This document discusses eating disorders, including anorexia nervosa, avoidant/restrictive food intake disorder, binge eating disorder, bulimia nervosa, pica, and rumination disorder. It covers the epidemiology, diagnostic criteria, screening tools, and treatments for these conditions. Treatment involves interdisciplinary care with mental health professionals, dietitians, and physicians using psychotherapy approaches like cognitive behavioral therapy and family therapy as well as pharmacotherapy when needed.

1. “People who see life as anything more than pure entertainment are missing the point.”
― George Carlin
INTRODUCTION
● Disturbance of eating that impairs health or psychosocial functioning
● Include
○ anorexia nervosa
○ avoidant/restrictive food intake disorder
○ binge eating disorder
○ bulimia nervosa
○ Pica
○ Rumination disorder
SCREENING
● SCOFF questionnaire >=2 ‘Yes’
○ Do you make yourself ​S​ick because you feel uncomfortably full?
○ Do you worry you have lost ​C​ontrol over how much you eat?
○ Have you recently lost more than ​O​ne stone (14 pounds or 6.35 kg) in a
three-month period?
○ Do you believe yourself to be ​F​at when others say you are too thin?
○ Would you say that ​F​ood dominates your life?
ANOREXIA NERVOSA
● Epidemiology
○ Young adults
○ F>M
○ Prevalence = 1-2%
● Diagnosis (DSM-5) = all 3 of the following
○ Restriction of energy intake that leads to a low body weight
○ Intense fear of gaining weight or becoming fat, or persistent behavior that
prevents weight gain, despite being underweight
○ Distorted perception of body weight and shape
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

2. “People who see life as anything more than pure entertainment are missing the point.”
― George Carlin
● Amenorrhea commonly occurs
● DSM-5 eliminated amenorrhea as a criterion
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER
● Epidemiology
○ Onset in early childhood
○ Prevalence = ?
● Diagnosis = DSM-5
○ Avoiding or restricting food intake, which may be based upon lack of interest in
food, the sensory characteristics of food, or a conditioned negative response
associated with food intake
○ The eating behavior leads to a persistent failure to meet nutritional and/or energy
needs, manifested by at least one of the following
■ Clinically significant weight loss
■ poor growth or failure to achieve expected weight gain
■ Nutritional deficiency
■ Supplementary enteral feeding or oral nutritional supplements are
required
■ Impaired psychosocial functioning
○ Not due to lack of available food or associated with a culturally sanctioned
practice
○ Does not occur solely in the course of anorexia nervosa or bulimia nervosa
○ Not due to a general medical condition (eg, GI disease, food allergies, or occult
malignancy) or another mental disorder
BINGE EATING DISORDER
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

3. “People who see life as anything more than pure entertainment are missing the point.”
― George Carlin
● Epidemiology
○ Young adults
○ F>M
○ a/w
■ Phobia
■ Depression
■ PTSD
■ Obesity
■ DM
■ Alcoholism
● When to suspect
○ Greater than expected weight dissatisfaction
○ Large weight fluctuations
○ Depressive symptoms
● Diagnosis = DSM-5
○ Episodes of binge eating
■ Eating more rapidly than normal
■ Eating until feeling uncomfortably full
■ Eating large amounts of food when not feeling physically hungry
■ Eating alone because of embarrassment by the amount of food
consumed
■ Feeling disgusted with oneself, depressed, or guilty after overeating
○ No inappropriate compensatory behaviors (eg, purging, fasting, or excessive
exercise) as are seen in bulimia nervosa
○ Binge eating does not occur solely during the course of bulimia nervosa or
anorexia nervosa.
BULIMIA NERVOSA
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

4. “People who see life as anything more than pure entertainment are missing the point.”
― George Carlin
● Epidemiology
○ F>M
○ Young adults
PICA
● Epidemiology
○ Childhood
○ Can occur during adolescence or adulthood
● Diagnosis = DSM-5
○ Repeated eating of nonfood substances for >= 1 month
○ The eating behavior is inappropriate to the patient’s developmental level, and is
not culturally supported or socially normal
● Pica may be a clinical manifestation of iron deficiency anemia
RUMINATION DISORDER
● Epidemiology
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

5. “People who see life as anything more than pure entertainment are missing the point.”
― George Carlin
○ Young adults
○ Can be found in adults
○ Prevalence ?
● Diagnosis = DSM-5
○ Repeated regurgitation of food, which may be rechewed, reswallowed, or spit out
○ Occurs for >= 1 month
○ Not due to a general medical condition, such as gastroesophageal reflux disease
or pyloric stenosis
○ does not occur solely during the course of avoidant/restrictive food intake
disorder, anorexia nervosa, binge eating disorder, or bulimia nervosa.
Mx
● Interdisciplinary care
○ mental health clinician
○ Dietitian
○ Physician
● Criteria for hospitalization
○ Medically unstable
○ medical complications
● Reducing stigma
○ The stigma of eating disorders = a/w dysfunctional thoughts
○ may interfere with treatment
● PREVENTION
○ Education
■ Idealization of thinness
■ Body dissatisfaction
■ Dieting
■ Negative affect (dysphoria)
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava

6. “People who see life as anything more than pure entertainment are missing the point.”
― George Carlin
TREATMENT
● Psychotherapy
○ Cognitive-behavioral therapy (CBT)
■ CBT encourages patients to change the dysfunctional
● cognitions = Thoughts and beliefs about body weight and shape
● Behavioral disturbances = excessive food restriction
○ Psychodynamic psychotherapy
■ Time-limited psychodynamic psychotherapy addresses conscious and
unconscious meanings of eating disorder symptoms, the effects of
symptoms upon current relationships and the patient’s relationship with
the therapist
■ Does not advise patients about eating behaviors.
○ Motivational interviewing
■ motivate patients with anorexia nervosa to gain weight by eliciting both
their reasons to do so, and their ambivalence about change
○ Family therapy
■ places parents in charge of making decisions about appropriate eating
and related behaviors
● Pharmacotherapy
Non nobis solum nati sumus
(​Not for ourselves alone are we born​)
-Dr. Eashan Srivastava