical Manual of
Mental Disorders (DSM) recognizes eating
disorders as:
 Pica
 Rumination Disorder
 Avoidant/Restrictive Food Intake Disorder
 Anorexia nervosa
 Bulimia nervosa
 Binge eating disorder
 Pica is a psychological disorder characterized
by an appetite for substances that are largely
non-nutritive, such as ice, hair, paper, drywall
or paint, sharp objects, metal, stones or soil,
glass, feces and chalk.
 Pica may lead to intoxication in children,
which can result in an impairment of both
physical and mental development.
 Pica is most commonly seen in pregnant
women, small children, and persons
with developmental disabilities such as autism. 
 Children eating painted plaster containing lead may
suffer brain damage from lead poisoning.
  It may cause surgical emergencies to address
intestinal obstructions, as well as more subtle
symptoms such as nutritional deficiencies
and parasitosis.
 Pica
 A. Persistent eating of nonnutritive, nonfood substances
over the period of at least 1 month.
 B. The eating of nonnutritive, nonfood substances the
inappropriate to the developmental level of the individual.
 C. The eating behavior is not part of a culturally supported or
socially normative practice.
 D. If the eating behavior occurs in the context of another
mental disorder (e.g. intellectual disability, autism spectrum
disorder) or medical condition (e.g. pregnancy), it is
sufficiently severe to warrant additional clinical attention.
 Rumination disorder is repeatedly and persistently
regurgitating food after eating, but it's not due to a
medical condition or another eating disorder such as
anorexia, bulimia or binge-eating disorder.
 Food is brought back up into the mouth without
nausea or gagging, and regurgitation may not be
intentional.
 Sometimes regurgitated food is rechewed and
reswallowed or spit out.
 The disorder may result in malnutrition if the
food is spit out or if the person eats
significantly less to prevent the behavior.
 The occurrence of rumination disorder may
be more common in infancy or in people who
have an intellectual disability.
 Rumination Disorder
 A. Repeated regurgitation of food over the period of at least
one month. Regurgitated food may be re-chewed, re-
swallowed, or spit out.
 B. Not attributable to an associated gastrointestinal or other
medical condition (e.g. reflux).
 C. Does not occur exclusively during the course of anorexia
nervosa, bulimia nervosa, binge-eating disorder, or
avoidant/restrictive food intake disorder.
 D. If symptoms occur in the context of another mental
disorder (e.g. intellectual disability), they are sufficiently
severe to warrant additional clinical attention.
 This disorder is characterized by failing to meet minimum
daily nutrition requirements because individual don't have
an interest in eating; avoid food with certain sensory
characteristics, such as color, texture, smell or taste; or
concerned about the consequences of eating, such as fear of
choking.
 Food is not avoided because of fear of gaining weight.
 The disorder can result in significant weight loss or failure to
gain weight in childhood, as well as nutritional deficiencies
that can cause health problems.
 Avoidant/Restrictive Food Intake Disorder
 A. A feeding or eating disturbance (e.g. lack of apparent
interest in eating 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
associated with one (or more) of the following:
1. Significant weight loss (or failure to achieve expected weight gain or
faltering growth in children).
2. Significant nutritional deficiency.
3. Dependence on enteral feeding or oral nutritional supplements.
4. Marked interference with psychosocial functioning
 B. The disturbance is not better explained by lack of available
food or by an associated culturally sanctioned practice.
 C. 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.
 D. The eating disturbance is not attributable to a concurrent
medical condition or not better explained by another mental
disorder. When the eating disturbance occurs in the context of
another condition or disorder, the severity of the eating
disturbance exceeds that routinely associated with the
condition or disorder and warrants additional clinical attention
 Anorexia nervosa is characterized by extreme food
restriction and excessive weight loss, accompanied
by the fear of being fat.
 An anorexic person often perceives himself or
herself as fat even if they are severely underweight.
Anorexia is further characterized by refusal to
maintain a healthy body weight, an obsessive fear
of gaining weight, and an unrealistic perception of
current body weight.
 Anorexia Nervosa
 A. Restriction of energy intake relative to requirements,
leading to a significantly low body weight in the context of
age, sex, developmental trajectory, and physical health.
Significantly low weight is defined as a weight that is less
than minimally normal or, for children and adolescents, less
than minimally expected.
 B. Intense fear of gaining weight or of becoming fat, or
persistent behaviour that interferes with weight gain, even
though at a significantly low weight.
