EATING DISORDERS
Anorexia nervosa
Diagnostic criteria
A. Restriction of energy intake relative to requirements leading to a significantly low body weight, defined as weight that is less than minimally or normal or, for children and adolescents less than that minimally expected.
B. Intense fear of gaining weight or becoming fat, or persistent behavior 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. Brain is starved, so can become trapped within the thinking.
Subtypes
Binge eating/purging
Restricting
During the last three months there are recurrent episodes of binge eating or purging behavior (30-40%). This diagnosis trumps bulimia when individual is low weight.
Eating very little all day long; rigid routines for doing so. During the last three months the person has not engaged in episodes of binge-eating or purging behavior
Specifiers
Full remission
Partial remission
Criteria A (low weight) has not been met for a sustained period of time, but B and/or C are still met.
None of the criteria are met for a sustained period of time
Severity (BMI)
Moderate BMI 16-16.99
Severe BMI 15-15.99
Mild BMI > 17
Extreme BMI < 15
Signs & symptoms
6-10% mortality: cardiovascular (related to malnutrition) and suicide; 1,000 deaths per year in the US
Dry skin, lanugo (fine hair), excess energy (cortisol), edema, bradycardia, hypotension, hypothermia, bloating, co-morbid depression
They've removed amenorrhea from the DSM criteria
Onset
onset frequently follows a crisis with family, school, or sexuality
Loss of self-esteem is countered in dieting in effort to "take control"
Males and females have equal body fat until age 9; as teens, female body fat = 25%, 10-12% male.
Dieting may be initially reinforced by family and/or peers
Bimodal distribution
Treatment
Pharmacotherapy
Psychotherapy
Inpatient
Indicated in cases of marked weight loss, significant complications, and extreme psychological distress, including suicidal ideation
Antidepressants are not helpful for weight gain in acute phase nor for long term weight maintenance.
Open label case studies suggest atypical antipsychotics may be useful in treatment resistant anorexia. Controlled trials needed.
Address weight phobia, maturational conflict and family functioning
Maudsley family based treatment for adolescents with anorexia nervosa. Twenty sessions over 6-12 months. Phase 1 puts the parents in charge of the refeeding process. Phase 2 involves return to independent eating. Phase 3 focuses on more general issues of adolescence (psychosocial issues likely existent prior to anorexia nervosa).
Bulimia nervosa
Full recovery of a third to about a half of people.
Diagnostic criteria
B. Recurrent, inappropriate compensatory behavior in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, or diuretics.
C. Binge/compensation both occur, on average once per week for 3 months
A. Recurrent episodes of bing eating -- both eating in a discrete period of time (e.g. within any two hour period), an amount of food that is definitely larger than most people would eat during a similar period of time and under similar circumstances, and sense of lack of control over eating during the episode.
CBT for adults
D. Self evaluation unduly influenced by weight and shape.
E. Does not occur during an episode of AN
Specifiers
Partial/full remission
Severity is based upon purging episodes each week
Moderate 4-7
Severe 8-13
Mild 1-3 episodes
Extreme > 14
Brain regions
Impulsivity -- frontostriatal circuits in left inferolateral PFC, bilateral inferior frontal gyrus, lenticular and caudate nuclei, ACC
Treatment
Psychotherapy
Pharmacological
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Binge eating disorder
No compensatory behavior
Most prevalent of the eating disorders (don't have to be overweight
Type II diabetes and bariatric risk factors
Treatment
Psychotherapy
Behavioral weight loss (BWL)
CBT