This document provides information on screening and assessment tools for eating disorders. It describes several self-report questionnaires and clinical interviews used to screen for and diagnose eating disorders, including the SCOFF questionnaire, Eating Attitudes Test (EAT-26/40), Bulimia Test-Revised (BULIT-R), Eating Disorder Examination (EDE), and Interview for the Diagnosis of Eating Disorders-IV (IDED-IV). Diagnostic criteria from the DSM-5 for anorexia nervosa including associated features are also outlined.
The topic is "Eating disorders" which has many psychological causes and impacts on the mental condition of the patient. Moreover, the presentation covers the psychological treatment of such conditions along with other treatment plans.
A crash-course ED 101 for dietitians not familiar with eating disorders
- What does "normal eating" mean and when does it become "disordered eating?"
- What are the spectrum of eating disorders?
- What are the causes of eating disorders and what does treatment involve?
- What is the dietitian's role in eating disorders?
- What are some ways to screen eating disorders and obsessive/compulsive exercise?
- Why are "Health at Every Size" and "Intuitive Eating" effective approaches in preventing clinical eating disorders?
The topic is "Eating disorders" which has many psychological causes and impacts on the mental condition of the patient. Moreover, the presentation covers the psychological treatment of such conditions along with other treatment plans.
A crash-course ED 101 for dietitians not familiar with eating disorders
- What does "normal eating" mean and when does it become "disordered eating?"
- What are the spectrum of eating disorders?
- What are the causes of eating disorders and what does treatment involve?
- What is the dietitian's role in eating disorders?
- What are some ways to screen eating disorders and obsessive/compulsive exercise?
- Why are "Health at Every Size" and "Intuitive Eating" effective approaches in preventing clinical eating disorders?
"Eating Disorders" is presented by Dr. Carl Christensen, MD, Ph.D.; Addictionologist; and Lori Perpich, LLP, MS Clinical Behavioral Psychology; cognitive behavioral therapist and EDEN program facilitator. This program examines the evidence that eating disorders are true biopsychosocial diseases, similar to chemical dependency. It defines various eating disorders and their consequences, explores neurobiological theories of addiction, discusses screening tools used for eating disorders, and provides information on treatment options and resources for eating disorders. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
Men, muscles and masculinity: The general practitioner and the male experienc...Scoti Riff
The prevalence of body dissatisfaction and disordered eating amongst males is on the rise. Early figures that men accounted for 1 in 10 diagnoses of anorexia and bulimia nervosa are now considered underestimates, and researchers have increasingly focused on new disorders, such as muscle dysmorphia, that capture the “male experience” of wanting a more muscular body. I review the nature and prevalence of male body dissatisfaction and disordered eating, and explore their relationship with traditional notions of masculinity. I further review the stigmatisation of males with body image and eating disorders, and discuss the challenge that stigma represents to treatment seekers and to health professionals. In addition, I explore the concept of muscularity-oriented disordered eating and some of its major components, including nutritional supplements, steroid use, and compulsive exercise. Finally, the role of the general practitioner in recognising and addressing male body dissatisfaction and disordered eating is addressed, and guidelines for working with males are suggested.
About 30 million people have an eating disorder at one point in their lives, yet eating disorders are the deadliest form of mental illness. View this informative slideshare to learn more.
** Please note that some images in the Slideshare may be sensitive to some readers.
"Eating Disorders" is presented by Dr. Carl Christensen, MD, Ph.D.; Addictionologist; and Lori Perpich, LLP, MS Clinical Behavioral Psychology; cognitive behavioral therapist and EDEN program facilitator. This program examines the evidence that eating disorders are true biopsychosocial diseases, similar to chemical dependency. It defines various eating disorders and their consequences, explores neurobiological theories of addiction, discusses screening tools used for eating disorders, and provides information on treatment options and resources for eating disorders. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
Men, muscles and masculinity: The general practitioner and the male experienc...Scoti Riff
The prevalence of body dissatisfaction and disordered eating amongst males is on the rise. Early figures that men accounted for 1 in 10 diagnoses of anorexia and bulimia nervosa are now considered underestimates, and researchers have increasingly focused on new disorders, such as muscle dysmorphia, that capture the “male experience” of wanting a more muscular body. I review the nature and prevalence of male body dissatisfaction and disordered eating, and explore their relationship with traditional notions of masculinity. I further review the stigmatisation of males with body image and eating disorders, and discuss the challenge that stigma represents to treatment seekers and to health professionals. In addition, I explore the concept of muscularity-oriented disordered eating and some of its major components, including nutritional supplements, steroid use, and compulsive exercise. Finally, the role of the general practitioner in recognising and addressing male body dissatisfaction and disordered eating is addressed, and guidelines for working with males are suggested.
About 30 million people have an eating disorder at one point in their lives, yet eating disorders are the deadliest form of mental illness. View this informative slideshare to learn more.
** Please note that some images in the Slideshare may be sensitive to some readers.
From metabolic syndrome to cachexia: what’s new about metabolic biomarkers?Bertin Pharma
What does Metabolic Syndrom really mean? What impact on world population? Which biomarkers can serve your studies? What treatments for tomorrow?...
These are just some of the questions Virginie Tolle and Odile Viltart, researchers at the INSERM (The French National Institute for Health and Medical Research ) answered in this very complete article for Bertin Pharma.
Good reading!
