FEEDING AND

EATING DISORERS

GABISILE R MATHIBELA
CONTENT

• Introduction
• General description
• Cultural considerations
• Clinical presentation/ features
• Diagnostic criteria
• Differential diagnosis
• Comorbidity
• Course and prognosis
• Bio psychosocial model/formulation
• Treatment plan
• Case Management
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INTRODUCTION

• Eating is something we all need and do daily, yet for some, eating may become a
disorder

• Eating disorders are not discriminatory and can affect anyone.

• Extreme abnormalities in eating behaviours characterize the eating disorder

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GENERAL DESCRIPTION

• Eating disorders are characterized by a persistent disturbance of eating or eating-

related behaviour that results in the altered consumption or absorption of food.

• This significantly impairs physical health or psychosocial functioning.

• Typically, people with eating disorders develop an unhealthy preoccupation with food,
body size, weight or shape.

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 CULTURAL CONSIDERATION

• Acceptable eating habits vary widely between religious and ethnic groups.
• Eating disorders have been conceptualized as culture-bound syndromes.
• Cultural beliefs and attitudes have been identified as significant contributing factors in the
development of eating disorders
• The idealization of the thin body type within Western societies has been identified as a
possible factor leading to the development of anorexia nervous.
• Eating disorders are more prevalent in countries that are industrialized and where
thinness is associated with attractiveness.
• White women from industrialized Western countries are particularly at risk for the
development of eating disorders.
• Black and non-Western women have been thought to be protected by contrasting ideals
that value plumpness as a metaphor for attractiveness, fertility, and prosperity.
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CULTURAL CONSIDERATION

• Western pressures towards thinness blend with traditional idioms of distress and
culturally sanctioned rituals of remedial purging and social over-eating .
• In African culture, culturally sanctioned overeating and purging may place individuals at
particular risk for the development of bulimia nervosa.
• Anorexia nervosa occurs in all cultures, but the incidence is higher among individuals
who have been exposed to Western culture .
• In industrialized countries, the prevalence is about 1 percent of the general population.
• In the United States, bulimia nervosa may be more prevalent among Hispanics and
blacks than non-Hispanic whites.

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TYPES OF EATING DISORDERS

Avoidant
Anorexia Bulimia Binge eating restrictive Rumination
Pica
nervosa, nervosa disorder food intake disorder
disorder

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ANOREXIA NERVOSA 8
 DESCRIPTION

Anorexia nervosa can be describe as the refusal to maintain a minimally normal body weight.

Anorexia nervosa is frequently, but not always, connected with body image issues.

Subtypes : the restricting type ( individuals diet to limit calorie intake)

binge-eating/purging type (they rely on purging)

There are also different tiers of anorexia based on BMI ranging from :

Mild: BMI ≥ 17 kg/m2.

Moderate: BMI 16–16.99 kg/m2.

Severe: BMI 15–15.99 kg/m2.

Extreme: BMI < 15 kg/m2.

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CLINICAL FEATURES (AN)

• Present for 3 months or more

• Onset is between the ages of 10-30 years

• Extremely restricted eating and/or intensive and excessive exercise

• Extreme thinness

• A relentless pursuit of thinness and unwillingness to maintain a normal or healthy weight

• Intense fear of gaining weight

• Distorted body or self-image that is heavily influenced by perceptions of body weight and
shape
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• Denial of the seriousness of low body weight

DIAGNOSTIC CRITERIA

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DIAGNOSTIC CRITERIA

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DIAGNOSTIC CRITERIA

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DIFFERENTIAL DIAGNOSIS

• Medical conditions ( gastrointestinal disease)- weight loss present however individuals usually
do not also manifest a disturbance in the way their body weight or shape is experienced or an
intense fear of weight gain or persist in behaviors that interfere with appropriate weight gain.
• Substance abuse- Individuals with substance use disorders may experience low weight because of
poor nutritional intake but generally do not fear gaining weight and do not manifest body image
disturbance.
• Schizophrenia- individuals might have delusions about food being poisoned thus leading to less
food intake and weight loss but rarely are they concerned with caloric content. Individuals do not
express a fear of gaining weight.
• Bulimia nervosa- individuals do not have an abnormally low body weight.
• Social anxiety - individuals may feel humiliated or embarrassed to be seen eating in public,
however the embarrassment is not isolated to eating behaviors only and is not accompanied by
intense fear of gaining weight and body image disturbance

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DIFFERENTIAL DIAGNOSIS

• Avoidant/restrictive food intake disorder- restriction of intake is due to a lack of interest in food,
aversion to the sensory characteristics, or concern about potential adverse consequences of eating
such as choking or vomiting, and will not be accompanied by intense fear of gaining weight and
body image disturbance
• Obsessive compulsive disorder- may exhibit obsessions and compulsions related to food,
however the obsessions and compulsions are not associated with an intense fear of gaining weight
and are not due to the need to loss weight.
• Major depressive disorder - Individuals with major depressive disorder do not have either a desire
for excessive weight loss or an intense fear of gaining weight. Depressed individuals usually have a
decreased appetite, whereas anorexia nervosa patients often claim to have a normal appetite and
to feel hungry.
• Body dysmorphic disorder- individuals may be preoccupied with an imagined defect in bodily
appearance, However with individuals with BBD the imagined body appearance is not limited to
weight or shape only
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 COMORBIDITIES

Alcohol use
disorder and Bipolar
other disorder
substance use

Major
OCD depressiv
e disorder

Anxiety
16
disorders

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COURSE AND PROGNOSIS

The course can range from

Spontaneous recovery without treatment

Recovery after a variety of treatments

A fluctuating course of weight gains followed by relapses

A gradually deteriorating course resulting in death caused by complications of starvation

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COURSE AND PROGNOSIS

A better prognosis is associated with an early onset such as during adolescence and the short-
term response of patients to almost all hospital treatment programs is good.

