FEEDING AND EATING DISORDERS-

Feeding and eating disorders are characterized by a persistent disturbance of eating or

eating-related behavior that results in the altered consumption or absorption of food and that
significantly impairs physical health or psychosocial functioning.
FOLLOWING ARE ITS TYPES/ CATEGORIES-

PICA-

The DSM-5 lists the following symptoms for individuals with PICA disorder:

1. Persistent eating of nonnutritive substances: The primary symptom of PICA disorder

is the persistent consumption of non-food substances. This behavior must persist for at
least one month to meet the diagnostic criteria.

2. Inappropriate consumption behavior: The individual's eating behavior is considered

inappropriate to their developmental level. For example, an adult eating dirt or hair would
be considered inappropriate.

3. Not a culturally sanctioned behavior: The individual's behavior is not a part of a

culturally sanctioned or socially normative practice.

4. Severe enough to require clinical attention: If the behavior occurs in the context of
another mental disorder (e.g. intellectual disability, autism spectrum disorder), it is
sufficiently severe to warrant additional clinical attention.

5. Not due to a medical condition: The eating behavior is not attributable to a medical
condition, such as pregnancy or a gastrointestinal condition.

6. Not better explained by another mental disorder: The eating behavior is not better
explained by another mental disorder, such as obsessive-compulsive disorder, where
the ingestion of non-food substances is better accounted for.

Here are the DSM-5 criteria for Pica disorder:

A. Persistent eating of non-nutritive substances for a period of at least one month. The eating of
non-nutritive substances must be inappropriate to the developmental level of the individual and not a
part of a culturally sanctioned practice.

B. The eating behavior is not part of a socially normative cultural or religious practice.
C. The eating behavior is not better explained by the presence of another mental disorder, such as
autism spectrum disorder, schizophrenia, or another psychotic disorder.

D. If the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability), it
is severe enough to warrant additional clinical attention.

SYMPTOMS-

Symptoms of pica occur as a result of the toxic or poisonous content as well as the bacteria in
nonfood items that are ingested. The symptoms may include:

​ Nausea
​ Pain or abdominal cramping in the stomach
​ Constipation
​ Diarrhea
​ Fatigue
​ Behavior problems
​ School problems

Most people with pica eat regular nutrient-filled foods in addition to ingesting nonfood
items. But in many instances, those who are affected by pica are nutritionally malnourished.

AETIOLOGY -

1. Nutritional deficiencies: PICA disorder has been linked to certain nutrient deficiencies,
particularly iron-deficiency anemia. This is because individuals with iron-deficiency
anemia may experience cravings for non-food items that contain iron, such as clay or
dirt. Similarly, pregnant women with PICA disorder may crave non-food items as a result
of nutrient deficiencies.

2. Developmental factors: PICA disorder is more common in children, especially those

with developmental disorders such as autism spectrum disorder or intellectual disability.
Some experts believe that individuals with developmental disorders may eat non-food
items as a form of self-stimulatory behavior or to gain sensory input.

3. Psychological factors: PICA disorder has been associated with certain psychological
disorders, such as schizophrenia and obsessive-compulsive disorder. In these cases,
the behavior may be a way of coping with anxiety or other psychological distress.
4. Cultural factors: PICA disorder is more prevalent in certain cultures, particularly those
in which the consumption of non-food items is a socially accepted practice. For example,
geophagy (the consumption of earth or clay) is a common practice in certain African and
South American cultures.

5. Environmental factors: Exposure to certain environmental toxins or substances, such

as lead or mercury, can trigger PICA disorder. This is because these substances can
cause cognitive impairments or changes in behavior that may lead to the consumption of
non-food items.

6. Genetic factors: There may be a genetic component to PICA disorder, as it appears to

run in families. However, the specific genes involved have not yet been identified.

Overall, the development of PICA disorder is likely to be complex and multifactorial, with
genetic, biological, psychological, and environmental factors all playing a role. Effective
treatment of PICA disorder requires identifying and addressing the underlying causes of
the behavior, which may include nutritional deficiencies, psychological disorders, and
environmental factors.

PROGNOSIS-

Pica disorder treatment may be successful, but it varies quite a bit depending on the
underlying causes and any related factors. In kids, pica usually improves as they grow up.
But for those with mental illness or developmental disorders, it commonly continues into
the teenage years or even into adulthood.

Pica treatment has been found to be more successful in children who have undergone a
medical assessment and behavioral evaluation by a mental health or medical professional.
Behavioral assessments help to identify and treat associated problem behaviors, such as
aggression.

EPIDEMIOLOGY-

PICA disorder is a relatively rare condition, and the exact prevalence is difficult to determine
due to the lack of large-scale epidemiological studies. However, the disorder is more
commonly seen in certain populations, including:

1. Children and adolescents: PICA disorder is more commonly diagnosed in children and
adolescents than in adults.
2. Individuals with developmental disabilities: Individuals with developmental disabilities,
such as autism spectrum disorder or intellectual disability, are at an increased risk for
developing PICA disorder.