11 Feeding, Eating and Elimination DisordersThe diagnostic crite.docxjesusamckone
11 Feeding, Eating and Elimination Disorders
The diagnostic criteria for the Feeding and Eating Disorders in this chapter are categorized by recurrent disordered eating activities and attitudes that are mutually exclusive, with the exception of pica, which results in significant physical and/or psychosocial impairment (APA, 2013). Research demonstrates that eating disorders often originate in childhood or adolescence with the average age of onset between 8 and 21 years (Hudson, Hiripi, Pope, & Kessler, 2007). Approximately 20 million women and 10 million men in the United States suffer from a clinically significant eating disorder during their lifetime (Wade, Keski-Rahkonen, & Hudson, 2011). Despite this prevalence, only one in ten individuals with an eating disorder receives treatment (Noordenbox, 2002). It is estimated that over 90% of those diagnosed with an eating disorder are young females between the ages of 12 and 25 (SAMHSA, 2003), but adult males suffer significantly as well (EDC, 2007).
Data from the National Comorbidity Replication Survey (NCS-R) and the Adolescent Supplement (NCS-A) show that adults and children with eating disorders often have coexisting mental disorders such as depression, anxiety, and substance use; sadly, few seek treatment specific to their eating disorder. More distressing, this data demonstrates that eating disorders are often associated with functional impairment and suicidality (Hudson et al., 2007; Swanson, Crow, Le Grange, Swendsen & Merikangas, 2011).
The first three disorders were relocated to this category “Feeding and Eating Disorders” to highlight that although they are most often diagnosed in children, they can occur at any age, including adulthood. These disorders are distinguished by problems with the process of eating and retaining food, eating inappropriate food, or lack of interest in or avoidance of food. Among individuals with intellectual disabilities their presence appears to increase with the severity of the condition. Pica Disorder is the eating of nonfood items such as paint chips, string, hair, or newspaper. Although it may occur with other eating and mental disorders, symptoms must be severe enough to warrant an independent diagnosis. Rumination Disorder involves vomiting and re-eating food. Avoidant/Restrictive Food Intake Disorder was formerly feeding disorder of infancy or early childhood, but it has been expanded to capture a broader range of symptoms and age levels. This disruption in eating and feeding behavior is marked by continuous inability to meet appropriate sustenance and dietary needs. It is associated with a serious decrease in body weight, failure to grow, nutritional deterioration, reliance on enteral feeding and impairment in psychosocial functioning (APA, 2013). For any of these diagnoses, all three eating disorders should not develop solely during the course of another eating disorder and cannot be a culturally sanctioned practice or attributable to a medica.
11 Feeding, Eating and Elimination DisordersThe diagnostic crite.docxaulasnilda
11 Feeding, Eating and Elimination Disorders
The diagnostic criteria for the Feeding and Eating Disorders in this chapter are categorized by recurrent disordered eating activities and attitudes that are mutually exclusive, with the exception of pica, which results in significant physical and/or psychosocial impairment (APA, 2013). Research demonstrates that eating disorders often originate in childhood or adolescence with the average age of onset between 8 and 21 years (Hudson, Hiripi, Pope, & Kessler, 2007). Approximately 20 million women and 10 million men in the United States suffer from a clinically significant eating disorder during their lifetime (Wade, Keski-Rahkonen, & Hudson, 2011). Despite this prevalence, only one in ten individuals with an eating disorder receives treatment (Noordenbox, 2002). It is estimated that over 90% of those diagnosed with an eating disorder are young females between the ages of 12 and 25 (SAMHSA, 2003), but adult males suffer significantly as well (EDC, 2007).
Data from the National Comorbidity Replication Survey (NCS-R) and the Adolescent Supplement (NCS-A) show that adults and children with eating disorders often have coexisting mental disorders such as depression, anxiety, and substance use; sadly, few seek treatment specific to their eating disorder. More distressing, this data demonstrates that eating disorders are often associated with functional impairment and suicidality (Hudson et al., 2007; Swanson, Crow, Le Grange, Swendsen & Merikangas, 2011).
The first three disorders were relocated to this category “Feeding and Eating Disorders” to highlight that although they are most often diagnosed in children, they can occur at any age, including adulthood. These disorders are distinguished by problems with the process of eating and retaining food, eating inappropriate food, or lack of interest in or avoidance of food. Among individuals with intellectual disabilities their presence appears to increase with the severity of the condition. Pica Disorder is the eating of nonfood items such as paint chips, string, hair, or newspaper. Although it may occur with other eating and mental disorders, symptoms must be severe enough to warrant an independent diagnosis. Rumination Disorder involves vomiting and re-eating food. Avoidant/Restrictive Food Intake Disorder was formerly feeding disorder of infancy or early childhood, but it has been expanded to capture a broader range of symptoms and age levels. This disruption in eating and feeding behavior is marked by continuous inability to meet appropriate sustenance and dietary needs. It is associated with a serious decrease in body weight, failure to grow, nutritional deterioration, reliance on enteral feeding and impairment in psychosocial functioning (APA, 2013). For any of these diagnoses, all three eating disorders should not develop solely during the course of another eating disorder and cannot be a culturally sanctioned practice or attributable to a medica ...
Professor Julio Licinio opens the First National Symposium on Translational Psychiatry, 4 -5 April 2011, at The John Curtin School of Medical Research, The Australian National University.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
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Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
EATING DISORDERS (Psychiatry-7)by dr Shivam sharma.pptxShivam Sharma
For any queries ,contact shvmshrm@outlook.com
---
## Introduction to Eating Disorders
Welcome to this comprehensive presentation on Eating Disorders, a critical and often misunderstood area of mental health. This presentation is designed to provide in-depth knowledge and insights into the various aspects of eating disorders, making it valuable for both postgraduate medical aspirants preparing for the INI-CET and the general public seeking to understand these complex conditions.
