A presentation about common eating disorders in detail , most common types are anorexia nervosa , bulimia nervosa , night eating disorder , binge eating disorder , purging disorder , rumination disorder , pica , Avoidant/Restrictive Food Intake Disorder , Anorexia nervosa is a syndrome characterized by three essential criteria, one behavioral, one psychopathological, and the last, physiologic. •The first is self- induced starvation, to a significant degree (behavioral). •The second is a relentless drive for thinness or a morbid fear of fatness (psychopathological). •The third criterion is the presence of medical signs and symptoms resulting from starvation (physiologic). Two subtypes of anorexia nervosa exist: restricting and binge/purge. •Approximately half of anorexic persons will lose weight by drastically reducing their total food intake. The other half of these patients will not only diet but will also regularly engage in binge eating, followed by purging Behaviors. •Anorexia nervosa is much more prevalent in females than in males and usually has its onset in adolescence. •The outcome of anorexia nervosa varies from spontaneous recovery to a waxing and waning course to death People with bulimia nervosa have episodes of binge eating combined with inappropriate ways of stopping weight gain. Physical discomfort—for example, abdominal pain or nausea—terminates the binge eating, which is often followed by feelings of guilt, depression, or self-disgust. Individuals with binge-eating disorder engage in recurrent binge eating during which they eat an abnormally large amount of food over a short time.

1. Eating Disorders
By :Dr.Rasti Hussein Mohammed
Arabic Board Trainee , 2nd year
Internal Medicine
Supervised By
Dr.Rebwar Gharib Hama
1
12/28/2023

2. Eating disorders :
Eating disorders are a group of conditions characterized by
abnormal eating habits and severe disturbance in an individual's
thoughts, emotions, and behavior related to food and weight ,
include :
1- Anorexia Nervosa
2- Bulimia Nervosa
3- Binge-Eating Disorder
4- Night-Eating Syndrome
5- Purging Disorder
6- Pica
7- Rumination Disorder
8- Avoidant/Restrictive Food Intake Disorder 2

3. 1- Anorexia Nervosa
• Anorexia nervosa is a syndrome
characterized by three essential criteria,
one behavioral, one psychopathological,
and the last, physiologic.
• The first is self- induced starvation, to a
significant degree (behavioral).
• The second is a relentless drive for
thinness or a morbid fear of fatness
(psychopathological).
• The third criterion is the presence of
medical signs and symptoms resulting
from starvation (physiologic).
3

4. • Two subtypes of anorexia nervosa exist: restricting and binge/purge.
• Approximately half of anorexic persons will lose weight by drastically
reducing their
total food intake. The other half of these patients will not only diet but will
also
regularly engage in binge eating, followed by purging Behaviors.
• Anorexia nervosa is much more prevalent in females than in males and
usually has its onset in adolescence.
• The outcome of anorexia nervosa varies from spontaneous recovery to a
waxing and waning course to death
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5. Diagnosis :
• The onset of anorexia nervosa usually occurs between the ages of 10
and 30 years.
• Intense fear of gaining weight and becoming obese is present in all
patients with the disorder and undoubtedly contributes to their lack
of interest in and even resistance to therapy.
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6. • Obsessive-compulsive behavior, depression, and anxiety are other
psychiatric symptoms of anorexia nervosa most frequently noted
clinically.
• Patients with the disorder frequently have poor sexual adjustment.
• Patients usually come to medical attention when their weight loss
becomes apparent. As the weight loss grows profound, physical signs
such as hypothermia (as low as 35°C), dependent edema,
bradycardia, hypotension, and lanugo (the appearance of neonatal-
like hair) appear, and patients show a variety of metabolic changes
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7. 7

