EATING DISORDER TYPES AND SYMPTOMS

 

Anorexia Nervosa

 

Anorexia Nervosa has the highest mortality rate of all the eating disorders. Studies place the rate of death between 20%-30% if left untreated, with the highest percentage of those deaths coming from suicide. One study puts the suicide rate as high as one out of every five sufferers.

Those with Anorexia Nervosa are unable to maintain a caloric intake that allows them to sustain a healthy weight. A person with Anorexia will be abnormally sensitive about being perceived as overweight or have an intense fear of becoming overweight. If this fear is not evident, there are still persistent behaviors that interfere with weight gain, even though weight is significantly low. They may turn to obsessive exercise, self-induced vomiting, diet pills, laxatives, or diuretics to control their weight. While suffering from Anorexia, the sufferer may have a difficult time recognizing the seriousness of their condition, have a distorted view of their body size, or be reliant on their body weight and shape for their self-worth.

A 2010 study reported that 56.2% of adults with Anorexia also suffered from other mental health issues. Out of those with comorbid conditions, 47.9% had an anxiety disorder, 42.1% had a mood disorder, 30.8% had an impulse control disorder, and 27.0% had a substance use disorder.

 

Diagnostic Criteria

  • Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

 

  • Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

 

  • Disturbance in the way in which one's body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

 

Specify whether:

Restricting type: During the last three months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.

 

Binge-eating/purging type: During the last three months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e., self-induced vomiting or the misuse of laxatives, diuretics, or enemas).

 

Signs and Symptoms May Include:

  • Dramatic weight loss in a relatively short period

  • Wearing big or baggy clothes or dressing in layers to hide body shape or weight loss

  • Obsession with calories and fat content of food

  • Use or hiding the use of diet pills, laxatives, or diuretics to facilitate weight loss

  • Fear of eating with or around others

  • Unusual food rituals such as shifting the food around the plate to look eaten

  • Cutting food into tiny pieces

  • Chewing food and spitting it out

  • Hiding food to throw away later

  • Vague or secretive eating patterns

  • Keeping a food diary

  • Pre-occupied thought of food, weight, and cooking

  • Self-defeating statement after eating

  • Hair loss, pale or gray appearance to the skin

  • Dizziness and headaches

  • Often putting themselves down

  • Complaints of feeling cold

  • Low blood pressure

  • Sleep disturbances

  • Mood swings

  • Anxiety, depression, or suicidal feelings

 

Physical Complications May Include But Are Not Limited To:

 

Delayed puberty

Amenorrhea

Anovulation

Low estrogen states

Increased growth hormone

Decreased antidiuretic hormone

Hypercarotenemia

Hypothermia

Hypokalemia

Hyponatremia

Hypoglycemia

Euthyroid sick syndrome

Hypercortisolism

Arrested growth

Osteoporosis

Cardiomyopathy

Mitral valve prolapse

Supraventricular and ventricular Dysrhythmias

Long QT syndrome

Bradycardia

Orthostatic hypotension

Shock due to congestive heart failure

Decreased glomerular filtration rate (GFR)

Elevated BUN

Edema

Acidosis with dehydration

Hypokalemia

Hypochloremic alkalosis with vomiting

Constipation

Decreased intestinal mobility

Delayed gastric emptying

Gastric dilation and rupture (from binging)

Hyperaldosteronism

Renal calculi

Peripheral neuropathy

Ventricular enlargement

Dry skin and hair

Hair loss

Lanugo body hair

Anemia

Leukopenia

Thrombocytopenia

Infertility

Low ̶ birth-weight infant

Patients who induce vomiting may develop:

Dental enamel erosion

Palatal trauma

Enlarged parotids

Esophagitis                                                                                                                           

Mallory-Weiss Lesions

 

Bulimia Nervosa

Bulimia Nervosa affects an estimated 1.5% of the population. People with Bulimia Nervosa will experience recurrent cycles of binging and purging and are likely to understand their behavior is problematic. There is often a lot of shame around their actions, which can lead to increased isolation and secrecy. The definition of a binge is eating an amount of food that is larger than most people would eat within a two-hour period. Sufferers often feel a sense of lack of control over their eating during the episode. The purging action may include self-induced vomiting, excessive exercise, use of laxatives, diuretics, or other medications, or compensating by fasting or restricting. A person with Bulimia is typically worried about their weight or shape and may be at, above, or below a healthy weight.