3. Pregnant women: Pregnant women may experience cravings for non-food items, such as
dirt or clay, which can lead to PICA disorder.

4. Certain cultures and communities: Some cultural or ethnic groups may engage in the
consumption of non-food items as a traditional practice or as a response to food scarcity.

5. Institutionalized individuals: Individuals who are institutionalized, such as those in

correctional facilities or nursing homes, may engage in PICA behavior due to environmental
factors such as boredom or lack of stimulation.

Overall, the prevalence of PICA disorder is thought to be relatively low, but it can have
serious consequences for both physical and mental health.

Rumination Disorder-
DIAGNOSTIC CRITERIA as per DSM-5-
The DSM-5 diagnostic criteria for rumination disorder are:

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

B. The behavior is not attributable to a medical condition, such as gastrointestinal reflux

or another gastrointestinal disorder.

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

D. The behavior is not due to a co-occurring mental disorder, such as a generalized

anxiety disorder, panic disorder, or obsessive-compulsive disorder.

E. The behavior is not due to medication or substance use.

F. The behavior causes significant distress or impairment in social, academic, or

occupational functioning.

G. The onset of the behavior can occur at any age, but it typically begins in infancy or
early childhood.
AETIOLOGY-
Rumination disorder is a rare eating disorder that is characterized by the repeated
regurgitation and re-chewing of food after it has been swallowed. While the exact
etiology of rumination disorder is not well understood, several factors have been
proposed to contribute to its development.

1. Early learning: Rumination disorder may be a learned behavior that develops in

infancy or early childhood. Infants may begin regurgitating food as a self-soothing
mechanism, and if this behavior is reinforced by caregivers, it may become a habitual
behavior.

2. Psychological factors: Psychological factors, such as anxiety or stress, may contribute

to the development or maintenance of rumination disorder. Individuals with rumination
disorder may use regurgitation as a coping mechanism to manage their emotional
distress. Studies have also shown that individuals with rumination disorder may have
higher levels of anxiety and depression than individuals without the disorder.

3. Gastrointestinal factors: Some studies have suggested that individuals with rumination
disorder may have abnormalities in the muscles or nerves of the gastrointestinal tract
that make it easier for them to regurgitate food. For example, some individuals may have
weak lower esophageal sphincters, which can lead to acid reflux and the regurgitation of
food.

4. Medical conditions: Some medical conditions, such as gastroesophageal reflux

disease (GERD) or a hiatal hernia, may contribute to the development of rumination
disorder. These conditions can cause discomfort or pain in the digestive system, which
may lead to the development of rumination disorder as a way to cope with these
symptoms.

5. Neurological factors: There is some evidence to suggest that neurological factors,

such as damage to the vagus nerve or abnormalities in brain chemistry, may contribute
to the development of rumination disorder. Research has shown that individuals with
rumination disorder have altered levels of neurotransmitters such as dopamine and
serotonin, which play a role in the regulation of mood and behavior.

Overall, the development of rumination disorder is likely due to a combination of genetic,

environmental, and psychological factors. Treatment for the disorder typically involves a
combination of medical management to address any underlying medical conditions and
psychological interventions, such as cognitive-behavioral therapy, to address any
psychological factors that may be contributing to the behavior.

EPIDEMIOLOGY-
The prevalence of rumination disorder in the general population is not well established. However, it is
more commonly observed in infancy and early childhood, with an estimated prevalence of 6-10%
among infants and young children. In this age group, rumination disorder is more common in males
than females.
In adults, rumination disorder is rare, with a prevalence estimated to be less than 1%. It is more
commonly observed in individuals with intellectual disabilities or developmental disorders, such as
autism spectrum disorder.It is most commonly observed in low-income families, and is more common
in individuals with developmental disabilities or intellectual disabilities.

PROGNOSIS-
The prognosis for rumination disorder can vary depending on several factors, including the severity of
symptoms, the age at onset, and the presence of comorbid conditions. In general, early diagnosis and
intervention can lead to better outcomes.
With appropriate treatment, many individuals with rumination disorder are able to achieve complete
remission of symptoms. However, in some cases, the disorder may persist for several years or even
into adulthood.
If left untreated, rumination disorder can lead to a range of complications, including malnutrition,
dehydration, dental problems, and social isolation. It can also have a significant impact on an
individual's quality of life and may interfere with their ability to engage in social, educational, or
occupational activities.
Overall, the prognosis for rumination disorder is generally good with early diagnosis and appropriate
treatment. It is important for affected individuals to receive comprehensive care that addresses the
underlying causes of the disorder, as well as any associated medical or psychological issues.

Avoidant/Restrictive Food Intake Disorder

The diagnostic criteria for Avoidant/Restrictive Food Intake Disorder (ARFID) as per DSM-5 are as
follows:

A. An eating or feeding disturbance (e.g., apparent lack of interest in eating or 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:

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

D. The eating disturbance is not due to a disturbance in the sense of taste or smell.

E. The eating disturbance is not better explained by avoidant/restrictive food intake associated with
another mental disorder, such as anorexia nervosa, bulimia nervosa, or avoidant/restrictive food intake
disorder.

