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Eating Disorder - Coggle Diagram
Eating Disorder
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ANOREXIA
DSM 4 Anorexia Nervosa
- Refusal to maintain a minimally normal body weight > does not say how this refusal manifests.
- No actual mention of food.
- No mention of what this minimally normal body weight is
- Could be below 85% of your expected weight based on age, height, weight, gender, etc.
- BMI of 17.5 > unclear where this number came from
- Intense fear of becoming fat
- Disturbance in body perception
- Amenorrhea > absence of menstrual cycle
- Subtypes:
- Restricting type
- binge-eating/purge type
What criteria were to be retained for the DSM5?
- Weight criteria varied widely, and it was found that the weight of those with anorexia didn’t play a role in how unwell they were > not entirely important
- Fear of fat is different across cultures> in China for example, their attitude towards weight gain is consistent with an eating disorder, but they didn’t express a fear of fat in the way that we conceptualise it.
- Amenorrhea only applies to women and is just a physiological byproduct of being at too low of a weight > it’s not a symptom of a psychiatric condition.
DSM 5 Anorexia Nervosa
- Restricted energy intake leads to low body weight
- Intense fear of becoming fat
- Disturbance in body perception
Weight indicators are important for considering brain function (needed for recovery, etc), the risk of death, etc, but doesn’t matter in how unwell a patient is.
- Anorexia has the highest mortality rate of any psychiatric condition (~20%) > being at such a low body weight, but also a very high comorbidity with depression.
BULIMIA
DSM 4 Bulimia Nervosa
- Binge eating
- A large amount of food in a discrete period of time > no amounts are specified in regards to food or time
- A lack of control over eating
- Inappropriate compensatory behaviours
- Binge and compensatory behaviours 2x per week for 3 months > based on clinical observations at the time
- Self-evaluation influenced by weight/shape
- How people feel about themselves as a person, rather than appearance
- Does not occur exclusively during episodes of AN
Subtypes:
- Purging type
- Nonpurging type
What criteria were to be retained for the DSM5?
- Size of binge is important as it differentiates patients by how unwell they are > it DOES matter.
- Frequency of binge does not matter.
- ONLY CHANGE FOR THE DSM5 WAS FREQUENCY OF BEHAVIOUR > 2x A WEEK TO 1x A WEEK
- Severity indicator added because compensatory behaviours like vomiting and using laxatives can be dangerous to the body.
- Rupturing stomach, tearing esophagus, changing body chemistry, etc.
- The mortality rate is lower than anorexia, but still higher than the general population, still a high comorbidity with depression.
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Diagnoses
- Have featured in the DSM since its first edition, but not in the same state it’s in today > the DSM 3 first proposed actual diagnostic criteria.
- DSM 4 was when the diagnostic criteria were very clearly defined.
- Anorexia nervosa, bulimia nervosa, eating disorder not otherwise specified (some symptoms, but not meeting the threshold diagnostic criteria).
- Approaches taken from moving from DSM 4 to DSM 5:
- Approach is to change the parameters of the existing criteria, like relaxing the criteria for other disorders to shrink the proportion of EDNOS.
- Another approach is to identify new disorders that had previously been considered EDNOS, like binge eating disorder, to shrink the proportion of EDNOS.
BINGE EATING DISORDER
DSM 5
- Binge episodes
- Eating a large amount in a discrete period
- Experience a lack of control over eating.
- Binge eating associated with
- Eating much more rapidly than normal
- Eating until uncomfortably full
- Eating large amounts of food when not hungry
- Eating alone because of embarrassment
- Feeling disgusted, depressed, or guilty after eating
- Distress about binge eating
- Binge eating 1x per week for 3 months
- Binge eating is not associated with compensatory behaviours
- People tend to be overweight or obese, HOWEVER, not every overweight person has BED.
Prevalence/Changes
- Point prevalence > the amount of people with a disorder at a particular region at a particular point in time
- Lifetime prevalence > the amount of people who may be affected by the disorder in their lifetime.
- Incidence > number of new cases that emerge over a specific time period.
Eating disorders among men are more common than we used to think > women may suffer more than men do, but not as much as reported.
- EDNOS is now OSFED > other specified feeding and eating disorders.
- We now know and can specify whats happening, but the people just don’t meet the full criteria for AN, BN, or BED.
- Purging disorder is emerging out of OSFED > similar to BN but the purges are subjective (smaller)
- Night eating disorder > eating majority of daily calories at night.
- ARFID > very narrow range of foods patients are willing to eat > tend to malnourished and low in weight.