### Objectives:
1. **Understanding Eating Disorders**: Gain a clear understanding of what eating disorders are, their types, and their distinguishing characteristics.
2. **Etiology and Risk Factors**: Explore the underlying causes and risk factors that contribute to the development of eating disorders.
3. **Clinical Features and Diagnosis**: Learn about the clinical features, diagnostic criteria, and the importance of early detection.
4. **Management and Treatment**: Review the current approaches to managing and treating eating disorders, including medical, psychological, and nutritional interventions.
5. **Prevention and Awareness**: Discuss strategies for prevention, early intervention, and increasing awareness about eating disorders.
This presentation aims to bridge the gap between academic knowledge and practical understanding, providing you with the tools to recognize, diagnose, and effectively manage eating disorders. Whether you are preparing for a medical exam or seeking to educate yourself or others about these serious conditions, this presentation will equip you with essential information and practical insights.
Let's begin our journey into understanding eating disorders and the significant impact they have on individuals and society.
---
For any queries ,contact shvmshrm@outlook.com
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
3. SSccrreeeenniinngg aanndd AAsssseessssmmeenntt
Screening should occur with any individual
indicating issues with body weight, body
shape, or attitudes towards eating that
appear to be disordered
Suicidality should be assessed at the same
time due to elevated risk in individuals with
eating disorders
Depression and anxiety symptoms should be
assessed
4. SSCCOOFFFF SSccrreeeenn
Do you make yourself Sick because you feel
uncomfortably full?
Do you worry you have lost Control over how
much you eat?
Have you recently lost more than One stone in a
3 month period?
Do you believe yourself to be Fat when others
say you are too thin?
Would you say that Food dominates your life?
*One point for every ‘yes’
**Score of ≥ 2 indicates a likely case of anorexia or
bulimia
Morgan, J. Reid, F. , (1999). The SCOFF questionnaire: Assessment of a new screening tool for eating disorders.
British Medical Journal. 319:1467. doi: http://dx.doi.org/10.1136/bmj.319.7223.1467
http://en.wikipedia.org/wiki/SCOFF_questionnaire
6. EEaattiinngg AAttttiittuuddeess TTeesstt
http://psychcentral.com/quizzes/eat.htm
40 item version – EAT-40 (Garner & Garfinkel, 1979)
26 item version - EAT-26 (Garner, Olmsted, Bohr, &
Garfinkel, 1982)
12 item version – EAT-12 (Lavik, Clausen, & Pedersen,
1991).
Children’s Eating Attitudes Test (ChEAT; Maloney et al.,
1989)
Sensitivity .77; specificity .95 & .94; Positive predictive
values .82 & .79; negative predictive values .93 & .94
3 factors (across cultures and gender and age):
◦ Dieting and purging behaviors
◦ Binging and food preoccupation
◦ Social pressures to eat
7. Eating Attitudes Test ((GGaarrnneerr && GGaarrffiinnkkeell,, 11997799))
EEAATT--2266 SSeellff TTeesstt
26 Item self-report inventory:
http://eat-26.com/Form/
40 item EAT-40
http://eat-26.com/Form/index.php?test_type=Good concurrent validity (Williamson,
Anderson, Jackman, & Jackson, 1995).
Simple and Quick
May be given repeatedly to gauge
progress in treatment
8. Bulimia TTeesstt--RReevviisseedd ((BBUULLIITT--RR))
((TThheelleenn,, FFaarrmmeerr,, WWoonnddeerrlliicchh,, && SSmmiitthh,, 11999911))
28 item questionnaire based on DSM II-R
R = .99
Can discriminate BN from AN
Cutoff – 104
Brief, easy to score, well-validated
◦ Internal Consistency: (Adult women: r = .92-.98; Girls:
r = .9; Boys: r = .88)
◦ Test-Retest over 2 month period: .95
◦ High concurrent and convergent validity in adult and
adolescent females
Screening or progress in treatment
9. Eating DDiissoorrddeerr EExxaammiinnaattiioonn ((EEDDEE))
CCooooppeerr && FFaaiirrbbuurrnn,, 11998877;; FFaaiirrbbuurrnn && CCooooppeerr,, 11999933))
2 behavioral indices
◦ Overeating
◦ Methods of extreme weight control
4 Subscales:
◦ Restraint
◦ Eating concern
◦ Shape concern
◦ Weight concern
Investigator-based interview
Inter-rater reliability (Cooper, Fairburn, 1987; Wilson & Smith,
1989); Test-Retest (Rizvi, Peterson, Crow, & Agras, 2000); &
Internal consistency (Cooper, Cooper, & Fairburn, 1989).
Commonly used in treatment outcome studies
Requires training to use
10. Interview for the Diagnosis ooff EEaattiinngg DDiissoorrddeerrss--IIVV ((IIDDEEDD--IIVV))
((KKuuttlleessiicc,, WWiilllliiaammssoonn,, GGlleeaavveess,, BBaarrbbiinn,, && MMuurrpphhyy--EEbbeerreennzz,,
11999988))
Semi-structured interview
Differential Diagnosis DSM-IV AN, BN, & BED
Good reliability and validity (Kutlesic et al., 1998)
Strength: client responses are rated on severity scales
directly related to DSM-IV criteria
Score of 3 or above on a 1-5 scale is diagnostic
Following interview, rater completes a diagnostic
checklist using the severity ratings that leads directly to
differential diagnosis according to DSM-IV criteria.