Note: ARFID was previously known as "Selective Eating Disorder" and was included in the DSM-IV-TR as
a subtype of Feeding Disorder of Infancy or Early Childhood. The DSM-5 expanded the diagnosis to
include individuals of all ages and removed the requirement that the disorder must have onset in
childhood.

AETIOLOGY-
The etiology of Avoidant/Restrictive Food Intake Disorder (ARFID) is not well understood and is likely to
be complex, involving multiple factors such as biological, psychological, and environmental factors.
Here is a more detailed explanation of some of the possible factors that may contribute to the
development of ARFID:

1. Sensory issues: Some individuals with ARFID may have sensory processing difficulties, such as
hypersensitivity to certain textures, tastes, smells, or colors of food. These individuals may avoid
certain foods because they find them aversive or overwhelming.

2. Medical conditions: ARFID can develop as a result of medical conditions, such as gastrointestinal
problems, food allergies, or chronic pain, that make eating difficult or uncomfortable. In some cases,
the fear of experiencing adverse symptoms may lead individuals to avoid certain foods altogether.

3. Developmental issues: ARFID can also develop as a result of developmental issues, such as delayed
oral-motor development, that make eating difficult or uncomfortable. Additionally, some children with
developmental disorders, such as autism spectrum disorder, may have a limited range of preferred
foods due to sensory or behavioral issues.

4. Psychological factors: Psychological factors, such as anxiety, depression, trauma, or

obsessive-compulsive tendencies, can also contribute to the development of ARFID. For example,
individuals with anxiety may avoid certain foods due to fears of choking or vomiting, while those with
depression may lose their appetite or interest in food.

5. Family and cultural influences: Family and cultural influences can also play a role in the development
of ARFID. For example, parents who are overly concerned about their child's weight or nutrition may
inadvertently encourage selective eating behaviors. Similarly, cultural norms and beliefs about food
may limit an individual's willingness to try new or unfamiliar foods.

It is important to note that the etiology of ARFID may be different for each individual, and in many
cases, multiple factors may be involved.

EPIDEMIOLOGY-

The epidemiology of Avoidant/Restrictive Food Intake Disorder (ARFID) is not well-established, as it is a

relatively new diagnostic category that was added to the DSM-5 in 2013. However, some studies have
suggested that ARFID is more common than previously recognized, particularly among children and
adolescents.

A population-based study of nearly 1,000 children and adolescents aged 8 to 17 years found that the
prevalence of ARFID was 3.2%, which was higher than the prevalence of anorexia nervosa (0.5%) and
bulimia nervosa (0.2%). Another study of over 1,300 children and adolescents found that 21% of those
referred to a feeding clinic met criteria for ARFID, with higher rates among younger children.

ARFID has been found to occur more frequently in males than females, and is more common in children
and adolescents than in adults. It is also more prevalent in individuals with developmental disorders,
such as autism spectrum disorder, than in the general population.

ARFID is associated with significant impairment in social, academic, and occupational functioning, as
well as with medical complications such as nutritional deficiencies and weight loss. Early identification
and intervention for ARFID may help to improve outcomes and prevent the development of more severe
eating disorders.

PROGNOSIS-

The prognosis for Avoidant/Restrictive Food Intake Disorder (ARFID) can vary depending on the
severity of the disorder, the age of onset, and the presence of comorbid conditions. Generally, early
identification and intervention are associated with better outcomes.

Research on the natural course of ARFID is limited, but some studies have suggested that the majority
of individuals with ARFID recover within a few months to a year of onset, particularly if the disorder is
identified and treated early. However, some individuals may continue to struggle with ARFID for longer
periods of time, and some may go on to develop other eating disorders.
Individuals with ARFID may be at increased risk for medical complications, such as malnutrition,
dehydration, and gastrointestinal problems. These complications can have long-term consequences,
particularly in cases of chronic or severe ARFID.

The presence of comorbid conditions, such as anxiety disorders or autism spectrum disorder, may also
affect the prognosis for ARFID. Treatment may need to be tailored to address both the eating disorder
and the underlying condition.

Environmental- Environmental risk factors for avoidant/restrictive food intake disorder include familial
anxiety. Higher rates of feeding disturbances may occur in children of mothers with eating disorders.

Genetic and physiological- History of gastrointestinal conditions, gastroesophageal reflux disease,

vomiting, and a range of other medical problems has been associated with feeding and eating
behaviors characteristic of avoidant/restrictive food intake disorder.

Overall, early identification and intervention for ARFID are important for improving prognosis and
preventing the development of more severe eating disorders. Treatment may involve a multidisciplinary
team approach, including medical management, nutritional counseling, and psychotherapy.

