Assessment of feeding and Eating Disorders .pptx

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By Prof. Heba Essawy MD., CEDS.,
Prof of Psychiatry
Head of EDs Clinics
International chapter chair Iaedp - Middle East
Okasha Institute of Psychiatry- Ain Shams
University
Assessment for Feeding
and Eating Disorders

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Eating Disorders is Alarming
 FEDs have lifetime prevalence about 10%
 FEDs has elevated rates of morbidity and
mortality
 FEDs have an elevated risk of suicide
 Global disease buurden of Eds increased by 65%
between 1990 and 2006
 Improving diagnostic guidelines for feeding and
Eating Disorders FEDs in DSM 5 and ICD-11 has
significant implications for prevention and
treatment
Bernou Malise 2021

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40-60% of primary school girls (ages 6-12) are concerned
about their weight . (Smolak, 2011)
Among high-school students, 44% of females and 15% of
males attempted to lose weight. (Serdula et al., 1993)
 Teenagers , one half girls and one third boys use
unhealthy weight control behaviors (ex, skipping meals,
fasting, smoking cigarettes, purging)
(Neumark-Sztainer, 2005)
Eating Disorders is alarming:

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 Feeding and Eating disorders are alarming
 Classification criteria for FED
 DSM 5
 ICD 11
 Eating Disorders Examination questionnaire
EDE-Q
Roadmap

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Feeding and Eating Disorders
 Feeding disorders include a range of conditions
characterized by
-restricted or limited intake :ARFID
- Behavioral disturbances : pica, Rumination –
Regurgitation disorder
 Eating Disorders: AN,BN, BED
Characterized by : Abnormal eating behavior
Preoccupation with food
Preoccupation with body
Preoccupied with weight
Preoccupied with shape

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Feeding and Eating
Disorders
 Feeding and eating disorders are not better
accounted for by other health conditions
and are not developmentally appropriate
or culturally

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Feeding and Eating
Disorders: Classification
- DSM-5
- ICD-11

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ANOREXIA
NERVOSA

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DSM-5: Diagnostic criteria
for Anorexia Nervosa
• Restriction of energy intake relative to requirements
leading to a significantly low body weight in the
context of age, sex.
 Intense fear of gaining weight or becoming fat, or
persistent behavior that interferes
with weight gain.
 Disturbance in one's body weight or shape , persistent
lack of recognition of the seriousness of low body
weight
Specify:
 Restricting type
 Purging type/Binge Eating.

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Subtypes AN (DSM-5):
Restricting Type: during last 3months, the
person has not engaged in recurrent episodes
of binge eating or purging behavior
Binge-Eating/Purging Type: during last 3
months, the person engaged in
recurrent episodes of binge eating or purging
behavior

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AN: diagnostic guidelines
ICD11
 Significant low body weight
 BMI less than 18,5Kg/m2 in adults ,
 For children , less than 5th percentile or failure to
gain weight as expected
 Rapid weight loss less 20%of total body weight
within 6 months ( may replace the low body
weight)

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AN: Diagnostic Guidelines
ICD11
 Persistent pattern of restrictive eating that aimed
at establishing or maintaining abnormally low
weight associated with extreme fear of weight
 Significant low body weight for the individual s
height age ,developmental stage and weight
history that is not due to the unavailability of food
or due to any medical condition

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Anorexia Nervosa: ICD 11
 Anorexia Nervosa with significantly low body weight
restricting pattern
Binge- Purging Pattern
unspecified
 Anorexia Nervosa with dangerously low body weight
restricting pattern
Binge- Purging Pattern
unspecified
 Anorexia Nervosa in recovery with normal body
weight

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Anorexia Nervosa with
significantly low body weight
 Meets all definitional requirements for Anorexia
Nervosa,
 BMI between 18.5 kg/m2 and 14.0 kg/m2 for
adults
 Between the fifth percentile and the 0.3 percentile
for BMI-for-age in children and adolescents.

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significantly low body weight,
restricting pattern
 Individuals meet the definitional requirements of
- significantly low body weight
- induce weight loss
- maintain low body weight
through restricted food intake or fasting alone or in
combination with increased energy expenditure
(such as through excessive exercise) but who do not
engage in binge eating or purging behaviors.

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Anorexia Nervosa with significantly
low body weight, binge-purge pattern
 low body weight
 present with episodes of binge eating or purging
behaviors.
 Induce weight loss and maintain low body weight
through restricted food intake, commonly
accompanied by significant purging behaviors
aimed at getting rid of ingested food (e.g. self-
induced vomiting, laxative abuse or enemas).
 This pattern also includes individuals who exhibit
binge eating episodes but do not purge.

