Feeding and Eating Disorers Presentation
Feeding and Eating Disorers Presentation
EATING DISORERS
GABISILE R MATHIBELA
CONTENT
• Introduction
• General description
• Cultural considerations
• Clinical presentation/ features
• Diagnostic criteria
• Differential diagnosis
• Comorbidity
• Course and prognosis
• Bio psychosocial model/formulation
• Treatment plan
• Case Management
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INTRODUCTION
• Eating is something we all need and do daily, yet for some, eating may become a
disorder
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GENERAL DESCRIPTION
• Typically, people with eating disorders develop an unhealthy preoccupation with food,
body size, weight or shape.
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CULTURAL CONSIDERATION
• Acceptable eating habits vary widely between religious and ethnic groups.
• Eating disorders have been conceptualized as culture-bound syndromes.
• Cultural beliefs and attitudes have been identified as significant contributing factors in the
development of eating disorders
• The idealization of the thin body type within Western societies has been identified as a
possible factor leading to the development of anorexia nervous.
• Eating disorders are more prevalent in countries that are industrialized and where
thinness is associated with attractiveness.
• White women from industrialized Western countries are particularly at risk for the
development of eating disorders.
• Black and non-Western women have been thought to be protected by contrasting ideals
that value plumpness as a metaphor for attractiveness, fertility, and prosperity.
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CULTURAL CONSIDERATION
• Western pressures towards thinness blend with traditional idioms of distress and
culturally sanctioned rituals of remedial purging and social over-eating .
• In African culture, culturally sanctioned overeating and purging may place individuals at
particular risk for the development of bulimia nervosa.
• Anorexia nervosa occurs in all cultures, but the incidence is higher among individuals
who have been exposed to Western culture .
• In industrialized countries, the prevalence is about 1 percent of the general population.
• In the United States, bulimia nervosa may be more prevalent among Hispanics and
blacks than non-Hispanic whites.
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TYPES OF EATING DISORDERS
Avoidant
Anorexia Bulimia Binge eating restrictive Rumination
Pica
nervosa, nervosa disorder food intake disorder
disorder
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ANOREXIA NERVOSA 8
DESCRIPTION
Anorexia nervosa can be describe as the refusal to maintain a minimally normal body weight.
Anorexia nervosa is frequently, but not always, connected with body image issues.
There are also different tiers of anorexia based on BMI ranging from :
• Extreme thinness
• Distorted body or self-image that is heavily influenced by perceptions of body weight and
shape
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DIAGNOSTIC CRITERIA
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DIAGNOSTIC CRITERIA
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DIFFERENTIAL DIAGNOSIS
• Medical conditions ( gastrointestinal disease)- weight loss present however individuals usually
do not also manifest a disturbance in the way their body weight or shape is experienced or an
intense fear of weight gain or persist in behaviors that interfere with appropriate weight gain.
• Substance abuse- Individuals with substance use disorders may experience low weight because of
poor nutritional intake but generally do not fear gaining weight and do not manifest body image
disturbance.
• Schizophrenia- individuals might have delusions about food being poisoned thus leading to less
food intake and weight loss but rarely are they concerned with caloric content. Individuals do not
express a fear of gaining weight.
• Bulimia nervosa- individuals do not have an abnormally low body weight.
• Social anxiety - individuals may feel humiliated or embarrassed to be seen eating in public,
however the embarrassment is not isolated to eating behaviors only and is not accompanied by
intense fear of gaining weight and body image disturbance
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DIFFERENTIAL DIAGNOSIS
• Avoidant/restrictive food intake disorder- restriction of intake is due to a lack of interest in food,
aversion to the sensory characteristics, or concern about potential adverse consequences of eating
such as choking or vomiting, and will not be accompanied by intense fear of gaining weight and
body image disturbance
• Obsessive compulsive disorder- may exhibit obsessions and compulsions related to food,
however the obsessions and compulsions are not associated with an intense fear of gaining weight
and are not due to the need to loss weight.
• Major depressive disorder - Individuals with major depressive disorder do not have either a desire
for excessive weight loss or an intense fear of gaining weight. Depressed individuals usually have a
decreased appetite, whereas anorexia nervosa patients often claim to have a normal appetite and
to feel hungry.