Anorexia Nervosa
The diagnostic criteria for Anorexia Nervosa (AN) as per the DSM-5 are:

A. Restriction of energy intake relative to requirements, leading to a 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.

B. Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight
gain, even though the individual is underweight.

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 recognition of the seriousness of the current
low body weight.

The severity of AN is based on the current body mass index (BMI) and is classified as follows:

Mild: BMI of 17.0 to 18.49 kg/m2

Moderate: BMI of 16.0 to 16.99 kg/m2

Severe: BMI of 15.0 to 15.99 kg/m2

Extreme: BMI less than 15.0 kg/m2

(just extra add-ons)
Anorexia Nervosa (AN) is an eating disorder characterized by restriction of food intake leading to
significantly low body weight, intense fear of gaining weight or becoming fat, and disturbance in the
way one's body weight or shape is experienced. Some common symptoms of AN include:

1. Significant weight loss: Individuals with AN usually have a significantly low body weight, which may
be less than what is considered healthy for their age, height, and sex.

2. Restriction of food intake: People with AN tend to limit their food intake, often by severely restricting
the types or amount of food they eat. This restriction may lead to malnutrition and other health
problems.

3. Distorted body image: People with AN often have a distorted perception of their body shape and
weight, and may see themselves as overweight even when they are underweight.

4. Intense fear of weight gain: Individuals with AN have an intense fear of gaining weight or becoming
fat. This fear may be irrational and may persist even when they are underweight.

5. Preoccupation with food and weight: People with AN may spend a lot of time thinking about food
and weight, and may have rigid rules around what they can and cannot eat.

6. Perfectionism: Individuals with AN may have a tendency toward perfectionism, and may feel that
they need to be in control of their food intake and weight to feel successful.

7. Physical symptoms: AN can lead to a range of physical symptoms, including fatigue, weakness,
dizziness, and constipation, among others.

It is important to note that not all individuals with AN will exhibit all of these symptoms, and the severity
of the symptoms may vary from person to person.

Aetiology-
The etiology of anorexia nervosa (AN) is complex -

1. Genetics: There is evidence to suggest that AN has a genetic component. Twin studies have found
that there is a higher concordance rate for AN in monozygotic (identical) twins compared to dizygotic
(fraternal) twins. Several candidate genes have been identified that may be associated with AN,
including genes involved in the regulation of appetite, weight, and mood.

2. Neurobiology: There are several neurobiological factors that have been implicated in the
development of AN, including alterations in serotonin and dopamine neurotransmitter systems,
changes in brain structure and function, and disturbances in the hypothalamic-pituitary-adrenal (HPA)
axis.
3. Psychological factors: Psychological factors such as low self-esteem, perfectionism, and a tendency
towards obsessive and compulsive behavior are commonly associated with AN. Individuals with AN
may use their disordered eating behaviors as a way to cope with negative emotions and feelings of
anxiety or depression.

4. Sociocultural factors: Sociocultural factors such as the idealization of thinness and beauty in
Western culture, as well as pressure to conform to societal expectations of femininity, can contribute to
the development of AN. In addition, exposure to critical comments about weight or appearance from
family members, peers, or the media may contribute to body dissatisfaction and disordered eating
behaviors.

5. Life events and stress: Traumatic life events such as abuse, neglect, or bullying may increase the risk
of developing AN. Stressful life events such as divorce, bereavement, or academic pressure may also
contribute to the onset of AN.

It is important to note that while these factors have been identified as potential contributors to the
development of AN, the exact etiology of the disorder remains unclear and is likely to be multifactorial.

EPIDEMIOLOGY-
Anorexia nervosa (AN) is a relatively rare disorder, with a prevalence estimated to be around 0.3-1%
among adolescent and young adult women, and 0.1% among men. Here are some key epidemiological
factors associated with AN:

1. Age and gender: AN typically develops during adolescence or young adulthood, with the majority of
cases occurring between the ages of 15 and 19. AN is much more common in females than males, with
a male-to-female ratio estimated to be around 1:10.

2. Socioeconomic status: AN is more commonly diagnosed in individuals from higher socioeconomic

backgrounds.

3. Cultural factors: AN is more common in Western cultures where there is an emphasis on thinness,
and in populations that are exposed to Western cultural influences.

4. Co-occurring mental health conditions: AN is frequently diagnosed alongside other mental health
conditions, such as depression, anxiety disorders, and substance use disorders.

5. Mortality: AN has the highest mortality rate of any psychiatric disorder, with an estimated 5-10% of
individuals with AN dying as a result of the disorder.

It is important to note that the exact prevalence and incidence rates of AN may be underestimated, as
many individuals with AN may not seek treatment or may be misdiagnosed. Additionally, while AN is
more commonly diagnosed in females, it is increasingly recognized as a significant health concern for
males as well.

PROGNOSIS-
The prognosis for anorexia nervosa (AN) can vary depending on the severity of the illness and the
individual's response to treatment. AN is a serious and potentially life-threatening disorder, and early
intervention is critical for improving outcomes. Here are some key factors that can impact the
prognosis for AN:

1. Age at onset: Individuals who develop AN at a younger age may have a better prognosis than those
who develop the disorder later in life.