11. EEaattiinngg DDiissoorrddeerr IInnvveennttoorryy--33
((GGaarrnneerr,, 11999911))
Self-report inventory
Assess symptoms of AN and BN
Provides standardized assessment of severity of symptoms – not
diagnostic
Can provide useful background info
Validated with both clinical and non-clinical groups across different
cultures, both adolescents and adults
Translated into Arabic, Bulgarian, Chinese, Dutch, German,
Hebrew, Portuguese, Spanish, & Swedish
Moderate to high internal consistency (r = .70-.93) for subscales
91 questions, 11 subscales
◦ 3 assess attitudes and behaviors concerning eating, weight, and shape
◦ Other 8 assess: psychological disorders, Ineffectiveness, perfectionism,
interpersonal distrust, introspective Awareness, Maturity Fears,
Ascetics, Impulse Regulation, and Social Insecurity
14. DDiiaaggnnoossiiss
DSM 5 Chapter: Feeding and Eating
Disorders
Clinical Features:
◦ “persistent disturbance of eating or eating-related
behavior that results in the altered
consumption or absorption of food and that
significantly impairs physical health or
psychosocial functioning” (APA, p. 329)
15. SSiimmiillaarriittiieess ttoo SSuubbssttaannccee AAddddiiccttiioonnss::
“Some individuals with disorders described in this
chapter report eating-related symptoms resembling
those typically endorsed by individuals with substance
use disorders, such as craving and patterns of
compulsive use” (APA, p. 329).
“This resemblance may reflect the involvement of the
same neural systems, including those implicated in
regulatory self-control and reward, in both groups of
disorders. However, the relative contributions of
shared and distinct factors remain insufficiently
understood” (APA, p. 329).
16. AAnnoorreexxiiaa NNeerrvvoossaa ((330077..11))
((CCrriitteerriioonn AA))
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.
If you weight the client in the office, then make
certain shoes are off, overcoats/sweaters are off,
and pockets are emptied prior to weighing.
17. AAnnoorreexxiiaa NNeerrvvoossaa ((CCrriitteerriioonn BB))
Diagnostic Features:
◦ Persistent energy intake restriction
◦ Intense fear of gaining weight or of becoming
fat, or persistent behavior that interferes with
weight gain
◦ Disturbance in self-perceived weight or shape
18. AAnnoorreexxiiaa NNeerrvvoossaa ((CCrriitteerriioonn CC))
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 persistent lack of
recognition of the seriousness of the
current low body weight.
19. AAnnoorreexxiiaa NNeerrvvoossaa ((CCooddiinngg))
Regardless of code, specify which type.
Crossover between subtypes over the course of the
disorder is not uncommon. Therefore, subtype
describes current symptoms only.
The ICD-9 Code is 307.1 which is assigned regardless
of the subtype.
The ICD-10 CM code depends on the subtype:
◦ Restricting Type (F50.01): 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
misuse of laxatives, diuretics or enemas).
◦ Binge-Eating/Purging Type (F50.02): During the last 3
months, the individual has engaged in recurrent episodes
of binge eating or purging behavior (i.e. self-induced
vomiting or misuse of laxatives, diuretics or enemas).
20. AAnnoorreexxiiaa NNeerrvvoossaa ((SSppeecciiffiieerrss))
Remission, if applicable: After full criteria previously met,
◦ Partial Remission: 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.
◦ Full Remission: None of the criteria have been met for a
sustained period of time.
Current Severity: (adults – based on BMI and children and
adolescents based on BMI percentile). 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
21. AAnnoorreexxiiaa NNeerrvvoossaa::
AAssssoocciiaatteedd FFeeaattuurreess
Some health effects may be reversed with nutritional rehabilitation,
but some are not completely reversible, such as bone mineral
density
Comorbidity:
◦ Depression – Suicide risk is elevated (12/100,000/year)
◦ Biploar Disorder
◦ Anxiety Disorders
◦ Obsessive Compulsive features (both related and unrelated to food –
restricting type more likely to have OCD)
◦ Substance Addictions (more common with binge/purge type)
◦ Hoarding
Semi-starvation may be associated with:
◦ Problems with major organs (heart)
◦ Physiological disturbance (amenorrhea)
◦ Vital sign abnormalities
◦ May or may not have lab abnormalities
22. AAnnoorreexxiiaa NNeerrvvoossaa
More females than males 10:1
12 month prevalence for females is approximately .4%
Usually begins during adolescence or young adulthood, but
rarely before puberty or after 40
◦ Younger: may manifest atypical features, including denying ‘fear
of fat.’
◦ Older: more likely to have a longer duration of the illness &
clinical presentation may include more signs and symptoms of
long-standing disorder
Course and outcome are highly variable
◦ Course: Onset often triggered by stressful life event
◦ Outcomes:
Some individuals recover fully after a single episode of AN. However,
some have fluctuating or chronic problems with AN over their lives.
Hospitalization may be required to restore weight and to address
medical complications. Remission rates lower for these folks.
Most experience remission within 5 years of presentation (p. 342)
Mortality rate 5% per decade due most often to medical complications
or suicide.
23. AAnnoorreexxiiaa NNeerrvvoossaa::
RRiisskk && PPrrooggnnoossttiicc FFaaccttoorrss
Temperamental:
◦ “individuals who develop anxiety disorders or display obsessional traits
in childhood are at an increased risk of developing AN
Environmental:
◦ “Historical and cross-cultural variability in the prevalence of AN
supports its association with cultures and settings in which thinness is
valued” (APA, p. 342).
◦ “Avocations that encourage thinness, such as modeling and elite
athletics, are also associated with increased risk. (APA, p. 342).
