Eating Disorders

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1. Criteria (Pica) Criteria:

A): Persistent eating of nonnutritive, nonfood sub-
stances over a period of at least 1 month
B): The eating is inappropriate to the development level
of the individual (a minimum of 2 years of age is sug-
gested as developmentally inappropriate).
C): The eating behavior is not part of a culturally or
socially normative practice
D: If the eating behavior occurs in the context of another
mental disorder or AMC, it is sufficiently severe to war-
rant additional clinical attention.

**specify if in remission

2. Length of Criteria -Sxs must be present for at least 1 month

Necessary for Diag-
nosis (Pica)

3. Rule Out (Pica) -Anorexia Nervosa

-Factitious Disorder
-Non-suicidal self-injury and non-suicidal self-injury be-
haviors in PDs

4. Comorbidity (Pica) -Autism Spectrum

-Intellectual Disability
-Schizophrenia
-OCD
-Trichotillomania and excoriation

5. Prevalence (Pica) -Unclear; however, among those with intellectual dis-

ability, the prevalence appears to increase with the
severity of the condition

6. Cultural Considera- -This eating behavior in some cultures is believed to be

tions (Pica) of spiritual or medicinal and thus it is socially normative
(do not give diagnosis)

7. Gender Considera- -Occurs equally in both males and females

tions (Pica)

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8. Development and -Childhood is most common onset, but it can occur in
Course (Pica) adolescence or adulthood as well (most adult cases
occur in those with intellectual disabilities)
-Course can be protracted and can result in medical
emergencies

9. Risk Factors (Pica) -Neglect, lack of supervision, and developmental delay

can increase risk for diagnosis

10. Other Notes (Pica) -May occur during pregnancy with specific cravings
-Can be fatal depending on the substances that are
ingested
-Often occurs with other dxs associated with impaired
social functioning

11. Criteria (Rumina- Criteria:

tion Disorder) A): Repeated regurgitation of food over a period of
at least 1 month (should occur at least several times
per week, typically daily). Regurgitated food may be
re-chewed, re-swallowed, or spit out.
B): The repeated regurgitation is not attributable to an
associated gastrointestinal or other medical condition
C): The eating disturbance does not occur exclusively
during the course of AN, BN, BED, or Avoidant/Restric-
tive Food Intake Disorder
D): If sxs occur in the context of another mental disorder
or neurodevelopmental disorder, they are sufficiently
severe to warrant additional clinical attention

**specify if in remission

12. Length of Time for -Symptoms must occur for at least 1 month
(Rumination Disor- -Should occur at least several times per week , typically
der) daily

13. Rule Out (Rumina- -Gastrointestinal conditions****

tion Disorder) -Anorexia Nervosa
-Bulimia Nervosa

14.
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Comorbidity (Ru- -This behavior can occur in the context of a concurrent
mination Disorder) medical or mental condition

15. Prevalence Rates -Inconclusive, but is commonly higher in individuals with

(Rumination Disor- intellectual disability
der)

16. Development and -Can occur in infancy, childhood, adolescence, or adult-

Course (Rumina- hood (in infants, onset is usually between 3 and 12
tion Disorder) months)
-Can be protracted and can result in medical emer-
gencies (severe malnutrition); can also be episodic or
continuous until treated
-In infants, it frequently remits spontaneously

17. Risk Factors (Rumi- -Psychosocial problems (lack of stimulation, neglect,

nation Disorder) stressful life situations, and parent-child relationship
problems) can be predisposing factors in children

18. Other Notes (Rumi- -Can be fatal (esp. in infancy)

nation Disorder) -Can cause malnutrition (growth delays/developmental
delays)

19. Criteria A): An eating or feeding disturbance (apparent lack

(Avoidant/Restric- of interest in eating or food; avoidance based on the
tive Food Intake sensory characteristics of food; concern over aversive
Disorder) consequences of eating) as manifested by persistent
failure to meet appropriate nutritional and/or energy
needs associated with 1 of the following:
1. Significant weight loss
2. Significant nutritional deficiency
3. Dependence on enteral feeding or oral nutritional
supplements
4. Marked interference with psychosocial functioning

B): The disturbance is not better explained by lack of

available food or by an associated culturally sanctioned
practice

C):The disturbance doesn't occur exclusively during the

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course of AN or BN, and there is no evidence of a
disturbance in the way in which one's body weight or
shape is experienced

D): The eating disturbance is not attributable to a con-

current medical condition or not better explained by
another mental disorder

20. Rule out -Anorexia Nervosa

(Avoidant/Restric- -Other AMC
tive Food Intake -Specific neurological dxs associated with feeding diffi-
Disorder) culties
-Reactive attachment disorder
-Autism Spectrum Disorder
-Specific phobia, SAD, or another anxiety dx
-OCD
-MDD
-Schizophrenia spectrum dx
-Factitious disorder