2. Duration of illness: The longer an individual has had AN, the more difficult it may be to achieve full
recovery.

3. Severity of illness: Individuals with severe AN, as indicated by low body weight, medical
complications, or psychiatric comorbidities, may have a poorer prognosis than those with less severe
forms of the disorder.

4. Treatment history: Individuals who have received previous treatment for AN may have a better
prognosis if they have responded well to treatment and are able to maintain recovery.

5. Social support: A strong support system, including family, friends, and healthcare professionals, can
improve the prognosis for AN by providing encouragement, motivation, and accountability.

6.Genetic and physiological- There is an increased risk of anorexia nervosa and bulimia nervosa among
first-degree biological relatives of individuals with the disorder. An increased risk of bipolar and
depressive disorders has also been found among first-degree relatives of individuals with anorexia
nervosa, particularly relatives of individuals with the binge-eating/purging type. Concordance rates for
anorexia nervosa in monozygotic twins are significantly higher than those for dizygotic twins.

While full recovery from AN is possible, many individuals experience a chronic and relapsing course of
the disorder. Long-term complications of AN can include osteoporosis, heart damage, gastrointestinal
problems, and reproductive issues. Early intervention, ongoing monitoring, and maintenance of healthy
behaviors and attitudes towards food and weight are important for improving the long-term prognosis
for AN.

Bulimia Nervosa-
The DSM-5 criteria for Bulimia Nervosa include the following:

A. Recurrent episodes of binge eating characterized by both of the following:

1. Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is 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 (e.g., a feeling that one cannot stop eating
or control what or how much one is eating).

B. Recurrent inappropriate compensatory behavior to prevent weight gain, such as self-induced

vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.

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

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

E. The disturbance does not occur exclusively during episodes of Anorexia Nervosa.

AETIOLOGY-
The etiology of bulimia nervosa is complex and multifactorial, involving a combination of genetic,
psychological, and environmental factors. Here are some key factors that are associated with the
development of bulimia nervosa:

1. Genetic factors: Studies suggest that genetic factors may play a role in the development of bulimia
nervosa. Twin and family studies have shown that the risk of developing bulimia nervosa is higher
among first-degree relatives of individuals with the disorder.

2. Psychological factors: Psychological factors, such as low self-esteem, perfectionism, and negative
body image, are strongly associated with the development of bulimia nervosa. Individuals with bulimia
nervosa often have distorted beliefs about their weight, shape, and eating habits.

3. Environmental factors: Environmental factors, such as childhood trauma, sexual abuse, and family
dysfunction, have been implicated in the development of bulimia nervosa. Cultural factors, such as
societal pressures to be thin, can also contribute to the development of the disorder.

4. Neurobiological factors: Neurobiological factors, such as abnormalities in the serotonin and

dopamine systems, have been associated with the development of bulimia nervosa. These
abnormalities may contribute to the compulsive binge eating and purging behaviors seen in the
disorder.

5. Dietary factors: Certain dietary patterns, such as chronic dieting and restrictive eating, have been
associated with the development of bulimia nervosa. These patterns may lead to a loss of control over
eating and a cycle of binge eating and purging.

It is important to note that the development of bulimia nervosa is likely due to a combination of these
factors, and the exact etiology of the disorder is still not fully understood.
Epidemiology-
Bulimia nervosa is a relatively common eating disorder, with a prevalence of approximately 1-2% in
women and 0.1% in men in the general population. Here are some key epidemiological factors
associated with bulimia nervosa:

1. Age and gender: Bulimia nervosa most commonly develops in adolescence or early adulthood, with
onset typically occurring between the ages of 15 and 25. The disorder is more common in women than
in men, with a female-to-male ratio of approximately 10:1.

2. Socioeconomic status: Bulimia nervosa is more common in higher socioeconomic groups, although
it can occur in individuals from all socioeconomic backgrounds.

3. Culture: Bulimia nervosa is most commonly reported in Western cultures, particularly in North
America and Europe. However, the disorder has been reported in other cultures as well.

4. Comorbidity: Bulimia nervosa often co-occurs with other psychiatric disorders, such as depression,
anxiety, and substance use disorders.

5. Mortality: Bulimia nervosa has a lower mortality rate than anorexia nervosa, but it is still associated
with significant health risks. Complications of bulimia nervosa can include electrolyte imbalances,
gastrointestinal problems, and dental problems.

6. Treatment: Effective treatments for bulimia nervosa are available, including cognitive-behavioral
therapy and antidepressant medications. However, many individuals with bulimia nervosa do not seek
treatment, and those who do may not receive adequate care.

It is important to note that the epidemiology of bulimia nervosa is constantly evolving, and new
research is needed to fully understand the prevalence and risk factors associated with the disorder.

PROGNOSIS-
The prognosis for individuals with bulimia nervosa varies and can depend on various factors such as
the severity of the disorder, the presence of comorbid conditions, and the individual's response to
treatment.