Genetic and Physiological:
◦ Increase risk in 1st degree biological relatives
◦ Increased risk of bipolar and depressive disorders of 1st degree
relatives, particularly binge/purge type
◦ Monozygotic twins higher than dizygotic twins
◦ Brain abnormalities using fMRI identified (but this may result from
malnutrition vs. primary abnormalities)
24. AAnnoorreexxiiaa NNeerrvvoossaa::
DDiiaaggnnoossttiicc MMaarrkkeerrss
Hematology
Serum Chemistry
Endocrine
Electrocardiography
Bone Mass
Electroencephalography
Resting Energy Expenditure
Physical Signs and Symptoms
26. AAnnoorreexxiiaa NNeerrvvoossaa::
DDiiffffeerreennttiiaall DDiiaaggnnoossiiss
Medical Conditions such as gastrointestinal
disease, hyperthyroidism, occult malignancies, and
AIDS.
Major Depressive Disorder
Schizophrenia
Substance Use Disorders
Social Anxiety Disorder (Social phobia), OCD,
and Body Dysmorphic Disorder
Bulimia Nervosa
Avoidant/restrictive Food Intake Disorder
*What is the primary cause of the symptom?
27. BBuulliimmiiaa NNeerrvvoossaa ((330077..5511,, FF5500..22))
CCrriitteerriioonn AA
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).
28. BBuulliimmiiaa NNeerrvvoossaa
Binging Triggers
◦ Interpersonal stressors
◦ Dietary restraint
◦ Negative feelings related to body weight,
body shape, and food
◦ boredom
Consequences
◦ Negative self-evaluation
◦ Dysphoria
29. BBuulliimmiiaa NNeerrvvoossaa ((CCrriitteerriiaa,, ccoonntt..))
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.
30. BBuulliimmiiaa NNeerrvvoossaa ((SSppeecciiffiieerrss))
Remission: After full criteria for BN were previously met,
◦ In partial remission: Some, but not all, of the criteria have been met for
a sustained period of time.
◦ In full remission: None of the criteria have been met for a sustained
period of time.
Severity (current): the minimum level of severity is based on the
frequency of inappropriate compensatory behaviors. It may be
increased to reflect other symptoms and the degree of functional
disability.
◦ Mild: An average of 1-3 episodes per week of inappropriate
compensatory behavior
◦ Moderate: An average of 4-7 episodes per week of inappropriate
compensatory behavior
◦ Severe: An average of 8-13 episodes per week of inappropriate
compensatory behavior
◦ Extreme: An average of 14 or more episodes per week of
inappropriate compensatory behavior
31. BBuulliimmiiaa NNeerrvvoossaa::
DDiiaaggnnoossttiicc FFeeaattuurreess
Recurrent episodes of binge eating
Recurrent inappropriate compensatory
behaviors to prevent weight gain
Self-evaluation unduly influenced by body
shape and weight
Must occur 1x/week for 3 months on
average
32. BBuulliimmiiaa NNeerrvvoossaa::
AAssssoocciiaatteedd FFeeaattuurreess
Typically normal weight or overweight (BMI ≥ 18.5
and ≤ 30 in adults).
Uncommon among obese individuals
Between binges – restrict caloric intake
Menstrual irregularity
Fluid and electrolyte disturbances due to purging
Rare but potentially fatal complications including
esophageal tears, gastric rupture, and cardiac
arrhythmias.
Serious cardiac and skeletal myopathies may happen
due to vomiting
Abuse of laxatives may lead to dependence
Gastrointestinal symptoms and rectal prolapse
33. BBuulliimmiiaa NNeerrvvoossaa
Prevalence:
◦ 12 month prevalence among young females is 1%-1.5%.
◦ Prevalence is highest among young adults – peaks in older adolescence and young
adulthood.
◦ More common in females than males 10:1.
Course and Outcome:
◦ Onset before puberty or after 40 is uncommon.
◦ Frequently begins during or after an attempt at dieting.
◦ Multiple stressful life events can precede onset
◦ Disturbed eating behavior persists for at least several years in most clinical samples –
may be chronic or intermittent
◦ Symptoms of many diminish over time without treatment, although treatment clearly
impacts outcome
◦ Remission longer than 1 year associated with better outcome
◦ Significantly elevated risk for mortality (all-cause and suicide) Crude mortality rate –
2% per decade.
◦ Diagnostic cross-over to AN 10%-15% - often have multiple cross-overs between AN
and BN
◦ May cross-over to BED
34. BBuulliimmiiaa NNeerrvvoossaa::
RRiisskk && PPrrooggnnoossttiicc FFeeaattuurreess
Temperamental:
◦ Weight concerns, low self-esteem, depressive symptoms, social
anxiety disorder, and overanxious disorder of childhood are
associated with increased risk for the development of BN.
Environmental:
◦ Internalization of a thin body ideal increases risk. Childhood
sexual/physical abuse are at an increased risk.
Genetic and Physiological:
◦ Childhood obesity and early pubertal maturation increase risk.
