EATING

DISORDERS

MANOS, BENCIO, FERNANDES, PARAISO

 Diagnostic Criteria
A. Persistent eating of nonnutritive, nonfood substances
over a period of at least 1 month.
B. The eating of nonnutritive, nonfood substances is
inappropriate to the developmental level of the
PICA individual.
C. The eating behavior is not part of a culturally
supported or socially normative practice.
D. If the eating behavior occurs in the context of another
mental disorder (e.g., intellectual disability [intellectual
developmental disorder], autism spectrum disorder,
schizophrenia) or medical condition (including
pregnancy), it is sufficiently severe to warrant additional
clinical attention.
 Diagnostic Criteria
A. Repeated regurgitation of food over a period of at
least 1 month. Regurgitated food may be re-chewed, re-
swallowed, or spit out.
B. The repeated regurgitation is not attributable to an
RUMINATION associated gastrointestinal or other medical condition

DISORDER C. The eating disturbance does not occur exclusively

during the course of anorexia nervosa, bulimia nervosa,
binge-eating disorder, or avoidant/restrictive food
intake disorder.
D. If the symptoms occur in the context of another mental
disorder they are sufficiently severe to warrant additional
clinical attention.
 Diagnostic Criteria
A. An eating or feeding disturbance as manifested by persistent failure to meet
appropriate nutritional and/or energy needs associated with one (or more) of the
following:
1. Significant weight loss (or failure to achieve expected weight gain or faltering
growth in children).
2. Significant nutritional deficiency.
AVOIDANT/RESTRICTIVE
FOOD INTAKE DISORDER 3. Dependence on enteral feeding or oral nutritional supplements.
4. Marked interference with psychosocial functioning.
B. The disturbance is not better explained by lack of available food or by an
associated culturally sanctioned practice.
C. The eating disturbance does not occur exclusively during the course of
anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance
in the way in which one’s body weight or shape is experienced.
D. The eating disturbance is not attributable to a concurrent medical condition or
not better explained by another mental disorder. When the eating disturbance
occurs in the context of another condition or disorder, the severity of the eating
disturbance exceeds that routinely associated with the condition or disorder and
warrants additional clinical attention.
ANOREXIA
NERVOSA

BEALAURA BENCIO
 • People with anorexia nervosa starve themselves,
subsisting in little or no food for very long periods of
time, yet they remain convinced that they need to lose
more weight.
• As a result, their body weight is significantly below

DEFINITION what is minimally normal for their age and height

• Despite being emaciated, people with anorexia
nervosa have a distorted image of their body, often
believing that they are distinguishly fat and need to
lose more weight and they often develop elaborate
rituals around food
• Amenorrhea: causes women and girls who have began
menstruating to stop having menstrual periods
 Anorexia nervosa is characterized by emaciation, a

SUMMARY:
relentless pursuit of thinness and unwillingness to
maintain a normal or healthy weight, a distortion of body
image and intense fear of gaining weight, a lack of
menstruation among girls and women, and extremely
disturbed eating behavior
 Restricting Type of Anorexia Nervosa
 Simply refuse to eat and/or engage in excessive exercise
as a way of preventing weight gain

Bing/Purge Type of Anorexia Nervosa

TWO TYPES  Periodically engage in binge eating or purging behaviors

OF  Self-induced vomiting or the misuse of laxatives or

diuretics

ANOREXIA  Its difference between bulimia nervosa is that people

that binge/purge type of anorexia nervosa continue to be
substantially below a healthy body weight, whereas
people with bulimia nervosa typically are at normal
weight or somewhat overweight
 • Restriction of energy intake relative to requirements,
leading to a significantly low body weight in the context of

Criterion A 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

ANOREXIA
than that minimally expected.

NERVOSA:
DSM 5 Criterion 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.

