Dr.

Noor Alhuda Adnan Al Ghuraibawi

Department of Medicine / Division of Psychiatry

Feeding and Eating Disorders

Anorexia Nervosa

o Definition
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Anorexia nervosa (AN) is a syndrome characterized by three essential criteria. The first is a self-
induced starvation to a2significant degree—a behavior. The second is a relentless drive for
thinness and/or a morbid fear of fatness—a psychopathology. The third criterion is the presence of
3 medical signs and symptoms resulting from starvation—a physiological symptomatology.

o Epidemiology

Usually started at the ages of 15_ 17 & rarely after 30.

Female > male.

More common in Western Countries.

o Subtypes:

1- Restricting subtype: This is the most commonly known type of Anorexia Nervosa whereby a
person severely restricts their food intake.

2- Bing - eating / purging subtype: A person restricts their intake as above, but also during some
bouts of restriction the person has regularly engaged in binge-eating OR purging behavior (e.g.
self induced vomiting, over-exercise, misuse of laxatives, diuretics or enemas).
The difference between this type and bulimia that in this type the patient has very
low weight

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 Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry

o Etiology:

• Multifactorial.
• Individual: Perfectionism and impulse to control ( common in gymnasts & ballet dancers).
• Familial: Family effect, dysfuncional family environment
• Social factors: Wrong seeking for body perfectionism, preassure of the society to be thin,
effect of media, others.
• Biological: hypothalamic dysfunction, disordered serotonin, norepinphrine and dopamine.
o Medical Complication:

• Bradycardia, Hypotension & increased risk of heart failure and death.

• osteopenia and osteoporosis.
• Muscle loss and weakness.
• Severe dehydration, which can result in kidney failure.
• Fainting, fatigue, lethargy and overall weakness.
• Dry skin and hair, brittle hair and nails, hair loss.
• Anemia.
• Severe constipation.
• Prepubertal patients may have arrested sexual maturity and growth failure.
• Amenorrhea & Infertility.

o DSM-5 criteria, to be diagnosed as having Anorexia Nervosa a person must display:

A. Persistent restriction of energy intake leading to significantly low body weight (in context of
what is minimally expected for age, sex, developmental trajectory, and physical health) .

B. Either an intense fear of gaining weight or of becoming fat, or persistent behaviour that
interferes with weight gain (even though significantly low weight).

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

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 Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry

o Management:

• Severe weight loss or starvation is a medical emergency. Early treatment is important.

Individuals with severe anorexia may need to be hospitalized.
• A general goal is to help the person achieve a minimum healthy weight. Another priority is to
correct any problems with body fluids and salts.
• Anorexia nervosa is usually treated with amultidisciplinary team includes:

Educational, Supportive psychotherapy , Nutritional counseling , Cognitive behavior

therapy & Family therapy.

Bulimia Nervosa

o Definition & Epidemiology

• Bulimia Nervosa, is an eating disorder characterized by binge eating followed by purging.

Binge eating :eating a large amount of food in a short time.

Purging :the attempts to get rid of the food consumed.

Female>male

More common in Western countries.

o Etiology:

• Genetic: MZ : DZ = 22% : 9%

• Familial: high rates of psychiatric disturbance, e.g. depression.

• Biochemical: Disordered 5-HT system, Dopamine abnormalities.

• Psychological: higher rates of depression, alcohol abuse, personality disorders & in

physically abused sufferers.

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 Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry

o DSM-5 criteria, to be diagnosed as having Bulimia Nervosa a person must display:

• Recurrent episodes of binge eating. An episode of binge eating is characterised by both of

the following:

• Eating, in a discrete period of time (e.g. within any 2-hour period), an amount of food that is
definitely larger than most people would eat during a similar period of time and under similar
circumstances.

• A sense of lack of control over eating during the episode (e.g. a feeling that one cannot stop
eating or control what or how much one is eating).
Purging
• Recurrent inappropriate compensatory behaviour in order 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.

Management:

• Treating physical complications caused by bulimia

• Identifying and treat any associated mental health disorders such as depression or anxiety

• Encouraging and developing family support

• Nutritional counseling .
• Cognitive behavior therapy.

• SSRIs and other antidepressants have been shown to be helpful.

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 Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry

Binge Eating Disorder

• Binge Eating Disorder is less common but much more severe than overeating.

• Defined as: A recurrent episodes of binge eating. An episode of binge eating is

characterised by both of the following:

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

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

• Binge eating not associated with the recurrent use of inappropriate compensatory
behaviours as in Bulimia Nervosa and does not occur exclusively during the course of
Bulimia Nervosa, or Anorexia Nervosa methods to compensate for overeating, such as self-
induced vomiting.

o Management:

• cognitive behavioral therapy (CBT).

• Antidepressants, primarily selective serotonin reuptake inhibitors (SSRIs), may be helpful in

reducing frequency of binges as well as eating related obsessions.

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 Dr. Noor Alhuda Adnan Al Ghuraibawi
Department of Medicine / Division of Psychiatry

Pica

o Pica is a disorder characterized by individuals consuming non-nutritive substances such as

chalk, clay, dirt, paper, ice, cornstarch, and other non-nutritive substances. To be
diagnosed, the behavior:

§ Must be age inappropriate.

§ Occurs for at least one month.

§ Fall outside of any cultural norms.

§ More common in children and also occur during pregnancy

o Management:

• Assessment of mineral or nutrient deficiencies and correcting them.

• Cognitive behavior therapy.