◦ Familial transmission of BN may be present, as well as genetic
vulnerabilities for BN
Course Modifiers:
◦ Severity of psychiatric comorbidity predicts worse long-term
outcome of BN
36. BBNN:: DDiiffffeerreennttiiaall DDiiaaggnnoossiiss
Anorexia Nervosa, Binge-eating/purging
type
Binge Eating Disorder
Kleine-Levin Syndrome: disturbed eating
does not include over-concern about body
shape or weight
Major Depressive Disorder, with Atypical
Features
Borderline Personality Disorder: impulsive
behavior in BPD may result in BN symptoms
37. BBNN CCoommoorrbbiiddiittyy
Most have one other mental health issue
Many have multiple comorbidities
Increased frequency of:
◦ Depressive symptoms, bipolar & depressive
disorders
◦ Anxiety symptoms (social situations) or
anxiety disorders
◦ Substance Use Disorders (30% lifetime
prevalence among BN clients)
38. ((330077..5511//FF5500..88))BBiinnggee EEaattiinngg DDiissoorrddeerr
DSM IV TR:
◦ Appendix B: Criteria Sets and Axes Provided for Further Study
◦ Diagnosed as ED NOS
DSM 5:
◦ Added BED to Feeding and Eating Disorders chapter
◦ Recognition that a large percentage of ED NOS diagnoses could
be attributed to BED
◦ More severe and less common than overeating and associated
with significant physical and psychological problems
◦ Criteria A-E will must be met
39. Binge Eating DDiissoorrddeerr ((CCrriitteerriioonn AA))
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 (w/in 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 the
episode (e.g. feeling that one cannot stop eating or
control what or how much one is eating).
40. Binge EEaattiinngg DDiissoorrddeerr ((CCrriitteerriioonn BB))
B. The binge-eating episodes are associated with 3/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.
41. Binge Eating DDiissoorrddeerr ((CCrriitteerriiaa,, CCoonntt..))
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.
42. Binge Eating Disorder SSppeecciiffiieerrss ((pp.. 335500))
Partial/Full Remission After full criteria for BED
were met, binge-eating disorder were previously met,
◦Partial: Binge eating occurs at an average frequency of less
than one episode per week for a sustained period of time.
◦Full: none of the criteria have been met for a sustained
period of time.
Severity
◦Mild: 1-3 episodes of binge eating each week
◦Moderate: 4-7 episodes of binge eating each
week
◦Severe: 8-13 episodes of binge eating each week
◦Extreme: 14/more episodes of binge eating each
week
43. BBEEDD:: AAssssoocciiaatteedd FFeeaattuurreess
Prevalence: (p. 351)
◦ 12 month prevalence among adults:
Female: 1.6%
Males: .8%
Development & Course : (p. 352)
◦ Binge eating usually precedes BED whereas dieting
usually precedes onset of binge eating in bulimia
nervosa)
◦ Treatment seeking BED clients are usually older than
AN/BN treatment seeking clients
◦ Course: persistent, similar to BN in severity & duration
Risk and Prognostic Factors: Indication of
Genetic predisposition
44. BBEEDD:: AAssssoocciiaatteedd FFeeaattuurreess
Culture-Related Diagnostic Issues
◦ Similar across industrialized countries
◦ Similar across ethnicities
Functional Consequences
◦ Social role adjustment problems
◦ Impaired health-related quality of life & life
satisfaction
◦ Increased medical morbidity & mortality
◦ Increased health care utilization compared
with BMI-matched control subjects
45. BBEEDD:: AAssssoocciiaatteedd FFeeaattuurreess
Differential Diagnosis
◦ Bulimia Nervosa:
BED doesn’t have recurrent compensatory (purge/exercise) behavior
BED consistently higher rates of improvement than BN
◦ Obesity:
BED higher rates of overvaluation of body weight and shape
BED rates of psychiatric comorbidity are significantly higher
BED better outcomes
◦ Bipolar & MDD can be given in addition to BED if meet full
criteria for both
◦ Borderline PD & BED can be given if meet full criteria for both
Comorbidity *linked to severity of BED not degree of
obesity*
◦ Most common: bipolar, depressive, & anxiety disorders
◦ Less common: substance use disorders
46. OOtthheerr SSppeecciiffiieedd FFeeeeddiinngg oorr EEaattiinngg
DDiissoorrddeerr ((330077..5599
Atypical AN: all criteria met, except that
despite significant weight loss, the
individual’s weight is within or above
normal limits.
Bulimia Nervosa (of low frequency
and/or limited duration)
Binge-Eating Disorder (of low frequency
and/or limited duration
Purging Disorder
47. TTrreeaattmmeenntt
Eating Disorders requires specific
interventions
Training and supervised practice under
the supervision of an eating disorders
specialist is necessary for competency in
this area.
Must be able to work on an inter-disciplinary
treatment team due to the
medical and nutritional issues related to
these disorders.
48. RReessoouurrcceess aavvaaiillaabbllee oonnlliinnee
Eating Disorders Warning Signs
http://achancetoheal.org/eating-disorders/warning-signs/
Differential Diagnosis Tree
Fast Facts about EDs
http://www.aedweb.org/About_Eating_Disorders/3645.htm
Eating Disorders Parent Toolkit
Feelings Wheel
Guide to Medical Management of Eating Disorders
Meal Support Manual for Parents/Friends
Parent’s Role in Prevention
Bulimia Nervosa Guide
49. RReessoouurrcceess
Eating Disorders Factsheet APA:
http://www.dsm5.org/Documents/Eating%20Disorders%20Fact%20Sheet.pdf
Eating Disorders Helpline:
http://www.anad.org/eating-disorders-get-help/eating-disorders-helpline-email/
Eating Disorder Support Groups by State:
http://www.anad.org/eating-disorders-get-help/eating-disorders-support-groups/
Support Groups:
http://www.allianceforeatingdisorders.com/Support-Groups
Eating Disorders Anonymous:
http://www.eatingdisordersanonymous.org/
EDA Meetings:
http://www.eatingdisordersanonymous.org/meetings.html
Mentor Connect: Online mentoring relationships to replace eating disorders:
http://www.mentorconnect-ed.org/
50. RReessoouurrcceess
Eating Disorder Statistics:
http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/
Eating Disorder Mortality Statistics:
http://www.anad.org/get-information/about-eating-disorders/making-sense-of-ed-mortality-statistics/
Eating Disorders and Pro Eating Disorder Internet Sites:
http://www.anad.org/get-information/eating-disorders-and-the-internet/
Righting Insurance Discrimination of Eating Disorders:
http://www.anad.org/get-information/insurance-issues/
ECRI Institute for Research on Eating Disorder:
https://www.ecri.org/Pages/default.aspx
National Eating Disorders Association
http://www.nationaleatingdisorders.org/
51. RReessoouurrcceess
Binge Eating Disorder Association:
http://bedaonline.com/
Academy for Eating Disorders:
http://www.aedweb.org//AM/Template.cfm?Section=Home
The Eating Disorder Foundation:
http://www.eatingdisorderfoundation.org/
The Alliance for Eating Disorders Awareness: DSM V Diagnostic
Criteria
http://www.allianceforeatingdisorders.com/dsm-bed
Males and Eating Disorders:
http://www.allianceforeatingdisorders.com/males-and-eating-disorders
National Association for Males with Eating Disorders, Inc.