8. Anorexia nervosa has two clinical subtypes :
• food restricting and purging
• In the food-restricting category, present in approximately 50 percent
of cases, food intake is highly restricted and the patient may be
relentlessly and compulsively overactive, with overuse athletic
injuries.
• In the purging subtype, patients alternate attempts at rigorous dieting
with intermittent binge or purge episodes.
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9. • Patients with anorexia nervosa are often secretive, deny their
symptoms, and resist treatment. In almost all cases, relatives must
confirm a patient’s history.
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10. Laboratory examination :
• leukopenia with a relative lymphocytosis
• hypokalemic alkalosis
• Fasting serum glucose concentrations are often low .
• serum salivary amylase concentrations may increase if the patient is
vomiting.
• Young girls may have a high serum cholesterol level
• Amenorrhea , mild hypothyroidism , hypersecretion of corticotrophin-
releasing hormone
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11. • Electrocardiographic (ECG) changes, such as :
• T-wave flattening or inversion
• ST segment depression
• lengthening of the QT interval
• All these values revert to normal with nutritional rehabilitation and
cessation of purging behaviors
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12. Comorbidity :
• anorexia nervosa is associated with depression in 50 percent of cases,
social phobia in 22 percent of cases, and obsessive-compulsive
disorder (OCD) in 35 percent of cases.
• The suicide rate is higher in persons with the binge eating–purging
type of anorexia nervosa than in those with the restricting type.
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13. Course and Prognosis :
• Approximately 30 to 50 percent have achieved full recovery, and 10 to
20 percent remain chronically ill . The remainder improve but
continue to struggle with certain disordered behaviors.
• Compared to the general population, individuals with the illness are
up to six times more likely to die.
• The majority of deaths are attributable to medical complications of
low weight and malnourishment, but a smaller, yet significant,
proportion of deaths (approximately 1 in 5) are due to suicide.
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14. Treatment Approach:
• A comprehensive treatment plan, including hospitalization when
necessary and both individual and family therapy, is recommended. It
is important to consider behavioral, interpersonal, and cognitive
approaches. In many cases, medication may also help.
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15. Hospitalization :
• The first consideration in the treatment of anorexia nervosa is to
restore patients’ nutritional state; dehydration, starvation, and
electrolyte imbalances .
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16. Psychotherapy :
• FAMILY-BASED THERAPY. Family-based therapy (FBT) is an effective
treatment for anorexia nervosa, particularly in patients under the age
of 18.
• FBT, also known as the Maudsley method, generally consists of three
phases of treatment:
• In phase one, treatment focuses on the restoration of the patient’s
physical health, with decisions about what or when the patient will
eat made by the parents.
• Phase two. In this phase, the patient gradually begins to take
responsibility for decisions about eating.
• In phase three, the focus shifts to the patient’s growth and
development.
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17. • COGNITIVE-BEHAVIORAL THERAPY. Cognitive and behavioral therapy
have been found effective for inducing weight gain .
• DYNAMIC PSYCHOTHERAPY. Sometimes dynamic expressive
supportive psychotherapy used but their resistance may make the
process difficult and painstaking
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18. Pharmacotherapy :
• Pharmacologic studies have not yet identified any medication that
yields a definitive improvement of the core symptoms of anorexia
nervosa .
• Antidepressants, including selective serotonin reuptake inhibitors
(SSRIs) and tricyclic antidepressants (TCAs), have been tried .
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19. 2-Bulimia Nervosa .
• People with bulimia nervosa have
episodes of binge eating combined
with inappropriate ways of stopping
weight gain. Physical discomfort—for
example, abdominal pain or nausea—
terminates the binge eating, which is
often followed by feelings of guilt,
depression, or self-disgust.
19

20. Diagnosis and Clinical Features :
20

21. 21

22. Laboratory examination :
• Bulimia nervosa can result in electrolyte abnormalities and various
degrees of starvation.
• Thyroid function remains intact.
• Hypomagnesemia and hyperamylasemia.
• Many patients have menstrual disturbances.
• Hypotension and bradycardia occur in some patients.
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23. Comorbidity :
• Bulimia nervosa is characterized by higher rates of partial and full
recovery compared with anorexia nervosa.
• Studies have found that rapid symptom reduction predicts better
treatment outcomes.
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24. Treatment Approach:
• Most patients with uncomplicated bulimia nervosa do not require
hospitalization.
• In general, patients with bulimia nervosa are not as secretive about
their symptoms as patients with anorexia nervosa. Therefore,
outpatient treatment is usually not difficult, but psychotherapy is
frequently stormy and prolonged.
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25. Psychotherapy:
• COGNITIVE-BEHAVIORAL THERAPY. CBT should be considered the
benchmark, first-line treatment for bulimia nervosa.
• OTHER MODALITIES. “stepped-care” programs and internet-based
platforms, computer-facilitated programs, email-enhanced programs,
and administration of CBT via telemedicine to remote areas.
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26. Pharmacotherapy:
• Antidepressant medications help treat bulimia nervosa, particularly
the SSRI (fluoxetine ).
• TCAs (particularly amitriptyline and desipramine), trazodone, and
monoamine oxidase inhibitors (MAOIs).
• Bupropion is contraindicated due to an increased risk of seizure.
• Topiramate may have some efficacy In reducing binge episodes in
bulimia nervosa, as may lisdexamfetamine.
• Evidence indicates that CBT and medications (particularly fluoxetine)
are the most effective combination. 26