Most individuals with anorexia nervosa experience remission within 5 years of presentation
but in patients admitted to the hospital remission may be lower.

Those who have regained sufficient weight, however, often continue their preoccupation with
food and body weight, have poor social relationships, and exhibit depression

Worse outcomes are observed in patients who require hospitalization and in adults.

The condition is associated with a high risk of chronic course and poor prognosis in terms of
treatment and the risk of death
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 TREATMENT AND MANAGEMENT

• Nutritional rehabilitation- This is when a patient is given the proper nutrition and calories to help
them regain their healthy weight.

• Family-Based Treatment

• In phase 1, treatment focuses on the restoration of the patient’s physical health.

• In phase 2, the patient gradually begins to take responsibility for decisions about eating.

• In phase three, the focus shifts to the patient’s growth and development.

• Cognitive and behavioural therapy is used to teach patients to monitor their food intake, emotions,
bingeing behaviours, and interpersonal issues.

• Cognitive restructuring and problem-solving techniques help patients identify automatic thoughts and
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challenge core beliefs, addressing their vulnerability to anorectic behaviour.
 TREATMENT AND CASEMANAGEMENT

• Pharmacotherapy
• The use of olanzapine( promote weight gain) and antidepressants
• Management of eating disorders should be a multidisciplinary approach.
• Nutritional rehabilitation along with some form of re-educative psychotherapy remains the mainstay of
the management of anorexia nervosa
• Management should be a multidisciplinary approach involving psychiatrists, psychologists,
endocrinologists, dentists, gastroenterologists, internists so on and so forth. All personnel must work
closely together and maintain open communication and mutual respect.

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BULIMIA NERVOSA 21
 DESCRIPTION
Bulimia nervosa comprises of recurrent episode of binge eating together with
behaviours such as purging.

May be a failed attempt at anorexia nervosa.

Goal is typically maintaining weight

Unlike patients with anorexia nervosa, those with bulimia nervosa typically maintain a
normal body weight.

Subtypes

Purging: binge episode is followed by self-induced vomiting or misuse of laxatives or

diuretics (common)

Non-purging: binge episode is followed by excessive exercise or fasting to healthier

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food habits and attitudes.

CLINICAL PRESENATATION

first episodes of binge eating occur relatively frequently (once a week or more) for at least 3 months

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DIAGNOSTIC CRITERIA

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DIAGNOSTIC CRITERIA

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DIFFERENTIAL

• Kleine-Levin syndrome- there is also disturbed eating behavior. However, the characteristic
feature of bulimia nervosa, concern and self-evaluation with body shape and weight, are not
present.
• Major depressive disorder, with atypical features- Overeating is common in this disorder.
However, there is no inappropriate compensatory behaviors and they do not exhibit the excessive
concern with body shape and weight characteristic of bulimia nervosa. If criteria for both disorders
are met, both diagnoses should be given.
• Borderline personality disorder Binge-eating behavior makes up part of the impulsive behaviours
seen in borderline personality disorder. However , there are no features of inappropriate
compensatory purging behaviour of bulimia nervosa.
• Binge-eating disorder- Individuals who binge eat but do not engage in repeated, inappropriate
compensatory behaviors.
• Anorexia nervosa, binge-eating/purging type- An important distinction is that a diagnosis of
anorexia nervosa requires low body weight; and BMI<18, whereas this is not a diagnostic criterion
ADDfor bulimia nervosa
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COMORBIDITIES

Depressive Bipolar
disorder disorder

Substance
Anxiety
use
disorder
disorder

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COURSE AND PROGNOSIS

The course may be chronic or intermittent, with periods of remission alternating with recurrences of
binge eating

Bulimia nervosa is characterized by higher rates of partial and full recovery compared with
anorexia nervosa.

Untreated patients tend to remain chronic or may show small, but generally unimpressive,
degrees of improvement with time .

Approximately 30 percent continued to engage in recurrent binge-eating or purging behaviours.

A history of substance use problems and a longer duration of the disorder at presentation predicted
a worse outcome. deteriorating course resulting in death caused by complications of starvation
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TREATMENT PLAN AND MANAGEMENT

• Cognitive behavioural therapy-

• CBT in bulimia nervosa disordered behaviours ( binge eating, purging, restricting) are tackled first
and, once they have improved, cognitive distortions and beliefs that may be maintaining the
unhealthy behaviours (e.g., “Eating sugary foods will make me fat”). become the focus of treatment.
• Dialectic Behavioral Therapy
• focuses on helping patients develop mindfulness, emotion regulation, and distress tolerance in an
attempt to regulate distressing emotions that may contribute to maladaptive eating behaviors.
• Integrative cognitive-affective therapy (ICAT)
• In addition to focusing on distorted cognitions and problematic behaviors as in CBT, it emphasizes
the role of dysfunctional interpersonal interactions on the eating disorder
• Psychopharmacology
• Several antidepressants such as the SSRI fluoxetine appear to significantly reduce binge eating and
purging
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BIOPSYCHOSOCIAL MODEL

Biological influence - Inherited vulnerability (unstable or excessive

neurobiological response to stress associated with impulsive eating)

Psychological Influences- Anxiety focused on appearance and

presentation to others. Distorted body image

Social influences - Cultural pressures to be thin. Family

interactions/pressures. Social presentation

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