Studies have suggested that individuals with bulimia nervosa who receive treatment can experience
significant improvements in their symptoms and overall functioning. However, the length of time it
takes to achieve remission can vary widely, and some individuals may require ongoing treatment and
support.

Without treatment, bulimia nervosa can have serious consequences for an individual's physical and
mental health, including malnutrition, electrolyte imbalances, gastrointestinal problems, and increased
risk of suicide.
Temperamental- Weight concerns, low self-esteem, depressive symptoms, social anxiety disorder, and
overanxious disorder of childhood are associated with increased risk for the development of bulimia
nervosa.
Environmental- Internalization of a thin body ideal has been found to increase risk for developing
weight concerns, which in turn increase risk for the development of bulimia nervosa. Individuals who
experienced childhood sexual or physical abuse are at increased risk for developing bulimia nervosa.

Genetic and physiological- Childhood obesity and early pubertal maturation increase risk for bulimia
nervosa. Familial transmission of bulimia nervosa may be present, as well as genetic vulnerabilities for
the disorder.

Binge-Eating Disorder-
According to DSM-5, the diagnostic criteria for binge-eating disorder (BED) are as follows:

1. Recurrent episodes of binge eating, characterized by both of the following:

a. 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 people would eat in a similar period of time under similar
circumstances
b. 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)

2. The binge eating episodes are associated with three (or more) of the following:
a. Eating much more rapidly than normal
b. Eating until feeling uncomfortably full
c. Eating large amounts of food when not feeling physically hungry
d. Eating alone because of feeling embarrassed by how much one is eating
e. Feeling disgusted with oneself, depressed, or very guilty afterward

3. Marked distress regarding binge eating is present.

4. Binge eating occurs, on average, at least once a week for three months.

5. The binge eating is not associated with the recurrent use of inappropriate compensatory behaviors
(e.g., purging) as in bulimia nervosa and does not occur exclusively during the course of bulimia
nervosa, anorexia nervosa, or avoidant/restrictive food intake disorder.

Symptoms for Binge-Eating Disorder (more clarity)-

Individuals with binge-eating disorder are typically ashamed of their eating problems and attempt to
conceal their symptoms. Binge eating usually occurs in secrecy or as inconspicuous as possible. The
most common antecedent of binge eating is negative affect. Other triggers include inteφersonal
stressors; dietary restraint; negative feelings related to body weight, body shape, and food; and
boredom.
An indicator of loss of control is the inability to refrain from eating or to stop eating once started. Some
individuals describe a dissociative quality during, or following, the binge-eating episodes. The
impairment in control associated with binge eating may not be absolute; for example, an individual may
continue binge eating while the telephone is ringing but will cease if a roommate or spouse
unexpectedly enters the room.
Continual snacking on small amounts of food throughout the day would not be considered an eating
binge.

Etiology-
The etiology of Binge-Eating Disorder (BED) is complex and multifactorial, involving biological,
psychological, and environmental factors.

Biological factors that may contribute to the development of BED include genetic predisposition,
neurobiological abnormalities, and hormonal imbalances. Studies have shown that BED tends to run in
families, suggesting a genetic component. Neurobiological abnormalities in brain areas that regulate
appetite, reward, and impulse control have also been identified in individuals with BED. Hormonal
imbalances, such as alterations in leptin and ghrelin levels, may also play a role in the development of
BED.

Psychological factors that may contribute to the development of BED include low self-esteem, poor
body image, negative affect, and maladaptive coping strategies. Individuals with BED may use food as
a way to cope with negative emotions or stress, leading to a pattern of emotional eating and bingeing.

Environmental factors that may contribute to the development of BED include cultural and social
pressures to conform to a certain body ideal, as well as a history of childhood abuse or trauma.
Exposure to weight stigma and discrimination may also contribute to the development of BED.

Overall, the etiology of BED is complex and likely involves a combination of biological, psychological,
and environmental factors. Identifying and addressing these factors is important for the effective
treatment of BED.

Epidemiology-
Binge-eating disorder (BED) is the most common eating disorder in the United States. According to the
DSM-5, the lifetime prevalence of BED is estimated to be 1.4% in men and 2.8% in women. However,
these rates may be underestimated due to underreporting and the stigma associated with the disorder.

BED typically begins in adolescence or young adulthood, but it can develop at any age. The disorder
affects both men and women, although it is more commonly diagnosed in women. Research has also
found that BED is more common in certain populations, such as individuals with obesity, people who
have experienced childhood trauma, and those with psychiatric disorders such as depression and
anxiety.
In addition, studies suggest that there may be a genetic component to BED, as it appears to run in
families. However, environmental factors, such as dieting and a cultural emphasis on thinness, also
play a significant role in the development of the disorder.

PROGNOSIS-
Genetic and physiological- Binge-eating disorder appears to run in families, which may reflect additive
genetic influences. The prognosis for BED can vary depending on various factors such as the severity
of the disorder, co-occurring conditions, and the individual's response to treatment.