http://www.namedinc.org/
52. RReessoouurrcceess
Something Fishy: Issues for Men with Eating Disorders:
http://www.something-fishy.org/cultural/issuesformen.php
Etiology of Eating Disorders
http://www.allianceforeatingdisorders.com/what-causes-eating-disorders
Suggested Reading on Eating Disorders:
http://www.allianceforeatingdisorders.com/help-resources-suggested-readings
Eating Disorders Organizations and Websites:
http://www.allianceforeatingdisorders.com/organizations-and-websites
About Face:
http://www.about-face.org/
The Body Positive:
http://www.thebodypositive.org/
Body Image Health:
http://bodyimagehealth.org/
53. RReessoouurrcceess
Becoming Your Most Authentic Self:
http://bi3d.tridelta.org/Home
Andrea’s Voice Foundation: Disordered Eating and Related Issues:
http://andreasvoice.org/
The Elisa Project: Overcoming Eating Disorders Through Knowledge:
http://www.theelisaproject.org/
Families Empowered And Supporting Treatment of Eating Disorders
(FEAST):
http://www.feast-ed.org/
Community Outreach Prevention of Eating Disorders:
http://www.dahliapartnership.org/
Eating Disorders Coalition:
http://www.eatingdisorderscoalition.org/
Eating Disorders Hope:
http://www.eatingdisorderhope.com/
Editor's Notes
“persistent disturbance of eating or eating-related behavior that results in the altered consumption or absorption of food and that significantly impairs physical health or psychosocial functioning” (APA, p. 329)
“Some individuals with disorders described in this chapter report eating-related symptoms resembling those typically endorsed by individuals with substance use disorders, such as craving and patterns of compulsive use” (APA, p. 329).
“This resemblance may reflect the involvement of the same neural systems, including those implicated in regulatory self-control and reward, in both groups of disorders. However, the releative contributions of shared and distinct factors remain insufficiently understood” (APA, p. 329).
“Can be challenging because normal weight can vary by individuals, and different thresholds have been published defining thinness or underweight status” (APA, p. 340).
Criterion 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.
If you weight the client in the office, then make certain shoes are off, overcoats/sweaters are off, and pockets are emptied prior to weighing.
“This intense fear of becoming fat is usually not alleviated by weight loss. In fact, concern about weight gain may increase even as weight falls” (APA, p. 340).
Some clients may not recognize or acknowledge fear of gaining weight. The clinician may infer this fear based on observation, collateral information/history, physical and lab findings, or course over time either indicating a fear of gaining weight.
Diagnostic Features:
Persistent energy intake restriction
Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain
Disturbance in self-perceived weight or shape
Some feel globally overweight
Others realize they are thin but still concerned about specific body parts (i.e. hips/stomach) being too large
“They may employ a variety of techniques to evaluate their body size or weight, including frequent weighting, obsessive measuring of body parts, and persistent use of a mirror to check for perceived areas of ‘fat’” (APA, p. 340).
Self-esteem is highly dependent on their perceptions of body shape and weight.
See “weight loss as an impressive achievement and sign of extraordinary self-discipline” and gain as “an unacceptable failure of self-control” (APA, p. 340).
Often they don’t realize the medical effects of their malnourished state.
Clients may have “concerns about eating in public, feelings of ineffectiveness, a strong desire to control one’s environment, inflexible thinking, limited social spontaneity, and overly restrained emotional expression” (APA, p. 341).
Binge-eating/purging type: “have higher rates of impulsivity and are more likely to abuse alcohol and other drugs” (APA, pg. 341).
Excessive physical activity: may pre-date the onset of the disorder
Misuse of medication is common.
Hematology:
Leukopenia common – loss of all cell types but with apparent lymphocytosis. Mild anemia can occur, as well as thrombocytopnia and rarely bleeding problems.
Serum Chemistry:
Dehydration may be refledted by an elevated blood urea nitrogen level.
Hypercholesterolemia is common.
Heptic enzyme levels may be elevated.
Hypomagnesaemia, hypozicemia, hypophosphatemia, and hypermylasemia are occasionally observed.
Self-induced vomiting may lead to metabolic alkalosis (elevated serum bicarbonate), hypocloremia, and hypokalemia
Laxative abuse may cause a mild metabolic acidosis.
Endocrine:
Serum thyroxine (T4) levels are usually in low-normal range.
Triiodothyronine (T3) levels are decreased, while reverse T3 levels are elevated.
Females have low serum estrogen levels, whereas males have low levels of serum testosterone.
Electrocardiography:
Sinus bradycardia is common, and rarely, arrhythmias are noted.