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dangerously low body weight
 Meets all definitional requirements for Anorexia
Nervosa
 BMI under 14.0 kg/m2 in adults
 under the 0.3rd percentile for BMI-for-age in
children and adolescents.
 Severe underweight status is an important
prognostic factor that is associated with high risk
of physical complications and substantially
increased mortality.

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dangerously low body weight,
restricting pattern
 Induce weight loss
 Maintain low body weight through restricted
food intake or fasting alone or in combination
with increased energy expenditure (such as
through excessive exercise)
 Do not engage in binge eating or purging
behaviors.

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dangerously low body weight,
binge-purge pattern
 Present with episodes of binge eating or purging
behaviors.
 Induce weight loss and maintain low body weight
through restricted food intake, commonly
accompanied by significant purging behaviors
aimed at getting rid of ingested food (e.g. self-
induced vomiting, laxative abuse or enemas).
 This pattern also includes individuals who exhibit
binge eating episodes but do not purge.
.

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Anorexia Nervosa in recovery
with normal body weight
 Individuals recovering from Anorexia Nervosa
 Body weight is more than 18.5 kg/m2 for adults or
over the fifth percentile for BMI-for-age for
children and adolescents
 the diagnosis should be retained until a full and
lasting recovery is achieved
 Indicated by the maintenance of a healthy weight
and the cessation of behaviors to reduce body
weight independent of the provision of treatment
(e.g., for at least 1 year after intensive treatment is
withdrawn).

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BULIMIA
NERVOSA

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DSM-5: Diagnostic Criteria for Bulimia
Nervosa
A. Recurrent episodes of binge eating:
(1) Eating large amount in a discrete period of
time
(2) lack of control over eating
B. Recurrent compensatory behavior in order
to prevent weight gain.
C. Binge eating and inappropriate
compensatory behaviors is at least once a week
for 3 months.

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ICD11Bulimia Nervosa : Diagnostic
criteria
 Characterized by frequent, recurrent episodes of binge eating
(e.g., once a week or more over a period of at least one month).
 Binge eating episode is a subjective loss of control over
eating, eating,
 Feels unable to stop eating or limit the type or amount of food
eaten.
 Accompanied by repeated inappropriate compensatory
behaviors to prevent weight gain (e.g., self-induced vomiting,
misuse of laxatives or enemas, strenuous exercise).
 Preoccupied with body shape or weight, which strongly
influences self-evaluation.
 The individual is not significantly underweight and therefore
does not meet the diagnostic requirements of Anorexia
Nervosa.

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BINGE EATING
DISORDER

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DSM-5 Diagnostic Criteria for Binge
Eating Disorder
BE are associated WITH :
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not
feeling hungry
4. Feeling disgusted with oneself, depressed, or
very guilty afterwards

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ICD-11 Binge Eating Disorder
 Characterized by frequent, recurrent episodes of
binge eating (e.g., once a week or more over a
period of several months).
 A binge eating episode is a distinct period of time
during which the individual experiences a
subjective loss of control over eating, eating notably
more or differently than usual, and feels unable to
stop eating or limit the type or amount of food
eaten.
 Experienced as very distressing, with negative
emotions such as guilt or disgust.

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AVOIDANT RESTRICTIVE
FOOD INTAKE DISORDER
(ARFID)

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DSM-5: DIAGNOSTIC CRITERIA
FOR ARFID
An eating or feeding disturbance (e.g., apparent
lack of interest in eating or food; avoidance
based on the sensory characteristics of food;
concern about aversive consequences of eating)
as manifested by persistent failure to meet
appropriate nutritional and/or energy needs
associated with one (or more) of the following:
 Significant weight loss (or failure to achieve expected
weight gain or faltering growth in children).
 Significant nutritional deficiency.
 Dependence on interal feeding or oral nutritional
supplements.
 Marked interference with psychosocial functioning.
The disturbance is not better explained by lack of
available food or by an associated culturally
allowed practice.

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DSM-5: DIAGNOSTIC CRITERIA
FOR ARFID
• 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.
• 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.

