Eating Disorders: Clinical Presentation (LO1) (Topic 6)

Anorexia Nervosa
1. Main Characteristics
  1. AN is characterised by an intense fear of weight gain. It involves an ongoing pattern of self starvation and a preoccupation with control over food and weight
    1. DSM-V further specifies that an individual may also present with persistent behaviour that infers with weight gain despite being at a low weight.
      1. Additionally, the DSM-V also specifies disturbances in the way body weight or shape is perceived, disproportionate influence of body weight on self evaluation, and lack of recognition of seriousness of current low body weight.
  2. Typically you'd expect to see weight below 85% of expected weight. However,DSM-V removed a definitive weight requirement for diagnosis and instead requires for weight to be considered in the context of age, sex, dev trajectory and physical health.
2. Key physical symptoms
  1. Amenorrhea (loss of period)
  2. Low body weight
  3. loss of hair
  4. Low pulse rate and sensitivity to cold
3. Key psychological/behavioural symptoms
  1. Perfectionism and high self criticism
  2. Social Isolation
  3. Playing with or cutting food into small pieces
  4. May have alternating episodes of purging and binge eating
  5. Compulsive exercise and/or cleaning
  6. Nervousness at meal times
Bulimia Nervosa
1. Main Characteristics
  1. In constrast to AN, BN is characterised by recurrent episodes of binge eating followed by compensatory strategies including self induced vomiting, use of laxatives or diuretics, restriction or excessive exercise.
    1. Whilst a pattern of purging and binging can be seen in AN, it is not the core feature of diagnosis whereas a recurrent pattern of binging followed by inappropriate compensatory strategies is core to BN diagnosis. Further, the DSM requires that this pattern does occur exclusively during episodes of AN.
      1. Additionally, weight is typically average or above average
  2. Key Physical Symptoms
    1. Frequent Vomiting
      1. Tooth decay and oesophagus damage due to this
    2. Weight fluctuation due to bingeing and fasting
    3. Puffiness in Face
  3. Key Behavioural/Psychological Symptoms
    1. Fear or inability to stop eating
    2. Secretive behaviour and inconspicuous binge eating
    3. Perfectionism
    4. Petty stealing of money to buy food for binges.
Binge Eating Disorder
1. Main Characteristics
  1. BED is characterised by recurrent episodes of binge eating but, in contrast to BN, in the absence of inappropriate compensatory behaviours. Weight may be normal but is more likely to be overweight.
  2. Key physical symptoms
    1. Possible history of marked weight fluctuations
  3. Key Psychological or Behavioural Symptoms
    1. Eating alone due to embarrassment over how much one is eating
    2. Sense of lack of control over binging
    3. Feeling guilty or depressed after binging
Other Specified Feeding or Eating Disorder (OSFED)
1. Why does this category exist?
  1. In DSM-IV about 50% of patients fell into other specified eating disorder therefore this category was developed to provide more specific diagnosis to account for this
2. Included diagnoses under this category
  1. Atypical AN: despite sig weight loss, weight is at or above normal range.
  2. Purging disorder: recurring purging to influence shape or weight in the absence of binging.
  3. Sub threshold BN or BED: Behaviours occur less than one week or less than three months.
  4. Night eating syndrome
    1. Recurrent episodes of night eating, associated with significant distress
Avoidant/Restrictive Food Intake Disorder (ARFID)
1. Main characteristics of ARFID
  1. ARFID is characterised by eating or feeding disturbance and persistent failure to meet energy needs which is not accounted for by lack of available food or cultural practices.
  2. Three subtypes; those who do not eat enough and/or show little interest in eating, those who accept limited diet in relation to sensory features, and where food refusal is related to aversive experiences.
  3. Distinguished from AN or BN as there is no disturbance in how one views or experiences body weight or shape. The focus of diagnosis is purely on restrictive or avoidant behaviour in relation to eating.
Issues
1. Difficulties with Diagnosis
  1. There is a lot of overlap in symptoms so this can make diagnosis challenging
  2. Interpretation needed but this can be limited by developmental context and co-morbity.
2. Transdiagnosis
  1. Migration across disorders
    1. Patients with eating disorders tend to migrate between the diagnostic categories of anorexia nervosa, bulimia nervosa, and the atypical eating disorders (Fairborn and Harrison, 2003)
      1. This temporal movement, together with the fact that anorexia nervosa, bulimia nervosa, and the atypical eating disorders share the same distinctive psychopathology, suggest that common mechanisms are involved in their persistence.
        Given this, it is arguably more helpful to take a transdiagnostic approach to eating disorders.
        However, where do we draw the line? High co-morbidity means you could argue that there is significant overlap between EDs and other disorders and therefore, EDs could be considered part of these disorders.
        Yet, the fact that eating disorders do not tend evolve into other conditions lends support to the distinctiveness of the diagnostic category as a whole.

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Eating Disorders: Clinical Presentation (LO1) (Topic 6)

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