EATING DISORDERS
Major Types
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Anorexia Nervosa - starving
Bulimia Nervosa – binging + purging (through
vomiting)
Binge-Eating Disorder – binging (& distressing
over it)
Underlying these eating disorders is the drive to
become thin
Media age of onset: 18 to 21 years
Tend to be culturally specific
o Until recently, were not found in
developing countries where there is
limited access to food
Recently going global
o More than 90% of the severe cases are
young females who live in a socially
competitive environment
o “pro-ana” (anorexia) and “pro-mia”
(bulimia) websites and social networks
provide grounds for propagation.
o Strongest etiological contribution
seems to be sociocultural rather than
psychological or biological factors
persistent lack of recognition of the seriousness
of the current low body weight.
Specify current severity:
The minimum level of severity is based, for adults, on
current body mass index (BMI) (see below) or, for
children and adolescents, on BMI percentile. The ranges
below are derived from the World Health Organization
categories for thinness in adults; for children and
adolescents, corresponding BMI percentiles should be
used. The level of severity may be increased to reflect
clinical symptoms, the degree of functional disability,
and the need for supervision.
Mild: BMI ≥ 17 kg/m²
Moderate: BMI 16-16.99 kg/m²
Severe: BMI 15-15.99 kg/m²
Extreme: BMI < 15 kg/m²
BMI – a measure of body fat based on height and
weight
= weight in kg/(height in m) ²
< 18.5 = underweight
ANOREXIA NERVOSA
Diagnostic Criteria
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 that
minimally expected.
B. Intense fear of gaining weight or of 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
18.5 – 24.9 = normal
25 – 29.9 = overweight
30 – 34.9 = obese
35> = extreme obese
Clinical Description
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Has the highest mortality rate of any
psychological disorder (included in Barlow &
Durand) resulting from restriction of energy
intake (Criterion A)
o 20% of those who have the disorder die
as a result of it
Literally means “nervous loss of appetite”
o Those with AN, however, often have
healthy appetite but has an intense fear
of gaining weight or of becoming fat
(Criterion B)
o
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Compared to those with bulimia, they
have extraordinary control over their
diet and are proud of it.
o Many of those with bulimia have a
history of anorexia
Marked disturbance in body image (Criterion C)
o Disturbance in which one’s body image
is experienced
o Undue influence of body weight or
shape on self-evaluation
 Losing weight means selfcontrol, maintaining or gaining
weight is lack of it
o Persistent lack of recognition of the
seriousness of the current low body
weight
Two Subtypes
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Restricting Type - involves limiting calorie
intake
Binge-eating-purging Type
o Compared to those with bulimia, they
binge on relatively small amounts of
food and purge more consistently
Based on the “last 3 months,” as each subtype
may only be a phase
Medical Consequences
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Amenorrhea – cessation of menstruation
Dry skin
Brittle hair or nails
Sensitivity to or intolerance of cold
temperatures
Downy hair (lanugo) on the limbs and cheeks
Cardiovascular problems
If vomiting, electrolyte imbalance and resulting
cardiac & kidney problems
Comorbid Disorders
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Anxiety disorders, esp. obsessive-compulsive
disorder
Depressive disorder (71% of cases)
Substance abuse (27% of cases)
BULIMIA NERVOSA & BINGE EATING
DISORDER
BULIMIA NERVOSA
Diagnostic Criteria 307.51 (F50.2)
A. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following:
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 episode (e.g., a feeling that one cannot
stop eating or control what or how much
one is eating)
B. Recurrent inappropriate compensatory
behaviors in order 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.
Specify if:
In partial remission: after full criteria for bulimia
nervosa were previously met, some, but not all, of the
criteria have been met for a sustained period of time
In full remission: after full criteria for bulimia nervosa
were previously met, none of the criteria have been
met for a sustained period of time
Specify current severity:
The minimum level of severity is based on the
frequency of inappropriate compensatory behaviors
(see below). The level of severity may be increased to
reflect other symptoms and the degree of functional
disability.
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.
Clinical Description
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Like those with anorexia, people with bulimia
have a morbid fear of gaining weight and losing
control over eating.
o Unlike those with anorexia, those with
bulimia have a sense of lack of control
over eating (Criterion A.2), which they
are ashamed of.
Attempts to compensate for the binging
(criterion B) by
o Purging techniques
 Self-induced vomiting
 Using laxatives – drugs that
relieve constipation
 Using diuretics – drugs that
result in loss of fluids through
increased urination
o Excessive exercising
Self-evaluation is unduly influenced by body
shape & weight (Criterion D)
Medical Consequences
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Repeated vomiting causes the ff:
o Salivary gland enlargement – which
gives the face a chubby appearance
o Erosion of the dental enamel on the
inner surface of the front teeth
o Tear in the esophagus
o Electrolyte imbalance – chemical
imbalance of bodily fluids, including
sodium and potassium levels
 can result in cardiac arrhythmia
(disrupted heartbeat), seizures
and renal failure
 more body fat
laxative abuse
o severe constipation
o permanent colon damage
Comorbid Disorders
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anxiety disorders – historically (80.6% of cases)
or concurrently (66%)
depressive disorder – historically (50% - 70%) or
concurrently (20% of cases)
substance abuse (36.8%)
BINGE EATING DISORDER
Clinical Description
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binge-eating (and marked distress over it) minus
extreme compensatory behaviors of those with
bulimia
new in DSM-5
o elevated to a disorder because of its
own pattern of heritability different
from anorexia and bulimia, greater
likelihood of occurrence in males, and
later age of onset.
Diagnostic Criteria 307.51 (F50.8)
A. Recurrent episodes of binge eating. An episode
of binge eating is characterized by both of the
following:
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 episode (e.g., a feeling that one cannot
stop eating or control what or how much
one is eating)
B. The 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 afterward.
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.
BED vs. Obesity Only
BED
Have concerns about
shape and weight
Associated with more
severe obesity than
obesity without BED
Some (33%) binge-eat to
alleviate “bad moods” or
negative affect
Obesity
Not necessarily
concerned about shape
and weight
Associated with less
severe obesity
TREATMENT FOR EATING DISORDERS
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Treatment program
CBT-E (Enhanced Cognitive Behavioral Therapy)
IPT (Interpersonal Therapy)
Medication
o Vyvanse – seems to help people change
their behaviors because it is a stimulant;
it can be addictive and have side
effects; should be monitored by
physician
o SSRI antidepressants
o Anticonvulsant topiramate – which
seem to help with binge eating and the
thoughts that accompany it.
BULIMIA
Best treatment: combination of either CBT-E or IPT and
SSRI antidepressant (Selective Serotonin Reuptake
Inhibitors)
Medication: Fluoxetine or Prozac – seem to change
chemicals in the part of the brain that affect distorted
thoughts seen in Bulimia; help people regain control
over their bingeing and purging behaviors
ANOREXIA NERVOSA
CBT-E or IPT
Nutritional Support – team works toward helping
people with Anorexia gain weight safely while changing
their distorted thinking about food and their bodies.
Medication – not shown to be effective to treat
Anorexia Nervosa