21. Comorbidity -Anxiety Disorders

(Avoidant/Restric- -OCD
tive Food Intake -Neurodevelopmental dx (esp. autism, ADHD, ID)
Disorder)

22. Cultural Considera- -Appears to occur in various populations; dx should not

tions (Avoidant/Re- be given if avoidance of food is solely related to specific
strictive Food In- religious or cultural practices
take Disorder)

23. Gender Considera- -Occurs equally among M and F

tions (Avoidant/Re-
strictive Food In-
take Disorder)

24. Development and -Onset in infancy or early childhood (may persist into
Course adulthood)
(Avoidant/Restric-
tive Food Intake
Disorder)
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25. Risk Fac- - Parent-child interaction

tors (Avoidant/Re- - Anxiety dxs, autism, OCD, ADHD may increase risk
strictive Food In- - Family anxiety (may occur in children with mothers with
take Disorder) eating dxs)

26. Criteria (Anorexia A): Restriction of energy intake relative to requirements,

Nervosa) leading to significantly low body weight in the context of
age, sex, developmental trajectory, and physical health

B): Intense fear of gaining weight or of becoming fat,

or persistent behavior that interferes with weight gain,
even though at a significantly low weight

C): 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 recog-
nition of the seriousness of the current low body weight.

**Specify whether: restricting type or binge-eating/purg-

ing type
**Specify if: in partial remission or in full remission
**Specify Severity

27. Severity levels Mild: BMI >/= 17kg/m

(Anorexia Nervosa) Moderate: BMI 16-16.99 kg/m
Severe: BMI 15-15.99 kg/m
Extreme: BMI <15 kg/m

28. Rule Out (Anorexia -Psychosis/Delusions

Nervosa) -AMC (GI, Hyperthyroidism, AIDS)
-MDD
-Schizophrenia
-SUD
-SAD
-OCD
-BDD
-BN
-Avoidant/restrictive food intake disorder

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29. Comorbidity -Bipolar
(Anorexia Nervosa) -MDD
-Anxiety disorders (OCD)
-Substance use

30. Prevalence Rates -12 months for female is .4%

(Anorexia Nervosa)

31. Gender Consider- -10:1 (F:M) ratio

ations (Anorexia -5-10x more common in females, higher rates in homo-
Nervosa) sexual males

32. Cultural Consider- -Most prevalent in post-industrialized, high-income

ations (Anorexia countries
Nervosa)

33. Development Adolescence or young adulthood (rarely begins before

(Anorexia Nervosa) puberty or after age 40)

34. Course (Anorexia - Highly variable duration; older individuals more like-
Nervosa) ly to have longer duration and may have more sxs
of long-standing dx; many people have a period of
changed eating behavior prior to meeting full criteria;
some recover after a single episode, and other have a
chronic course

- Hospitalization may be required to restore weight and

address medical complications; most experience remis-
sion within 5 years; Mortality rate is 5% per decade

35. Risk Factors -Children with anxiety dxs or OC traits are at increased
(Anorexia Nervosa) risk
-"Thin Idea"
-28-84% heritability rates (55% MZ)

36. Other Notes -Individuals with AN rarely complain of weight loss

(Anorexia Nervosa) -Physiological disturbances (amenorrhea, vital sign ab-
normalities, loss of bone density, hormonal maturity, CV
problems, poor dentition, GI problems)
-Poor prognosis with later onset, poor parent relation-
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ships, longer illness duration, BN sxs, obsessions, de-
pression
-Good prognosis with early onset and healthy family
-Suicide risk (12 per 100,000 each year)

37. Criteria (Bulimia A): Recurrent episodes of binge eating. An episode of

Nervosa) binge eating is characterized by both of the following:
1. Eating in a discrete period of time (within any two
hours), an amount of food that is definitely larger than
what most individuals would eat in a similar period of
time under similar circumstances.
2. A sense of lack of control over eating during the
episode (a feeling that one cannot stop eating or control
what/how much they eat)

B): Recurrent inappropriate compensatory behaviors

in order to prevent weight gain, such as self-induced
vomiting, misuse of laxatives, diuretics, or other med-
ications, fasting, or excessive exercise

C): The binge eating and inappropriate compensatory

behaviors both occur, on average, at least once a week
for 3 months

D): Self-evaluation is unduly influenced by body shape

and weight

E): The disturbance does not occur exclusively during

episodes of AN

**Specify if: In partial remission, or in full remission

**Specify Current Severity: Mild, Moderate, Severe, Ex-
treme

38. Severity (Bulimia -Mild: 1-3 episodes/week

Nervosa) -Moderate: 4-7 episodes/week
-Severe: 8-13 episodes/week
-Extreme: 14+ episodes/week

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39. Duration of sxs for -at least one episode once a week for 3 months
Diagnosis (Bulimia
Nervosa)