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Types of ARFID include:
• Avoidant: Patients who only accept a limited diet in relation to sensory
features (sensory sensitivity); sensory aversion; sensory over-stimulation
• Aversive: Individuals whose food refusal is related to aversive or fear-
based experiences (phobic avoidance) including choking, nausea,
vomiting, pain and/or swallowing
• Restrictive: Individuals who do not eat enough and show little interest in
feeding or eating (low appetite); extreme pickiness; distractible and
forgetful
• ARFID “Plus”: Individuals with avoidant, aversive, or restrictive types of
ARFID presentations who begin to develop features of anorexia nervosa,
including concerns about body weight and size, fear of weight gain,
negativity about fatness, negative body image without body image
distortion and preference for less calorically-dense foods
• Adult ARFID: Individuals with avoidant, aversive, or restrictive types of
ARFID presentations beyond childhood; may have had similar symptoms
since childhood including selective or extremely picky eating, food
peculiarities, texture, color or taste aversions related to food.
ARFID: Facts and Fictions

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ICD 11 Avoidant-restrictive
food intake disorder
 Characterized by abnormal eating or feeding
behaviors that result in the intake of an insufficient
quantity of food to meet adequate energy or nutritional
requirements.
 Restricted eating has caused significant weight loss,
failure to gain weight as expected in childhood
 Dependence on oral nutritional supplements or tube
feeding, resulted in significant functional impairment.
 Not better accounted for by lack of food availability,
the effects of a medication or substance, or another
health condition.

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PICA

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ICD11 Pica
.
• Characterized by the regular consumption of non-
nutritive substances, such as non-food objects and
materials (e.g., clay, soil, chalk, plaster, plastic, metal
and paper) or raw food ingredients (e.g., large
quantities of salt or corn flour)
• Severe enough to require clinical attention in an
individual who has reached a developmental age at
which they would be expected to distinguish between
edible and non-edible substances (approximately 2
years).
• The behavior causes damage to health, impairment in
functioning, or significant risk due to the frequency,
amount or nature of the substances or objects ingested.

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RUMINATION
DISORDER

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ICD11 Rumination-
regurgitation disorder
 Characterized by the intentional and repeated bringing up of
previously swallowed food back to the mouth (i.e., regurgitation),
which may be re-chewed and re-swallowed (i.e., rumination), or
may be deliberately spat out (but not as in vomiting).
 The regurgitation behavior is frequent (at least several times per
week) and sustained over a period of at least several weeks.
 The regurgitation behavior is not fully accounted for by another
health condition that directly causes regurgitation (e.g.,
oesophageal strictures or neuromuscular disorders affecting
oesophageal functioning) or causes nausea or vomiting (e.g.,
pyloric stenosis).
 Rumination-regurgitation disorder should only be diagnosed in
individuals who have reached a developmental age of at least 2
years.

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EDE-Q

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EATING DISORDER
EXAMINATION( EDE-Q )
 . Prevalence of eating disorders (EDs), which occur
all over the world is increasing in the Middle East
 . The Eating Disorder Examination (EDE)
interview is the most widely used assessment tool
to assess EDs and ED symptoms and is generally
considered reliable and valid
 As administration of the EDE is time consuming a
self-report questionnaire, the Eating Disorder
Examination Questionnaire (EDE-Q) was created
to screen for EDs and assess its severity
Fairburn 1994, Melisse 2021

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EATING DISORDER
EXAMINATION( EDE-Q )
There is a lack of valid ED assessment tools in the
Middle East ( Thomas et.,al.,2016)
Normative data of the EDE-Q are only available for
Western populations and due to cultural differences,
norms for Western and Arabic populations may
differ ( Aardoom 2012)

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EATING DISORDER EXAMINATION(
EDE-Q ): Measures
.
 The EDE-Q is based on the DSM
 EDE-Q is a self-report questionnaire of 28 items with a
7-point Likert scale ranging from 0 (feature was absent)
to 6 (feature was markedly present or present every
day) ( Aardoom 2012)
 Measuring purging and binging behaviors during the
previous 28 days
 Consists of four subscales: dietary restraint, weight
concern, shape concern, and eating concern and a
global score for general severity ( Hilbert 2012)

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EATING DISORDER EXAMINATION(
EDE-Q ): Measures
.
 Dietary restraint, weight concern and eating
concern are each measured by items
 Shape concern by eight items
 Six additional items measure:
frequency of binge episodes, overeating, purging
and laxative abuse.
 Subscale scores are the mean of the items that
compose them, with a range of 0 to 6.

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Dr. Heba Essawy
Website
www. Hebaessawy.com
Facebook: Dr. Heba
Essawy
Email:
essawi_h@yahoo.com

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.

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Thank you
•

Assessment of feeding and Eating Disorders .pptx

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