CRITERIA
• Disturbance in the way in which one’s body weight or
Criterion C 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
 • Specify whether:
(F50.01) Restricting type: During the last 3 months, the individual has
not engaged in recurrent episodes of binge eating or purging behavior
(i.e., self-induced vomiting or the misuse of laxatives, diuretics, or
enemas). This subtype describes presentations in which weight loss is
accomplished primarily through dieting, fasting, and/or excessive
exercise.
(F50.02) Binge-eating/purging type: During the last 3 months, the
individual has engaged in recurrent episodes of binge eating or purging

SPECIFIERS: behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics,

or enemas).
• Specify if:
In partial remission: After full criteria for anorexia nervosa were
previously met. Criterion A (low body weight) has not been met for a
sustained period, but either Criterion B (intense fear of gaining weight or
becoming fat or behavior that interferes with weight gain) or Criterion C
(disturbances in self-perception of weight and shape) is still met.
In full remission: After full criteria for anorexia 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, for adults, on current body mass index
(BMI) (see below) or, for children and adolescents, on BMI percentile. The ranges
below are derived from 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 > 17kg/m2

SPECIFIERS: Moderate: BMI 16-16.99 kg/m2
Severe: BMI 15-15.99 kg/m2
Extreme: BMI < 15 kg/m2
 • Medical conditions (e.g., gastrointestinal disease, hyperhyroidism, occult
malignancies, and acquired immunodeficiency syndrome [AIDS]). Serious
weight loss may occur in medical conditions, but individuals with these
disorders 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. Acute weight loss
associated with a medical condition can occasionally be followed by the onset
or recurrence of anorexia nervosa, which can initially be masked by the
comorbid medical condition. Rarely, anorexia nervosa develops after bariatric
surgery for obesity.

DIFFERENTIAL • Major depressive disorder. In major depressive disorder, severe weight loss
may occur, but most individuals with major depressive disorder do not have

DIAGNOSIS
either a desire for excessive weight loss or an intense fear of gaining weight.
• Schizophrenia. Individuals with schizophrenia may exhibit odd eating
behavior and occasionally experience significant weight loss, but they rarely
show the fear of gaining weight and the body image disturbance required for a
diagnosis of anorexia nervosa.
• Substance use disorders. Individuals with substance use disorders may
experience low weight due to poor nutritional intake but generally do not fear
gaining weight and do not manifest body image disturbance. Individuals who
abuse substances that reduce appetite (e.g., cocaine, stimulants) and who also
endorse fear of weight gain should be carefully evaluated for the possibility of
comorbid anorexia nervosa, given that the substance use may represent a
persistent behavior that interferes with weight gain (Criterion B).
 • Social anxiety disorder (social phobia), obsessive-compulsive disorder, and
body dysmorphic disorder. Some of the features of anorexia nervosa overlap
with the criteria for social phobia, OCD, and body dysmorphic disorder.
Specifically, individuals may feel humiliated or embarrassed to be seen eating
in public, as in social phobia; may exhibit obsessions and compulsions related
to food, as in OCD; or may be preoccupied with an imagined defect in bodily
appearance, as in body dysmorphic disorder. If the individual with anorexia
nervosa has social fears that are limited to eating behavior alone, the diagnosis
of social phobia should not be made, but social fears unrelated to eating
behavior (e.g., excessive fear of speaking in public) may warrant an additional