40. Rule Out (Bulimia -AN, binge-eating/purging type

Nervosa) -Binge-eating disorder
-Kleine-Levin Syndrome
-MDD with atypical features
-Borderline PD

41. Comorbidity (Bu- -Depression

limia Nervosa) -Anxiety Disorders (During BN course)
-Borderline PD
-Substance use

42. Prevalence Rates -LHM says 1-3%

(Bulimia Nervosa) -12 months for females is 1-1.5%
-10:1 ratio (F:M)

43. Cultural Considera- -occurs with similar frequencies in most industrialized

tions (Bulimia Ner- nations
vosa)

44. Gender Considera- - 10:1 ratio (Females to males)

tions (Bulimia Ner-
vosa)

45. Onset (Bulimia Ner- -Puberty/early adulthood; peaks in older adolescence

vosa) and young adulthood; onset before puberty or after age
40 is uncommon; the binge eating often begins during
or after a diet

46. Course (Bulimia -Persists for at least several years in high % of cases;
Nervosa) may be chronic or intermittent with periods of remission
alternating with binge episodes

47. Recovery (Bulimia -Sxs may diminish without treatment; periods of re-
Nervosa) mission longer than 1 year are associated with better
long-term outcome

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48. Risk Factors (Bu- -54-83% heritable
limia Nervosa) -Experiencing multiple stressful life events can precipi-
tate onset
-Weight concerns, low self-esteem, depressive sxs,
SAD = increased risk
-Childhood obesity and early pubertal maturation in-
crease risk
-Severity of psychiatric comorbidity predicts worse
long-term outcome

49. Other Notes (Bu-
limia Nervosa)
-Those with BN are typically ashamed of their eating
problems and attempt to conceal their sxs
-The most common antecedent of binge eating is neg-
ative affect
-They are typically within normal weight or overweight
BMI
-Personality and clinical features = impulsivity, novelty
seeking, immaturity, self-harm and risk taking behaviors
(SUD, self-injury)
-Hx of AN is not uncommon, but those with BN have
more insight than AN
Crossover with AN is 10-15%

50. Criteria (Binge-Eat- A): Recurrent episodes of binge eating. An episode of

ing Disorder) binge eating is characterized by both of the following:
1. EAting, in a discrete period of time (with in any 2 hour
period) and amount of food that is definitely larger than
what most people would eat in a similar period of time
under similar circumstances
2. A sense of lack of control over eating during the
episode

B): The binge-eating episodes are associated with 3 or

more of the following:
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when not feeling physi-
cally hungry
4. Eating alone because of feeling embarrassed by how

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much one is eating
5. Feeling disgusted with oneself, depressed, or very
guilty afterward

C): Marked distress regarding binge eating is present

D): The binge eating occurs, on average, at least once

a week for three months

E): The binge eating is not associated with the recurrent

use of inappropriate compensatory behavior as in BN
and does not occur exclusively during the course of AN
or BN

**Specify if: in partial remission or in full remission

**Specify Severity: Mild, Moderate, Severe, Extreme

51. Symptom Severity -Mild: 1-3 episodes per week

(Binge-Eating Dis- -Moderate: 4-7 episodes per week
order) -Severe: 8-13 episodes per week
-Extreme: 14+ episodes per week

52. Duration of Symp- -Sxs must occur at least once a week for 3 months
toms for Diagnosis
(Binge-Eating Dis-
order)

53. Rule Out -BN

(Binge-Eating Dis- -Obesity
order) -Bipolar and depressive dxs
-Borderline PD

54. Comorbidity -Depression

(Binge-Eating -Alcohol use
Disorder) -Histrionic PD
-Borderline PD
-Avoidant PD

55. -12 month prevalence of BED among US adult is 1.6%

for females and .8% for males
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Prevalence Rates -It is more prevalent among individuals seeking
(Binge-Eating Dis- weight-loss treatment than in the general population
order)

56. Cultural Considera- -Occurs with roughly similar frequencies among indus-
tions (Binge-Eating trialized countries
Disorder)

57. Gender Considera- -1:2 (M:F ratio)

tions (Binge-Eating
Disorder)

58. Onset (Binge-Eat- -Unclear age of onset, but typically begins in adoles-
ing Disorder) cence or young adulthood

59. Course (Binge-Eat- -BED appears to be persistent with a course compara-

ing Disorder) ble to BN

60. Recovery -Remission rates in both natural course and treatment

(Binge-Eating outcome studies are higher for BED than for BN or AN
Disorder)

61. Risk Factors Appears to run in families

(Binge-Eating Dis-
order)

62. Other Notes -Occurs in normal-weight, overweight, and obese indi-

(Binge-Eating Dis- viduals
order) -Common in adolescents and college-age samples
-Uncommon crossover with AN or BN

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