Studies suggest that individuals with BED who receive treatment can achieve significant improvements
in their symptoms. Research has shown that psychological treatments such as Cognitive Behavioral
Therapy (CBT), Interpersonal Psychotherapy (IPT), and Dialectical Behavior Therapy (DBT) can be
effective in reducing binge-eating episodes, improving eating attitudes, and decreasing associated
psychological distress.

In addition to psychological treatment, pharmacotherapy can also be helpful in the management of

BED. Studies have shown that medications such as selective serotonin reuptake inhibitors (SSRIs),
topiramate, and lisdexamfetamine can be effective in reducing binge-eating episodes and improving
mood.

However, it is important to note that BED can be a chronic illness, and some individuals may struggle
with the disorder throughout their lives. Also, some individuals may experience relapses and require
ongoing support to maintain their recovery. Therefore, it is essential to seek early and effective
treatment to improve the chances of a positive outcome.

TREATMENT FOR FEEDING AND EATING DISORDERS-

The treatment of feeding and eating disorders involves a multidisciplinary approach that includes
medical, nutritional, and psychological interventions. The main goals of treatment are to restore
physical health, normalize eating behaviors, and address the underlying psychological and emotional
factors that contribute to the disorder. The following are some of the most common treatments for
feeding and eating disorders:

1. Nutritional interventions: Nutritional interventions involve restoring adequate nutrition through

various means, such as nutritional counseling, meal planning, and monitoring. In some cases,
nutritional supplements may be necessary to restore weight and nutritional status. Education about
nutrition, food preparation, and meal planning can help individuals develop a healthy relationship with
food and make informed choices about their diet.
Individuals with rumination disorder may have poor nutrition due to the regurgitation and re-chewing of
food. Nutritional counseling can help the individual to develop a healthy and balanced diet, and to learn
ways to manage the symptoms of rumination disorder.
Similarly, If PICA disorder is related to a nutritional deficiency, such as iron-deficiency anemia,
correcting the deficiency through dietary changes or supplementation may be effective in reducing the
cravings for non-food items.

2. Psychotherapy: Psychotherapy is a key component of treatment for feeding and eating disorders.
The type of therapy used may depend on the specific disorder and individual needs, but common
approaches include cognitive-behavioral therapy (CBT), interpersonal therapy (IPT), and family-based
therapy (FBT).
CBT is a type of therapy that can be effective in addressing the underlying psychological factors that
may be contributing to rumination disorder. CBT can help individuals to identify and change negative
thought patterns and behaviors, and to develop coping skills to manage stress and anxiety.

3. Medications: Medications may be used to treat certain symptoms of feeding and eating disorders,
such as depression, anxiety, and obsessive-compulsive behaviors. Selective serotonin reuptake
inhibitors (SSRIs) are commonly prescribed for these disorders.
Medical management may be necessary in cases of severe malnutrition or medical complications
related to ARFID. This may involve monitoring and managing electrolyte imbalances, providing
nutritional supplements, or administering medications to address gastrointestinal symptoms.

Medications that are sometimes prescribed off-label for ARFID include:

​ Cyproheptadine: This is an antihistamine that can stimulate appetite. It can be helpful for infants
and young children with ARFID who have lost interest in food and are underweight.4
​ Mirtazapine: This antidepressant, also known as Remeron, is sometimes used to stimulate
appetite and has a tendency to lead to weight gain. It may help reduce mealtime fear
​ Olanzapine: This is an atypical antipsychotic also known as Zyprexa. It is sometimes used to
decrease anxiety and cognitive rigidity affecting a person’s food beliefs, and it can promote
weight gain.

In some cases, medications such as antidepressants, antipsychotics, or mood stabilizers may be

prescribed to address underlying mental health conditions that may be contributing to the PICA
disorder.

4. Hospitalization: In some cases, hospitalization may be necessary to stabilize medical or psychiatric

conditions, or to provide intensive treatment for severe cases of feeding and eating disorders.

5. Support groups: Support groups can be a valuable resource for individuals with feeding and eating
disorders, providing a safe and supportive environment to share experiences and connect with others
who are going through similar challenges.

7. Body image therapy: This type of therapy helps individuals develop a more positive body image and
self-esteem, and learn to accept and appreciate their bodies at any size.
8. Occupational therapy- Occupational therapists take a holistic approach to restoring health,
well-being, and functioning through assessment and techniques designed to develop or recover
meaningful activities or occupations. Occupational therapists complete a full assessment of a person’s
sensory, motor, developmental, environmental, cultural, and behavioral factors that could be impairing
eating.
9. Speech Therapy- A speech therapist (speech-language pathologist) is another kind of rehabilitation
professional that can be part of an ARFID treatment team. Speech therapists treat issues relating to
speech, hearing, and swallowing. Speech therapists work with people of all ages, using a variety of
interventions. For example, they can help a person become more comfortable swallowing different
textures through techniques like pre-chaining, food chaining, and feeding programs that target different
consistencies.