DIFFERENTIAL
diagnosis of social phobia. Similarly, an additional diagnosis of OCD should be
considered only if the individual exhibits obsessions and compulsions unrelated
to food (e.g., an excessive fear of contamination), and an additional diagnosis
DIAGNOSIS of body dysmorphic disorder should be considered only if the distortion is
unrelated to body shape and size (e.g., preoccupation that one's nose is too
big).
• Bulimia nervosa. Individuals with bulimia nervosa exhibit recurrent episodes
of binge eating, engage in inappropriate behavior to avoid weight gain (e.g.,
self-induced vomiting), and are overly concerned with body shape and weight.
However, unlike individuals with anorexia nervosa, binge-eating/purging type,
individuals with bulimia nervosa maintain body weight at or above a minimally
normal level.
• Avoidant/restrictive food intake disorder. Individuals with this disorder may
exhibit significant weight loss or significant nutritional deficiency, but they do
not have a fear of gaining weight or of becoming fat, nor do they have a
disturbance in the way they experience their body shape and weight.
4 FACTS
ABOUT
ANOREXIA
 1. The Cause
Isn’t Fully
Known
Anorexia nervosa is a complex disease, and
the cause isn’t fully known. However, some
of the factors that may lead to eating
disorders include genetics, psychological
health, environment, trauma, and
biology.
 2. Most People
Don’t Seek
Treatment
Only one out of every 10 people with
anorexia will ever seek treatment. Part of
the problem is that the general population
believes that anorexia isn’t a real disease. In
turn, people are afraid to ask for help
because they feel ashamed or don’t feel as
though they’ll be taken seriously.
 3. Men Make Up
10% Of Those
Suffering From
Anorexia Nervosa
Although anorexia is far more common in
women,. men make up approximately 10%
of those suffering from the disease All too
often, men are under and undiagnosed
with anorexia because of its prevalence in
females.
 4. Treatment Is
Complex But
Attainable
Recovery from anorexia is possible, even
for someone who has been living with the
disease for many years. Anorexia is often
treated in an outpatient setting, but
hospitalization may be necessary in some
situations. The path to recovery can be long
and challenging, but having the right team
supporting you can make all the
difference..

Bockish, C. (2016, June 01). 5 Facts About Anorexia Nervosa.

Retrieved from https://www.orlandorecovery.com/blog/5-facts-
anorexia-nervosa/#gref
WHAT DOES
CULTURE
HAVE TO DO
WITH IT?
 There is some • A law in France banning the use of unhealthily thin
fashion models has come into effect.
evidence that – Models will need to provide a doctor's certificate

cultures that attesting to their overall physical health, with special

regard to their body mass index (BMI) - a measure of
do not value weight in relation to height.

thinness in – The health ministry says the aim is to fight eating

disorders and inaccessible ideals of beauty.

females have • In 2012, the Hong Kong Eating Disorder Association

lower rates of eating disorders are increasing exponentially in Hong

Kong which may be due to the fact that Hong Kong’s
anorexia billboards, TV programs and social media sites all
create and reinforce the belief that thinness equates to
nervosa. beauty.

http://www.bbc.com/news/world-europe-39821036
http://www.scmp.com/comment/insight-
opinion/article/1774159/how-ideal-thin-body-harms-hong-kong-
women-and-girls
 The • Korea: Lee Tae Im‘s famous extreme diet of eating only
3 spoons of rice a day gave her some nasty side effects.
motivations for “[Because of my diet], I was losing hearing in my ears and
self-starvation hearing ringing noises instead. Soon after that I had hand
tremors and would sometimes just collapse.” — Lee Tae Im
also vary
across culture
and time

http://kpopline.com/idols-reveal-the-worst-side-effects-of-going-on-
starvation-diets-2507.html
DO YOU:
DEVELOPING
A POSITIVE
BODY IMAGE
https://www.youtube.com/watch?v=IgqMqtnTJeE
BULIMIA
NERVOSA
CLAIRE PARAISO
Eating in a descrete period of time (e.g., within A sense of lack of control over eating during
any 2-hour period) the episode.
 Diagnostic Criteria
A Recurrent episode of binge eating

Recurrent inappropriate compensatory

B behaviors order to prevent weight gain

Binge eating and inappropriate compensatory

C behaviors both occur, on average at least once a
week for 3 months

Self-evaluation is unduly influenced by body

D shape and weight

Disturbance does not occur exclusively during

E episode of anorexia nervosa
 Specify if:

After full criteria for bulimia nervosa were

In partial previously met, some, but not all, of the criteria
remission have been met for a sustained period of time.