 C. 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.
 Restricting type: During the last three months, the
individual has not engaged in recurrent episodes of binge
eating or purging behaviour (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.
 Binge-eating/purging type: During the last three months
the individual has engaged in recurrent episodes of binge
eating or purging behaviour (i.e. self-induced vomiting, or
the misuse of laxatives, diuretics, or enemas).
 Bulimia nervosa is characterized by recurrent binge
eating followed by compensatory behaviors for the
intake of food, such as purging.
 Bingeing is characterized by eating a large amount
of food in a short period of time (relative to a
person’s normal eating habits).
 A purge can include self-induced vomiting,
excessive use of laxatives/diuretics, fasting, or
excessive exercise.
 Bulimia Nervosa
 A. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both:
 1. Eating in a discrete period of time (e.g. within any
2 hour period), an amount of food that is definitely
larger than what most individuals would eat in a
similar period of time under similar circumstances;
 2. A sense of lack of control over eating during the
episodes (e.g. a feeling that one cannot stop eating
or control what or how much one is eating.
 B. Recurrent inappropriate compensatory behaviors to
prevent weight gain, such as self-induced vomiting; misuse
of laxatives, diuretics, or other medications; fasting; or
excessive exercise.
 C. The binge eating and inappropriate compensatory
behaviors both occur, on average, at least once a week for 3
months.
 D. Self-evaluation is unduly influenced by body shape and
weight.
 E. The disturbance does not occur exclusively during
episodes of anorexia nervosa.
 Mild: An average of 1-3 episodes of inappropriate
compensatory behaviors per week.
 Moderate: An average of 4-7 episodes of
inappropriate compensatory behaviors per week.
 Severe: An average of 8-13 episodes of
inappropriate compensatory behaviors per week.
 Extreme: An average of 14 or more episodes of
inappropriate compensatory behaviors per week.
 Binge eating disorder, also referred to as
“compulsive overeating,” is characterized by
uncontrollably eating a large amount of food in a
short period of time; after a bingeing episode a
person will not purge and will feel an extreme sense
of guilt.
 Episodes of bingeing may be a method of self-
soothing in the face of emotional stressors; social
isolation and loneliness, in particular, have been
implicated as triggering factors in binge eating.
 Binge-Eating Disorder
 A. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both:
1. Eating in a discrete period of time (e.g. within any 2 hour
period), an amount of food that is definitely larger than
what most individuals would eat in a similar period of time
under similar circumstances;
2. A sense of lack of control over eating during the episodes
(e.g. a feeling that one cannot stop eating or control what
or how much one is eating).
 B. Binge eating episodes are associated with three
or more of the following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably full.
3. Eating large amounts of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is
eating.
5. Feeling disgusted with oneself, depressed, or very guilty
afterwards.
 C. Marked distress regarding binge eating is
present.
 D. The binge eating occurs, on average, at
least once a week for 3 months.
 E. 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.
 Mild: 1-3 binge eating episodes per week.
 Moderate: 4-7 binge eating episodes per
week.
 Severe: 8-13 binge eating episodes per
week.
 Extreme: 14 or more binge eating episodes
per week.
 Symptoms characteristic of a feeing or eating
disorder that cause clinical distress or
impairment in social, occupational, or other
important areas of functioning predominate.
 However DO NOT meet the full criteria for
any of the disorders in the feeding and eating
disorders diagnostic class
 This category can also be used in situations to
communicate the specific reason the
presentation does not meet the criteria for a
specific eating disorder.
 This is done by recording “other specified
feeding or eating disorder” followed by the
specific reason e.g. “bulimia nervosa- low
frequency”.
 Symptoms characteristic of a feeding and
eating disorder & cause clinical significant
distress or impairment in social, occupational
or other important areas of functioning
predominate.
 However DO NOT meet the full criteria for
any of the disorders in the feeding and eating
disorders diagnostic class.
 Used when the clinician chooses not to
specify the reason that criteria are not met
for a specific feeding and eating disorder.
 This includes times when there is insufficient
information to make a more specific
diagnosis (e.g. in emergency room setting).
 https://bodymatters.com.au/wp-
content/uploads/2015/01/DSM_V_Diagnostic_Criter
a_for_Eating_Disorders.pdf
 https://www.edcatalogue.com/dsm-5-eating-
disorders/
 https://www.eatingdisorders.org.au/eating-
disorders-a-z/what-is-an-eating-disorder/
 https://www.mayoclinic.org/diseases-
conditions/eating-disorders/symptoms-causes/syc-
20353603
Thank You