1. PSY600:DIAGNOSIS AND TREATMENT OF MENTAL HEALTH DISORDERS
Class 8:
Eating Disorders

2. Eating Disorders Eating Disorders include:
Anorexia Nervosa
Bulimia Nervosa
Binge-Eating Disorder
Other Specified Feeding or Eating Disorder
Unspecified Feeding or Eating Disorder
Eating Disorders are similar to Substance Disorders because they also elicit addiction Bx: e.g., lying, hiding, sneaking, denial, obsession, and compulsion

3. Anorexia Nervosa Basic criteria
Restriction of energy intake leading to significantly low body weight
Intense fear of gaining weight or becoming fat, or persistent Bx that interferes with gaining weight even though person is significantly underweight
Disturbance in how one’s body weight/shape is experienced; self evaluation unduly influenced by body weight/shape; denial of seriousness of low body weight

4. Anorexia Nervosa Specify Type for current episode Restricting Type
In past 3 months, person has not regularly binged or purged
I.e., weight loss is due to dieting, fasting, or excessive exercise
Binge-Eating/Purging Type
In past 3 months, person has regularly engaged in binge-eating or purging Bx
Purging includes: self-induced vomiting and misuse of laxatives, diuretics or enemas

5. Anorexia Nervosa Specify if: Specify severity: In partial remission
Criterion A no longer met for sustained period
Criterion B or C still met
In full remission
No criteria met for sustained period
Specify severity:
Mild – BMI ≥ 17 kg/m²
Moderate – BMI
Severe – BMI
Extreme – BMI < 15

6. Anorexia Nervosa 90% of Anorexia occurs in females
Px is better if disorder begins in adolescence rather than later
Sx usually accompanied by obsessive/compulsive Bx regarding monitoring weight, preparing food, food intake.
Serious risk of suicidal ideation and Bx
5-10% mortality rate from disorder or suicide
Often treatment resistant; appx 50% long-term full recovery rate (Butcher, Mineka, & Hooley (2007))

7. Bulimia Nervosa Basic criteria Recurrent episodes of binge eating
Eating in a discrete period of time significantly more than most people would eat
Sense of lack of control over eating during binge episode
Recurrent inappropriate compensatory Bx to prevent weight gain
Vomiting, laxatives/diuretics, fasting, excessive exercise
Binge eating and compensating occur an avg of once a week for 3 months.
Self-evaluation unduly influenced by body weight and shape
Sx don’t occur as part of Anorexia

8. Bulimia Nervosa Specify if: Specify current severity:
In partial remission
After full criteria previously met, some but not all criteria are met for a sustained period of time
In full remission
No criteria have been met for a sustained period of time
Specify current severity:
Mild – Avg of 1-3 episodes of compensatory Bx per week
Moderate – 4-7 episodes per week
Severe – 8-13 episodes per week
Extreme – 14 or more episodes per week

9. Bulimia Nervosa 90% of Bulimia occurs in females
People with Bulimia are typically not underweight
Binges are often triggered by emotional states
Shame and secrecy usually play large roles in this disorder
Appears to be very culture-bound (Butcher, Mineka, & Hooley, (2007)
Px better than for Anorexia
Elevated risk of suicide and death from complications of disorder
Serious possible health consequences include:
Dental damage
Esophageal damage
Electrolyte imbalance that can lead to heart complications

10. Binge-Eating Disorder
Binge eating without compensatory Bx
Binge episodes associated with 3 of the following:
Eating much more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not hungry
Eating alone due to shame
Feeling disgusted, depressed or guilty after
Marked distress over binge eating
Specify partial or full remission
Specify severity based on # of episodes per week
Most common eating disorder w/ gender ratio appx 2:1
Cultural/ethnic differences not present in U.S. as seen with AN and BN

11. Differential Diagnosis
Anorexia vs. Bulimia
Anorexia and Bulima Bx can be very similar, but only Anorexia fails to maintain minimal weight
Anorexia vs. MDD
MDD can lead to significant weight loss, but not the preoccupation with weight, body appearance, and food
Additionally Dx OCD, Social Phobia, or Body Dysmorphic Disorder only if Sx are unrelated to the preoccupations of anorexia
Other medical conditions can cause severe weight loss, but body preoccupations won’t be present

12. Differential Diagnosis
Anorexia, binge/purging type and Bulimia vs. Binge-eating Disorder
No significant weight loss with Binge-eating Disorder
No regular compensatory Bx with Binge-eating disorder
Bulimia and Binge-eating Disorder vs. MDD
MDD with atypical features can include binge eating, but not compensatory Bx or preoccupation with weight and body appearance
Increased eating with MDD may or may not come with loss of control; if it does, more than one Dx may be appropriate
Eating disorders vs. Borderline Personality Disorder
Binge eating meets a criterion for BPD. If criteria for BPD and an eating disorder are met, Dx both.
Eating Disorders have a high co-morbidity with bipolar disorders, MDD, anxiety disorders, substance disorders, and personality disorders

13. Treatment of Anorexia Multidisciplinary, individualized approach
Medical needs supersede psychological needs
Keep patient alive; hospitalize if necessary
Weight gain; adequate nutrition
Correct abnormal eating habits
Address psychological needs as patient stabilizes
Individual psychotherapy to address:
Eating patterns, triggers, and gradual steps toward normalized eating
Perfectionism, self-esteem, interpersonal problems
Dysfunctional thoughts/beliefs, esp. re body and self-worth
Problems with affect and Bx regulation
Family Tx and group therapy is often used

14. Treatment of Anorexia
Maudsley Approach (Family-based Tx) (Lock, Le Grange, et al., 2010)
Relatively recently developed Tx method for dependent adolescents
Focus on restoring healthy eating habits, not on underlying causes of disorder
Parents are given control over eating Bx initially, w/ gradual transfer of control back to patient
Goal is to avoid hospitalization and retain family relationships and normal aspects of daily life
Research shows best outcomes and lower relapse with this approach

15. Treatment of Bulimia Bulimia Individual or group psychotherapy – CBT
Emphasize behavioral aspects initially to break bulimic cycle
Exposure and response prevention
Cognitive aspects to address attitudes about weight, dieting methods, and body shape
Maudsley also used for BN
Medical management/medication
Prozac has shown some efficacy
Tx in combination with psychotherapy is best for effectiveness and relapse prevention

16. Treatment of Binge-eating Disorder
CBT
Identify and address Bx patterns before, during and after binge eating
Identify and address faulty thinking associated with binge eating
Stress management
Dialectical Behavior Therapy
Manage negative affect
Improve emotional regulation
Medications
SSRIs have shown effectiveness
Weight loss treatment may be necessary as well