Feeding & Eating Disorders B. Timothy Walsh, MD Professor of Psychiatry, Columbia University New York State Psychiatric Institute.

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Presentation transcript:

Feeding & Eating Disorders B. Timothy Walsh, MD Professor of Psychiatry, Columbia University New York State Psychiatric Institute

Feeding & Eating Disorders Defining characteristic: – persistent disturbance in eating behavior

Eating Disorders in DSM-IV Anorexia Nervosa Bulimia Nervosa

Feeding & Eating Disorders in DSM-5 Anorexia Nervosa Bulimia Nervosa Binge Eating Disorder (BED) Avoidant/Restrictive Food Intake Disorder (ARFID) Pica Rumination Disorder Not Obesity

Core Features - 1 Anorexia Nervosa (AN) – Persistent caloric restriction -> low weight; fear of weight gain Bulimia Nervosa (BN) – Binge eating & purging Binge Eating Disorder (BED) – Binge eating & no purging

Core Features - 2 Avoidant/Restrictive Food Intake Disorder (ARFID) – Restrictive food intake, but not AN Pica – Ingestion of non-nutritive, non-food substances Rumination Disorder – Regurgitation of ingested food

(AN) Anorexia Nervosa (AN) Anorexia Nervosa Bulimia Nervosa (BN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Binge Eating Disorder (BED) Disordered Eating

Prevalence (AN) Anorexia Nervosa (AN) Anorexia Nervosa Bulimia Nervosa (BN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Binge Eating Disorder (BED) Disordered Eating

Cost Severity Prevalence (AN) Anorexia Nervosa (AN) Anorexia Nervosa Bulimia Nervosa (BN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Binge Eating Disorder (BED) Disordered Eating

Cost Severity Intensity of Care Prevalence (AN) Anorexia Nervosa (AN) Anorexia Nervosa Bulimia Nervosa (BN) Bulimia Nervosa (BN) Binge Eating Disorder (BED) Binge Eating Disorder (BED) Disordered Eating

Intensity / Levels of Care Outpatient (primary care vs specialist care) Intensive Outpatient Program (IOP) – Generally 3X weekly multi-modal treatment Partial Hospital Program (PHP) – Daily comprehensive treatment, including meals Residential – 24 x 7 – All voluntary participation – Lower staffing than inpatient – Structured differently in different parts of US (e.g., supportive housing + PHP) Inpatient (psychiatry vs medicine or pediatrics)