• Body dysmorphic disorder- individuals may be preoccupied with an imagined defect in bodily
appearance, However with individuals with BBD the imagined body appearance is not limited to
weight or shape only
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COMORBIDITIES
Alcohol use
disorder and Bipolar
other disorder
substance use
Major
OCD depressiv
e disorder
Anxiety
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disorders
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COURSE AND PROGNOSIS
A better prognosis is associated with an early onset such as during adolescence and the short-
term response of patients to almost all hospital treatment programs is good.
Most individuals with anorexia nervosa experience remission within 5 years of presentation
but in patients admitted to the hospital remission may be lower.
Those who have regained sufficient weight, however, often continue their preoccupation with
food and body weight, have poor social relationships, and exhibit depression
Worse outcomes are observed in patients who require hospitalization and in adults.
The condition is associated with a high risk of chronic course and poor prognosis in terms of
treatment and the risk of death
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TREATMENT AND MANAGEMENT
• Nutritional rehabilitation- This is when a patient is given the proper nutrition and calories to help
them regain their healthy weight.
• Family-Based Treatment
• In phase 2, the patient gradually begins to take responsibility for decisions about eating.
• In phase three, the focus shifts to the patient’s growth and development.
• Cognitive and behavioural therapy is used to teach patients to monitor their food intake, emotions,
bingeing behaviours, and interpersonal issues.
• Cognitive restructuring and problem-solving techniques help patients identify automatic thoughts and
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challenge core beliefs, addressing their vulnerability to anorectic behaviour.
TREATMENT AND CASEMANAGEMENT
• Pharmacotherapy
• The use of olanzapine( promote weight gain) and antidepressants
• Management of eating disorders should be a multidisciplinary approach.
• Nutritional rehabilitation along with some form of re-educative psychotherapy remains the mainstay of
the management of anorexia nervosa
• Management should be a multidisciplinary approach involving psychiatrists, psychologists,
endocrinologists, dentists, gastroenterologists, internists so on and so forth. All personnel must work
closely together and maintain open communication and mutual respect.
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BULIMIA NERVOSA 21
DESCRIPTION
Bulimia nervosa comprises of recurrent episode of binge eating together with
behaviours such as purging.
Unlike patients with anorexia nervosa, those with bulimia nervosa typically maintain a
normal body weight.
Subtypes
first episodes of binge eating occur relatively frequently (once a week or more) for at least 3 months
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DIAGNOSTIC CRITERIA
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DIAGNOSTIC CRITERIA
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DIFFERENTIAL
• Kleine-Levin syndrome- there is also disturbed eating behavior. However, the characteristic
feature of bulimia nervosa, concern and self-evaluation with body shape and weight, are not
present.
• Major depressive disorder, with atypical features- Overeating is common in this disorder.
However, there is no inappropriate compensatory behaviors and they do not exhibit the excessive
concern with body shape and weight characteristic of bulimia nervosa. If criteria for both disorders
are met, both diagnoses should be given.
• Borderline personality disorder Binge-eating behavior makes up part of the impulsive behaviours
seen in borderline personality disorder. However , there are no features of inappropriate
compensatory purging behaviour of bulimia nervosa.
• Binge-eating disorder- Individuals who binge eat but do not engage in repeated, inappropriate
compensatory behaviors.
• Anorexia nervosa, binge-eating/purging type- An important distinction is that a diagnosis of
anorexia nervosa requires low body weight; and BMI<18, whereas this is not a diagnostic criterion
ADDfor bulimia nervosa
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COMORBIDITIES
Depressive Bipolar
disorder disorder
Substance
Anxiety
use
disorder
disorder
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COURSE AND PROGNOSIS
The course may be chronic or intermittent, with periods of remission alternating with recurrences of
binge eating
Bulimia nervosa is characterized by higher rates of partial and full recovery compared with
anorexia nervosa.
Untreated patients tend to remain chronic or may show small, but generally unimpressive,
degrees of improvement with time .
A history of substance use problems and a longer duration of the disorder at presentation predicted
a worse outcome. deteriorating course resulting in death caused by complications of starvation
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TREATMENT PLAN AND MANAGEMENT
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