After full criteria for bulimia nervosa were

In full remission previously met, none of the criteria have been met
for a sustained period of time.
An average of 1-3
An average of 4-7
episodes of inappopriate
episode of inappopriate
compensatory behaviors
compensatory behaviors
per week. Mild Moderate
per week.

Levels

An average of 14 or more Extreme Severe An average of 8-13

episodeof inappopriate episode of inappopriate
compensatory behaviors compensatory behaviors
per week. per week.
DIFFERENTIAL DIAGNOSIS
Individuals whose binge-eating behavior
occurs only during episode of anorexia
nervosa are given the diagnosis anorexia
nervosa, binge-eating/purging type, and
should not be given the additional diagnosis
of bulimia nervosa. For individulas with an
initial dignosis of anorexia nervosa, binge-
eating/purging type, a diagnosis of bulimia
nervosa should be given only when all
criteria for bulimia nervosa have been met
for at least 3 months.
DIFFERENTIAL DIAGNOSIS

Some individuals binge eat do not engage in

regular inapproriate compensatory
behaviors. In this cases, the diagnosis of
binge-eating disorder should be considered.
DIFFERENTIAL DIAGNOSIS

In certain neurological or other medical

conditions, such as Kleine-Levin Syndrome,
there is disturbed eating behavior, but the
characteristic psychological features of
bulimia nervosa, such as overconcern with
body dhape and weight, are not present.
DIFFERENTIAL DIAGNOSIS

Overeating is common in major depressive

disorder, with atypical features, but
individuals with this disorder do not engage
in appropriate compensatory behaviors and
donot exhibit the excessive concern with
body shape and weight characteristic of
bulimia nervosa. if criteria of this both
disorder are met, both diagnoses should be
given.
DIFFERENTIAL DIAGNOSIS

Binge-eating behavior is included in the

impulsive behavior criterion that is part of
the definition of borderline personality
disorder. If the criteria of both borderline
personality disorder and bulimia nervoare
met, both diagnoses should be given.
BINGE-EATING
DISORDER

Shannen Fernandes
 Binge-eating Disorder
• Was not officially recognized as a form of eating
disorders in the DSM-IV-TR
• Binge-eating disorder resembles bulimia nervosa,
except that it does not regularly engage in purging,
fasting, excessive exercise to compensate for binges
• People with binge-eating disorder may eat continuously
throughout the day with no planned meal times. Often
in response to stress and to feelings of anxiety or
depression. They may eat very rapidly and appear
almost in a daze as they eat.
• More common in women.
• Tends to be chronic and with a mean duration of 8 years
and another study found a mean duration of 14 years.
 Diagnostic Criteria
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 people would
eat in a similar period of time under similar circumstances.
2.A sense of lack of control over eating during 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.
 Specify if:
• In partial remission
• in full remission

Specify current severity:

• Mild: 1-3 binge-eating episode per week.
• Moderate: 4-7 binge-eating episodes per
week.
• Severe: 8-13 binge-eating episodes per week
• Extreme: 14 or more binge-eating episodes
per week.
Diagnostic • Recurrent episodes of binge eating that must occur, on
average, at least once per week for 3 months (criterion

Features
D).
• A single episode of binge eating need not be restricted
to one setting.
• An occurrence if excessive food consumption must be
accompanied by a sense of lack of control to be
considered an episode of binge eating.
• Binge eating must be marked by distress and at least
three of following features: eating much more rapidly
than normal; eating until feeling uncomfortably full;
eating large amounts of food when not feeling
physically hungry; eating alone because of feeling
embarrassed by how much one is eating; and feeling
disgusted with oneself, depressed, or very guilty
afterward (criterion B).
Obesity • Defined as a body mass index (BMI) of 30 or over
• Is not designated as an eating disorder by the DSM-IV-
TR, but clearly is a major health hazard.
• The dramatic historical increases in obesity point to
environment causes.
Understanding Eating
Disorders