A 2010 study reported that 94.5% of adults with Bulimia also suffered from other mental health issues. Out of those with comorbid conditions, 80.6% had an anxiety disorder, 70.7% had a mood disorder, 63.8% had an impulse control disorder, and 36.8% had a substance use disorder.

 

Diagnostic Criteria

Recurrent episodes of binge eating. An episode of binge eating is characterized by both:

  • Eating in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period under similar circumstance

 

  • A sense of lack of control over eating during the episodes (e.g., a feeling that one cannot stop eating or control what or how much one is eating.

 

Recurrent inappropriate compensatory behaviors to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for three months.

Self-evaluation is unduly influenced by body shape and weight.

The disturbance does not occur exclusively during episodes of anorexia nervosa.

 

Signs and Symptoms May Include:

  • Avoiding or having anxiety with activities that involve food

  • Isolating

  • Secretive eating

  • Frequent trips to the bathroom immediately following meals

  • Self-defeating statements after eating

  • Bruised or calloused knuckles

  • Swollen lymph glands or cheeks

  • Mood swings, depression, suicidal thoughts

  • Sensitivity to comments about weight or appearance

  • Guilt, self-disgust, shame, self-loathing

  • Anxiety

  • Avoiding food, periods of restricting, dieting behavior

  • Weight fluctuations

  • Dental issues

 

Physical Complications May Include But Are Not Limited To:

Dehydration

Electrolyte Imbalances

Arrhythmia

Mallory-Weiss Syndrome

Boerhaave Syndrome

Irregular Periods

Amenorrhea

Infertility

Russell's Sign

Damaged Tooth Enamel

Periodontitis

Constipation

Diarrhea

Irritable Bowel Syndrome

Low Blood Pressure

Kidney Damage

Anemia

Cardiovascular Disease

Stroke

Heart Attack

Subconjunctival Hemorrhage

Epistaxis

Gingivitis

Xerostomia

Sialadenosis

Gastroesophageal Reflux

Dysphagia

Odynophagia

Peripheral Edema

Tachycardia

Hypotension

Orthostasis

Hypokalemia

Pneumomediastinum

Cathartic Colon Syndrome

 

Binge Eating

 

An estimated 2.8 million people have Binge Eating Disorder. In an online survey, only 3% of those with BED reported getting a diagnosis from their doctor. While BED is associated with being overweight or obese, not everyone that is overweight or obese has BED, and not everyone with BED is overweight. Up to 30% of people looking into weight loss treatment are estimated to suffer from undiagnosed Binge Eating Disorder.

People who are struggling with Binge Eatings Disorder experience episodes of consuming an unusually large quantity of food in a short period of time. A binge episode may also include: eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, or eating alone out of shame over how much one is eating. Feelings of self-disgust, depression, or guilt after the binge are common. Increased weight is not uncommon with this disorder, which can lead to further anxiety and social stigma.

A 2010 study reported that 78.9% of adults with Binge Eating Disorder also suffered from other mental health issues. Out of those with comorbid conditions, 65.1% had an anxiety disorder, 46.4% had a mood disorder, 43.3% had an impulse control disorder, and 23.3% had a substance use disorder.

 

Diagnostic Criteria

Recurrent episodes of binge eating. An episode of binge eating is characterized by both:

Eating in a discrete period of time (e.g., within any 2 hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances;

A sense of lack of control over eating during the episodes (e.g., a feeling that one cannot stop eating or control what or how much one is eating).

 

Binge eating episodes are associated with three or more of the following:

Eating much more rapidly than normal.

Eating until feeling uncomfortably full.