Significant prolongation of the QTc interval is observed in some individuals.
Bone Mass:
Low bone mineral density, with specific areas of osteopenia or osteoporosis, is often seen.
Risk of fracture is significantly higher.
Electroencephalography:
Diffuse abnormalities, reflecting a metabolic encephalopathy, may result from significant fluid and electroltye disturbances.
Resting Energy Expenditure:
Often a significant reduction in resting energy expenditure
Physical Signs and Symptoms:
Amenorrhea is common
Emaciation
Significant hypotension, hypothermia, and bradycardia
Some individuals develop luago, a fine downy body hair (looks like a monkey’s hair).
Some develop peripheral edema, especially during weight restoration or upon cessation of laxative and diuretic abuse.
Rarely, petechia or ecchymoses, usually on the extremities, may indicate a bleeding diathesis.
Some have yellowing skin associated with hypercaratenemia.
Those who self-indicue vomiting may have hypertorphy of the salvary glands, particularly the parotid glands, as well as dental enamel erosion.
Some have scars or calluses on the dorsal surface of the hand from repeated contact with the teeth while inducing vomiting.
Typical in same circumstances:
Think about Thanksgiving vs. a regular meal
Loss of Control:
Some individuals describe a dissociative quality to binging
May feel acute loss of control over binging or generalized loss of control over eating patterns
May have abandoned efforts to control binging – still counts as loss of control
May be able to stop binging if interrupted due to shame about binging and being ‘found out’
We will go review the specific criteria for Binge Eating Disorder on the following slides.
Associated Features: (351)
Normal and overweight and obese individuals
Distinct from obesity. Most obese individuals do not engage in recurrent binge eating.
“Obese individuals with BED consume more calories in lab studies of eating behavior and have greater functional impairment, lower quality of life, more subjective distress, and greater psychiatric comorbidity than obese individuals without BED” (p. 351).
Diagnostic Features (p. 351)
“The context in which the eating occurs may affect the clinician’s estimation of whether the intake is excessive. For example, a quantity of food that might be regarded as excessive during a typical meal might be considered normal during a celebration or holiday meal.”
Discrete Period of Time: usually less than 2 hours
Single episode: may not be restricted to one setting (i.e. restaurant & home but not continual snacking on small amounts of food throughout the day.)
Sense of lack of Control:
”inability to refrain from eating or to stop eating once started.”
Dissociative quality during or following
May be able to stop if someone enters the room unexpectedly
May be described as acute loss of control or general pattern of uncontrolled eating
Binges can be planned
Or
May have stopped trying to control eating
Diagnostic Features:
“Binge eating seems to be characterized more by an abnormality in the amount of food consumed than by a craving for a specific nutrient” (p. 351).
Typically ashamed of their eating problems
Secrecy: Attempt to conceal their symptoms
Triggers:
Negative affect (emotion regulation)
Interpersonal stressors
Dietary restraint
Negative feelings related to body weight, body shape, and food
Boredom
“Binge eating may be minimized or mitigate factors that precipitated the episode in the short-term” (it works initially) “but negative self-evaluation and dysphoria often are delayed consequences”
(indicates a addictive/relapse cycle)
Prevalence:
12 month prevalence among 18yo/older:
Female: 1.6%
Males: .8%
Less skewed in BED than bulimia nervosa
As frequent among racial/ethnic minorities as white women
More prevalent among those seeking weight-loss treatment than general population
Development: not much known about development of BED
Associated with increased body fat, weight gain, and increases in psychological symptoms
Common in adolescent and college-age samples
Loss of control eating or episodic binge eating may represent a prodromal phase of eating disorders for some individuals.
Binge eating usually precedes BED whereas dieting usually precedes onset of binge eating in bulimia nervosa)
Usually begins in adolescence or young adulthood, but can begin in later adulthood.
Course:
Remission rates in both natural course and treatment outcome studies are higher for binge-eating disorder than for bulimia nervosa or anorexia nervosa.
Relatively persistent, course is comparable to BN in terms of severity and duration
Crossover from BED to AN/BN is uncommon
Risk & Prognostic Factors:
“BED appears to run in families, which may reflect additive genetic influences” (p. 352).
Culture-Related Diagnostic Issues:
Prevalence of BED similar across industrialized countries and among Latinos, Asians, Caucasians, and African Americans.
Functional Consequences of BED: Associated with
Social role adjustment problems
Impaired health-related quality of life and life satisfaction
Increased medical morbidity and mortality
Associated increased health care utilization compared with BMI-matched control subjects
May be associated with an increased risk for weight gain & devmt of obesity
Differential Diagnosis:
Bulimia Nervosa:
Clinical presentation & recurrent inappropriate compensatory behavior (e.g., purging, driven exercise) – not in BED
BED may report dieting attempts, but “don’t show marked or sustained dietary restriction designed to influence body weight & shape between binge-eating episodes” (352)
Response to treatment: BED consistently higher rates of improvement than BN
Obesity:
Associated with obesity but different.
BED clients with obesity have higher rates of overvaluation of body weight and shape
BED rates of psychiatric comorbidity are significantly higher
BED better treatment outcomes than obesity without BED
Bipolar & Depressive Disorders:
Increased eating in the context of major depressive episode may/may not be associated with loss of control.
If full criteria are met for MDD/Bipolar Disorder and BED, then they can both be given.
Borderline PD:
“If full criteria for both disorders are met, both diagnoses should be given” (353).
Comorbidity:
Most common are bipolar disorders, depressive disorders, anxiety disorders
Less common substance use disorders
“Psychiatric comorbidity is linked to the severity of binge eating and not to the degree of obesity” (353).