Lecture 14: Eating and Feeding Disorders

mental health notes Lecture 14: 4/16 Eating and Feeding Disorders Eating and Feeding Disorders Eating Responses Disordered eating vs eating disorder Adaptive Balanced eating patterns Appropriate caloric intake Ability to regulate eating habits Occasional overeating or skipping meals Maladaptive Overeating or fasting under stress Frequent bingeing, fasting, or night eating Severe dieting Eating disorders: Anorexia nervosa Bulimia nervosa Binge eating disorder Etiology Clinical Diagnoses Biological Factors Anorexia nervosa Genetics: 60% Bulimia nervosa Poor impulse control or NT dysfunction Binge-eating disorder Neurobiological Factors Serotonin alterations Cultural/Environmental Pica Rumination disorder Avoidant/restrictive food intake disorder Sociocultural inzuences Environmental factors Psychological Factors Cycle of Emotional Eating Most problematic emotions related to the development of an eating disorder: Shame, fear, and sadness May be a learned behavior A strong risk factor is perfectionism More likely to report higher levels of body image dissatisfaction, internaliwation of "hat is considered an 1ideal1 appearance Personal hx of depression/anxiety, including GAD, social phobia, OCD Association "ith stressful life events and hx of childhood trauma, physical, or sexual abuse Eating Disorders: Anorexia Nervosa Etiology & Diagnosis Etiology A'ects approximately 08 -085% of young "omen and 084% of young men Typical onset bet"een 4 -?0 years but can occur at any age Characteristic of Diagnoses Physical Signs & Symptoms Extreme "eight loss or not making expected developmental "eight gains Starvation ensues Emaciation: Thin appearance "ith muscle "asting Potentially life-threatening Can become chronic illness Fatigue or lethargyV insomnia Diwwiness or fainting Blushing discoloration of the Ingers Distorted self-perception and body image ;air that thins, breaks, or falls out Restricting type: ndividuals lose "eight mostly by dieting, fasting, and/or excessive exercising Lanugo: Soft, do"ny hair covering the body Binge-eating/purging type: ndividuals also engage in intermittent binge eating and/or purging behaviors Potential Consequences Amenorrhea: Absence of menstruation Dehydration Constipation, abdominal pain, bloating Dry or yello"ish skin Cold intolerance rregular heart rhythm Slo"ed breathing and pulse Ho" blood pressure S"elling of arms or legs Eroded teeth and calluses on the knuckles from induced vomiting Eating Disorders: Bulimia Nervosa Etiology & Diagnosis Bulimia nervosa is more common Physical and Behavioral Symptoms Frequent trips to the bathroom right after meals Potential Consequences Rare but potentially fatal complications: Estimated in 4-5% of population, mostly female-identifying Harge amounts of food disappearing or unexplained empty "rappers/containers Esophageal tears 5-4U% of female-identifying high school and college students in the .8S8 Chronic sore throat Dangerous cardiac arrhythmias S"elling of the salivary glands in the cheeks Multiple potential comorbidities Typical onset at 4U-4L years old Dehydration, electrolyte imbalance Recurrent, uncontrolled binge eating alternating "ith purging, fasting, or restricting Feeling diwwy or fainting from excessive purging behaviors resulting in dehydration At least once/"eek for three months Dental decay resulting from erosion of tooth enamel by stomach acid ;eartburn and GERD Haxative or diet pill misuse Recurrent unexplained diarrhea Misuse of diuretics Gastric rupture Binge-Purge Cycle Feelings of self-hatred and shame Strict dieting Diet slips or di2cult situation arises Binge eating triggered Purging to avoid "eight gain Eating Disorders: Binge-Eating Disorder Etiology & Diagnosis Characteristics Consuming large amounts of calories "ithin a contained amount of time Eating unusually large amounts of food "ithin a speciIc amount of time At least once/"eek for three months Eating even "hen full or not hungry, or eating until uncomfortably full Di'ers from bulimiaV no attempt to prevent "eight gain and no purging behaviors Prevalence: Approximately ?-5% of population Eating more rapidly during binge episodes Frequently eating alone or in secret Potential Consequencesd May become chronic Potentially serious health complications: Obesity, DM, ;TN Cardiovascular disease Comorbidities Associated "ith feelings of being out of control of intake along "ith marked distress Feeling depressed, disgusted, ashamed, guilty, or upset about this eating behavior Frequently dieting, possibly "ithout "eight loss Restricting one3s diet may lead to more bingeing Eating Disorder Assessment & Treatment Assessment Guidelines Treatment Options Complete biological, psychological, sociocultural evaluations Full Physical Examination &/S, "eight, skin, cardiovascular assessment Evidence of vomiting and/or laxatives, diet pills, or diuretic abuse Psychiatric ;istory Mental status exam Dieting and substance use Family history and assessment Medications Screening Adding these t"o questions may be as e'ective as more extensive questionnaires to identify people "ith eating disorders Are you satisIed "ith your eating patternsj Do you ever eat in secretj Feeding Disorders Pica Rumination Disorder Persistent eating of non-nutritive, non-food substances ncludes hair, paper, cloth/string, soap, clay, or soil Re-eating undigested food, "hich is then re-che"ed, re-s"allo"ed, or spit out Non-developmentally nor culturally normative practice May be diagnosed after one month of S/S Role in pregnancy: ron deIciency found in non-food substances ;abitual practices can result in severe malnutrition and even death Symptoms Nausea/vomiting Pain in the stomachV abdominal cramping Constipation and/or diarrhea May occur at any age, including infantry One predisposing factor is childhood neglect Not part of another medical or mental illness Avoidant/Restrictive Food Intake Disorder (ARFID) Food avoidance, "hich usually resolves as a toddler spontaneously Can result in signiIcant "eight loss, nutritional deIciency, marked interference "ith functioning, and dependence on supplements/enteral feeding C A "ho have not completed gro"th may not gro" along their developmental tra ectory Potential intestinal blockage May be related to strong dislikes of sensory qualities, personal anxiety, family anxiety, prematurity, and failure to thrive Head poisoning or toxic e'ects of "hat is ingested May be comorbid "ith autism Stomach ulcers Treatment: Behavioral modiIcation to increase regular food consumption Treat any depression/anxiety symptoms