Eating large amounts of food when not feeling physically hungry.

Eating alone because of feeling embarrassed by how much one is eating.

Feeling disgusted with oneself, depressed, or very guilty afterwards.

Marked distress regarding binge eating is present.

 

The binge eating occurs, on average, at least once a week for three months.

The binge eating is not associated with the recurrent use of inappropriate compensatory behavior as in bulimia nervosa and does not occur exclusively during the course of bulimia nervosa or anorexia nervosa.

 

Signs and Symptoms May Include:

  • Fear of not being able to control eating or not being able to stop eating

  • Isolation

  • Secretive eating habits

  • Hiding food in odd locations

  • Eating more rapidly than normal

  • Eating when not physically hungry

  • Feelings of guilt and shame

  • Eating in secret

  • Avoiding social situations, particularly those involving food

  • Eating 'normal' quantities in social settings, and bingeing when alone

  • Low self-esteem and embarrassment over physical appearance

  • Feeling extremely distressed, upset and anxious during and after a binge episode

  • Fear of the disapproval of others

  • Depression and suicidal thoughts

  • Overly sensitive to references about weight or appearance

 

Physical complications include but are not limited to:

Type II Diabetes

High Blood Pressure

High Cholesterol

Gallbladder Disease

Heart Disease

Shortness of Breath

Certain types of Cancer

Menstrual problems

Infertility

Decreased mobility

Hyperlipidemia

Dyslipidemia

Insulin Resistance

Sleep Apnea

Obesity

Heart Attack

Acute Massive Gastric Dilation

Metabolic Syndrome

Low Cortisol Levels

PCOS

Cholelithiasis

Dysphagia

Fatty Liver Disease

Diarrhea

Bloating

Edema

Chronic Pain

 

Other Specified Feeding or Eating Disorders

 

When a person meets some of the criteria for an eating disorder, but not all, they may be diagnosed under the category of OSFED. This diagnosis is equally as life-threatening as any other eating disorder. Those that fall within these diagnostic guidelines sometimes fear their illness won't be taken as seriously or may discount the severity of their illness themselves.

 

There are five categories of OSFED:

 

Atypical Anorexia Nervosa

When all the criteria for anorexia are met except for substantially low body weight, a person is diagnosed with Atypical Anorexia. The sufferer may be at or above a healthy weight range, which can lead to a slower diagnosis and the mistaken belief that they are not at as high of a level of risk of death as those that are of lower weight.

 

Binge Eating Disorder (of low frequency or limited duration)

A diagnosis that is used when all of the criteria for Binge-Eating Disorder are met, but the binge occurs, on average, less than once a week or for less than three months.

 

Bulimia Nervosa (of low frequency or limited duration)

This diagnosis is for those who meet all the criteria for Bulimia, but binging and purging episodes occur, on average, less than once a week or for less than three months.

 

Purging Disorder

When someone has behaviors of recurrent purging behavior used to influence weight or shape (e.g., self-induced vomiting; misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

 

Night Eating Syndrome

Someone with Night Eating Syndrome will experience episodes of night eating manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness of recall of the eating. The night eating is not better explained by external influences such as changes in the individual's sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder and or another mental disorder, including substance use, and is not attributable to another medical disorder or an effect of medication. This occurs when a person consumes at least 25% of their daily intake after the evening meal. Waking up after going to bed in order to eat may also occur.

 

Rumination Disorder

 

Rumination Disorder is a repeated regurgitation of food through re-chewing, re-swallowing, or spitting out food. It may exist as an eating disorder behavior in Anorexia and Bulimia or as a primary diagnosis. 

It may remain as a behavior after recovery from another eating disorder if undetected and unreported by the patient.

 

Diagnostic Criteria

 

Repeated regurgitation of food over a period of at least one month. Regurgitated food may be re-chewed, re-swallowed, or spit out.

 

Not attributable to an associated gastrointestinal or other medical condition (e.g., reflux).

 

Does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.

 

If symptoms occur in the context of another mental disorder (e.g., intellectual disability), they are sufficiently severe to warrant additional clinical attention. 