By: Mitch Dominic E. Manos

Biological ● As with most psychological disorders, anorexia
nervosa, bulimia nervosa, and binge-eating disorder

Factors ●
tend to run in families
Twin studies revealed that:
● Anorexia nervosa- 56% heritability
● Bulimia nervosa- 50-85% heritability
● Binge-eating disorder- 41% heritability
Biological
Factors
The hypothalamus plays a central role in regulating eating
●

● Disordered eating behavior might be caused by imbalances in or

dysregulation of any of the neurochemicals involved in this system or by
structural or functional problems in the hypothalamus.
Biological ● People with anorexia nervosa show
lowered functioning of the hypothalamus
Factors and abnormalities in the levels of several
hormones important to the functioning of
the hypothalamus, including serotonin and
dopamine.
● Some studies find that people with
anorexia continue to show abnormalities in
hypothalamic and hormonal functioning
and neurotransmitter levels after they gain
some weight, whereas other studies find
that these abnormalities disappear with
weight gain.
Biological ● Many people with bulimia show abnormalities in the
neurotransmitter serotonin.

Factors ● Deficiencies in serotonin might lead the body to crave

carbohydrates, and people with bulimia often binge on
high-carbohydrate foods.
Sociocultural • Social Pressures and Cultural Norms

and ● Psychologists have linked the historical and

crosscultural differences in the prevalence of eating
Psychological disorders to differences in the standards of beauty for
Factors women at different historical times and in different
cultures.
Standards
of Beauty
● Both anorexia nervosa and bulimia nervosa are much more common in
females than in males, perhaps because thinness is more valued and more
strongly encouraged in females than in males.
● The thin ideal promoted in women’s magazines seems to affect women’s
attitudes toward themselves.
● Stice and colleagues looked at what chronic exposure to the thin ideal in
fashion magazines actually does to adolescent girls’ mental health.
So, what's ● Avoid fashion magazines and other media depictions in
order to avoid some pressures to conform to the ideal

the moral of thinness

lesson?
 Athletes
and Eating
Disorders
● One group at increased risk for unhealthy and disordered eating habits is
athletes, especially those participating in sports in which weight is
considered an important factor in competitiveness.
● A research in Norway revealed that those participating in sports classified
as “aesthetic” or “weight-dependent,” including diving, figure skating,
gymnastics, dance, judo, karate, and wrestling, were most likely to have
anorexia or bulimia nervosa.
 Emotion ● Eating-disorder behaviors may sometimes serve as
maladaptive strategies for dealing with painful

Regulation emotions.
Depressive symptoms and a history of negative affect

Difficulties
●

predict future onset or exacerbation of anorexic and

bulimic symptoms and relapse into binge eating
among obese people.
Cognitive
Models of suggests that the overvaluation of
Christopher Fairburn
●

Eating
appearance is of primary importance in the development of the
eating disorders.
Disorders
Kathleen Vohs and colleagues (1999, 2001) suggested that
●

disordered eating is especially likely to result when body

dissatisfaction is combined with perfectionism and low self-
esteem.
● Research confirms that people with eating disorders are more
concerned with the opinions of others, are more conforming to
others’ wishes, and are more perfectionistic and rigid in their
evaluations of themselves and others than are other people.
 Family ● Hilde Bruch (1973, 1982), a pioneer in the study of
eating disorders, argued that anorexia nervosa often

Dynamics occurs in girls who have been unusually “good girls”—

high achievers, dutiful and compliant daughters who
are always trying to please their parents and others by
being “perfect.”
Treatments for Eating
Disorders
 Psychotherapy
for Anorexia
Nervosa
● Regardless of the type of psychotherapy a therapist uses with a client with
anorexia, he or she must do much work to win the client’s trust and
participation in the therapy.
● *Psychotherapy can help many people with anorexia, particularly
adolescents, but it typically is a long process, often marked by many
setback.
Individual ● Cognitive-behavioral therapies are the most
researched treatment for anorexia nervosa

Therapy ● The client’s overvaluation of thinness is confronted,

and rewards are made contingent on the person’s
gaining weight.
● The client also may be taught relaxation techniques to
use as she becomes extremely anxious about ingesting
food
 Family ● In family therapy , the person with anorexia and her
family are treated as a unit.