27. 3- Binge-Eating Disorder
• Individuals with binge-eating
disorder engage in recurrent
binge eating during which they
eat an abnormally large amount
of food over a short time.
27

28. 28

29. • Psychotherapy : CBT is the most effective psychological treatment for
binge-eating disorder and should be considered a first-line treatment ,
however, studies have not shown marked weight loss as a result of CBT.
• CBT combined with psychopharmacological treatments such as SSRIs
shows better results than CBT alone.
• Exercise has also shown a reduction in binge eating when combined
with CBT.
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30. • Psychopharmacotherapy : Symptoms of binge eating may benefit
from medication treatment, with strong evidence supporting the use
of lisdexamfetamine for both weight loss and reduction of binge
episodes.
• Antidepressant medications have demonstrated improvement in
binge eating but typically do not result in sustained weight loss.
• Most, but not all, studies show that medication added to CBT is more
effective than medication alone.
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31. 4-Night-Eating Syndrome
• As implied by the name, night-eating
syndrome includes recurrent episodes of
hyperphagia or night eating. It may be
associated with insomnia and a lack of
desire for food in the morning.
• Occurs in approximately 2 percent of the
general population; however, it has a higher
prevalence among patients with insomnia,
obesity (10 to 15 percent), eating disorders,
and other psychiatric disorders.
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32. • The age of onset for night-eating syndrome ranges from the late teens
to the late 20s and has a long-lasting course with periods of remission
with treatment.
• Various studies have shown positive results in patients treated with
SSRIs who showed improvement in nighttime awakenings, nocturnal
eating, and post-evening caloric intake.
• Weight loss and a reduction in nocturnal eating are associated with
an addition of topiramate to medication regimens.
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33. 5-Purging Disorder :
• Purging disorder is characterized by
recurrent purging behavior after
consuming a small amount of food
in persons of average weight who
have a distorted view of their
weight or body image.
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34. 6-Pica :
• Pica is persistent eating of
nonnutritive substances .
• Typically, no specific biologic
abnormalities account for pica.
• Pica can emerge in young
children, adolescents, or adults;
however, a minimum of 2 years
of age is suggested by DSM-5 in
the diagnosis of pica.
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35. • Pica occurs in both males and female . Among adults, certain forms of
pica, including geophagia (clay eating) and amylophagia (starch
eating), have been reported in pregnant women.
• Among the most severe complications are lead poisoning (usually
from lead-based paint), intestinal parasites after ingestion of soil or
feces, anemia and zinc deficiency after ingestion of clay, severe iron
deficiency after ingestion of large quantities of starch, and intestinal
obstruction from the ingestion of hairballs, stones, or gravel.
• pica often remits by adolescence.
• Pica associated with pregnancy is usually limited to the pregnancy
itself.
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36. • Laboratory Examination: No single laboratory test confirms or
rules out a diagnosis of pica.
• Levels of iron and zinc in serum should be determined and corrected
if low.
• In rare cases, when this is the etiology, giving the patient oral iron and
zinc may ameliorate the pica.
• A hemoglobin level should be determined to rule out anemia.
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37. • Course and Prognosis:
• The prognosis for pica is usually good, and typically in children with
normal intellectual function, pica generally remits spontaneously
within several months.
• Treatment : No definitive treatment exists for pica per se beyond
education and behavior modification.
• Treatments emphasize psychosocial, environmental, behavioral, and
family guidance approaches.
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38. 7-Rumination Disorder :
• Rumination is an effortless and painless
regurgitation of partially digested food
into the mouth soon after a meal, which
is either swallowed or spit out.
• The DSM-5 notes that the essential
feature of the disorder is repeated
regurgitation and re-chewing of food for
at least 1 month after a period of
normal functioning.
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39. 39

40. 8-Avoidant/restrictive food intake disorder:
• formerly known as feeding
disorder of infancy or early
childhood, is characterized by
a lack of interest in food, or
its avoidance based on the
sensory features of the food
or the perceived
consequences of eating.
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41. 41

42. • Most infants identified with feeding disorder within the first year of
life and who receive treatment do not go on to develop malnutrition,
growth delay, or failure to thrive.
• When feeding disorders have their onset later, in children 2 to 3 years
of age, growth and development can be affected when the disorder
lasts for several months.
• About 70 percent of infants who persistently refuse food in the first
year of life continue to have some eating problems during childhood.
• Most interventions for feeding disorders aim to optimize the
interaction between the mother and infant during feedings and
identifying any factors that can be changed to promote better
ingestion
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43. Thank you
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