 

 

Signs and Symptoms May Include:

 

  • Repeated regurgitation of food

  • Repeated re-chewing of food

  • Weight Loss

  • Bad Breath

  • Tooth Decay

  • Repeated stomachaches

  • Indigestion

  • Raw and chapped lips

 

 

Physical Complications May Include But Are Not Limited To:

 

Malnutrition

Lowered resistance to infections and diseases

Failure to grow and thrive

Weight loss

Stomach diseases such as ulcers

Dehydration

Bad Breath

Tooth Decay 

Aspiration Pneumonia

Respiratory Problems

Choking

 

Pica

 

A diagnosis of Pica occurs when a person eats substances that have no nutritional value for a period of at least one month. Examples of this behavior could include eating clay, cotton, or other non-food items.

 

Because of its features of eating non-nutritive and non-food substances, it is the only Feeding and Eating Disorder that can be diagnosed simultaneously with another eating disorder. 

 

 

Diagnostic Criteria

 

Persistent eating of non-nutritive, non-food substances over the period of at least one month.

 

The eating of non-nutritive, non-food substances that are inappropriate to the developmental level of the individual.

 

The eating behavior is not part of a culturally supported or socially normative practice. 

 

If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability, autism spectrum disorder) or medical condition (e.g., pregnancy), it is sufficiently severe to warrant additional clinical attention. 

 

 

Signs and Symptoms May Include:

 

The repeated eating substances that are not food provide no nutritional value.

Some typical substances ingested with Pica include: 

  • Paper

  • Dirt

  • Clay

  • Hair

  • Chalk

  • Charcoal

  • Ice

  • Wool

  • Talcum powder

  • Ash

 

 

Physical Complications May Include But Not Limited To:

 

Poisoning, such as lead poisoning

Parasitic Infections

Intestinal Blockages

Chocking

Intestinal Obstruction

 

Avoidant/Restrictive Food Intake Disorder

 

Avoidant/Restrictive Food Intake Disorder (ARFID) is an eating or feeding disturbance where a person is unable to meet their nutritional or energy needs. They may avoid foods due to texture or appearance and exist off on a very limited intake. It may also be due to repeated

gastrointestinal discomfort, or phobias around choking or vomiting. The sufferer may experience significant weight loss, not keeping up with expected growth, nutritional deficiencies, dependence on nutritional supplements, or having one’s dietary issues interfere with their psychosocial functioning.

 

As many as 13%-22% of young children are selective eaters with parents often believing they will outgrow it, but studies show up to 40% of this behavior continues into adolescents. Because of the risk of low weight and malnutrition, sufferers should follow a prescribed diet that promotes appropriate weight gain and maintenance. 

 

 

Diagnostic Criteria

 

A feeding or eating disturbance (e.g., lack of apparent interest in eating food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating)as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:

 

Significant weight loss (or failure to achieve expected weight gain or faltering growth in children). 

 

Significant nutritional deficiency. 

 

Dependence on enteral feeding or oral nutritional supplements. 

 

Marked interference with psychosocial functioning.

 

The disturbance is not better explained by a lack of available food or by an associated culturally sanctioned practice. 

 

 The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced. 

 

The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants

 

 

Signs and Symptoms May Include:

 

  • Sudden refusal to eat foods

  • Not eating foods that used to be eaten

  • Sudden fear of choking or vomiting

  • No appetite despite not eating and with no medical cause

  • Very slow eating

  • Difficulty eating meals with family or friends

  • No longer gaining weight

  • Losing Weight

  • No growth or delayed growth

 

Physical Complications May Include But Are Not Limited To:

 

(includes many of the complications seen in anorexia)

 

Bradycardia

Orthostatic Hypotension

Dehydration

Nutritional Depletion

Gastrointestinal Complications

Delayed Emptying of the Stomach

Low Testosterone

Low Estrogen

Amenorrhea

 

SOURCES for the above referenced information available.

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Spring, TX