Therapy ● Maudsley model- involves 10 to 20 sessions over 6 to 12

months
● Parents are coached to take control over their child’s
eating and weight.
Psychotherapy ● Cognitive-behavioral therapy (CBT) has received the
most empirical support for use in treating bulimia
for Bulimia nervosa

Nervosa ● The therapist teaches the client to monitor the

cognitions that accompany her eating, particularly the
binge episodes and purging episodes
● Then the therapist helps the client confront these
cognitions and develop more adaptive attitudes
toward weight and body shape.
Psychotherapy ● The behavioral components of CBT involve introducing
forbidden foods (such as bread) back into the client’s
for Bulimia diet and helping the client confront her irrational

Nervosa ●
thoughts about these foods.
The client is also taught to eat three healthy meals a
day and to challenge the thoughts she has about these
meals and about the possibility of gaining weight.
Psychotherapy ● Controlled studies of the efficacy of CBT for bulimia
reveal that about half the clients completely stop the
for Bulimia binge/purge cycle.

Nervosa ● CBT is more effective than drug therapies in producing

complete cessation of binge eating and purging and in
preventing relapse over the long term.
Psychotherapy • Aside from CBT, there are three other types of
psychotherapy:
for Bulimia ● Interpersonal Therapy (IPT)
Nervosa ● Supportive-expressive Psychodynamic therapy
● Behavior therapy (without a focus on cognitions)
 Psychotherapy for Bulimia
Nervosa
● In interpersonal therapy, the client and the therapist discuss
interpersonal problems related to the client’s eating disorder,
and the therapist works actively with the client to develop
strategies to solve these problems.
● In supportive-expressive psychodynamic therapy, the therapist
also encourages the client to talk about problems related to the
eating disorder—especially interpersonal problems—but in a
highly nondirective manner.
● In behavior therapy, the client is taught how to monitor her food
intake, is reinforced for introducing avoided foods into her fiet,
and is taught coping techniques for avoiding binging.
Psychotherapy ● In the studies, all the therapies resulted in significant
improvement in the clients’ eating behaviors and
for Bulimia emotional well-being, but the clients of CBT and IPT

Nervosa showed the greatest and most enduring

improvements.
Psychotherapy ● For binge-eating disorder, cognitive-behavioral
therapy has been shown to be more effective than
for Binge- both wait-list controls and antidepressant medications

Eating ● Intepersonal therapy has proven as effective as CBT for

binge-eating disorder.
Disorder
 Biological ● Drug treatments, including antidepressants, are often used to
treat anorexia nervosa, but there is no consistent evidence

Treatments that they are better than a placebo.

for Anorexia
Nervosa
 Biological ● The selective serotonin reuptake inhibitors (SSRIs),
such as fluoxetine (trade name Prozac), have been the

Treatments focus of much research on biological treatments for

bulimia nervosa.

for Bulimia ● These drugs appear to reduce binge-eating and

purging behaviors, but often they fail to restore the

Nervosa ●
individual to normal eating habits.
Adding cognitive-behavioral therapy to antidepressant
treatment increases the rate of recovery from the
disorder.
 Biological ● A meta-analysis of medications for binge eating found
that a number of drugs, including the SSRIs,

Treatments antiepileptic medications (such as topiramate), and

obesity medications (such as orlistat), all are better

for Binge than a placebo in reducing binge eating.

Eating
Disorder