10.Environmental modifications: For individuals who live in environments where non-food items are
readily available and easily accessible, environmental modifications may be necessary. This may
include removing non-food items from the home or workplace, or restricting access to them.(in case of
PICA Disorder)
Overall, successful treatment of feeding and eating disorders requires a personalized approach that
addresses the unique needs and challenges of each individual. Treatment is often a long-term process
that requires ongoing support and monitoring to prevent relapse and promote sustained recovery.

Differential Diagnosis-
Feeding and eating disorders can present with similar symptoms, and it can be challenging to
distinguish between them. The following are some differential diagnoses for feeding and eating
disorders:

1. Gastrointestinal disorders: Individuals with gastrointestinal disorders may experience nausea,

vomiting, abdominal pain, and bloating. These symptoms may lead to reduced food intake and weight
loss, which can be mistaken for an eating disorder.
Gastroesophageal reflux disease (GERD): GERD is a condition in which stomach acid flows back into
the esophagus, causing heartburn and other symptoms. Some individuals with GERD may regurgitate
food, which can be mistaken for rumination disorder. However, unlike rumination disorder, regurgitation
in GERD is not voluntary.

2. Diabetes: Diabetes can cause significant weight loss due to hyperglycemia, which leads to increased
urine output and dehydration. Individuals with diabetes may also experience polyphagia, a condition in
which they crave food and feel hungry all the time.

3. Substance abuse: Substance abuse can lead to weight loss due to decreased appetite or increased
metabolism. It can also cause binge eating, especially in individuals who abuse stimulants.

4. Hyperthyroidism: Hyperthyroidism can cause weight loss due to increased metabolism and appetite.
Individuals with hyperthyroidism may also experience tremors, anxiety, and palpitations.
5. Depression: Depression can cause changes in appetite and eating patterns, leading to weight loss or
weight gain. Individuals with depression may also experience fatigue, decreased motivation, and
feelings of worthlessness.

6. Obsessive-Compulsive Disorder (OCD): Individuals with OCD may have obsessive thoughts about
food and eating that lead to restrictive eating patterns. They may also have compulsive behaviors
around food, such as excessive weighing or measuring of food.

7. Personality Disorders: Individuals with personality disorders, such as borderline personality disorder,
may have unstable relationships, mood swings, and impulsive behaviors, including binge eating.

8. Other psychiatric disorders: Eating disorders can co-occur with other psychiatric disorders, such as
anxiety disorders, substance abuse disorders, and trauma-related disorders. It is essential to consider
these disorders when evaluating individuals with feeding and eating disorders.

Major depressive disorder. In major depressive disorder, appetite might be affected to such an extent
that individuals present with significantly restricted food intake, usually in relation to overall energy
intake and often associated with weight loss. Usually appetite loss and related reduction of intake
abate with resolution of mood problems. Avoidant/ restrictive food intake disorder should only be used
concurrently if full criteria are met for both disorders and when the eating disturbance requires specific
treatment.
9. Reactive attachment disorder. Some degree of withdrawal is characteristic of reactive attachment
disorder and can lead to a disturbance in the caregiver-child relationship that can affect feeding and the
child's intake. Avoidant/restrictive food intake disorder should be diagnosed concurrently only if all
criteria are met for both disorders and the feeding disturbance is a primary focus for intervention.

10.Specific phobia, social anxiety disorder (social phobia), and other anxiety disorders. Specific phobia,
another type, specifies "situations that may lead to choking or vomiting" and can represent the primary
trigger for the fear, anxiety, or avoidance required for diagnosis. Distinguishing specific phobia from
avoidant/restrictive food intake disorder can be difficult when a fear of choking or vomiting has
resulted in food avoidance. Although avoidance or restriction of food intake secondary to a pronounced
fear of choking or vomiting can be conceptualized as specific phobia, in situations when the eating
problem becomes the primary focus of clinical attention, avoidant/restrictive food intake disorder
becomes the appropriate diagnosis.

Selective Eating Disorder (SED): SED is a condition in which individuals have a limited range of
preferred foods and may avoid certain foods due to sensory or psychological reasons. SED is similar to
ARFID in that both involve selective eating behaviors, but SED is typically diagnosed in children and
does not require a significant impact on physical health or functioning.

Prader-Willi syndrome: Prader-Willi syndrome is a rare genetic disorder characterized by an insatiable

appetite and compulsive overeating. Individuals with this condition may also consume non-food items.
Nonsuicidal self-injury and nonsuicidal self-injury behaviors in personality disorders. Some individuals
may swallow potentially harmful items (e.g., pins, needles, knives) in the context of maladaptive
behavior patterns associated with personality disorders or nonsuicidal self-injury.

It is crucial to conduct a comprehensive evaluation to identify the underlying cause of symptoms and
make an accurate diagnosis. Differential diagnoses are made based on clinical presentation, medical
history, and physical examination.