Course Code: 518

Dietetics III
Lecture number: 2

Resource person: Asma khan

Unspecified Feeding or Eating Disorder
 Avoidant/Restrictive Food Intake Disorder

• 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.

• The eating disturbance does not occur exclusively during the 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.

• 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 additional clinical attention.

 Pica

Persistent eating of nonnutritive, nonfood

substances over a period of at least 1
month
Inappropriate to the developmental level of
the individual

Not part of a culturally supported practice.

• If the eating behaviors occurs in the context of
another mental disorder (e.g., intellectual disability
[intellectual developmental disorder], autism
spectrum disorder, schizophrenia) or medical
condition (including pregnancy), it is sufficiently
severe to warrant additional clinical attention.
 Rumination Disorder

Repeated regurgitation of food over a period of at least 1

month

Regurgitated food may be

re-chewed
re-swallowed
or spit out
• The repeated regurgitation is not attributable to an associated
gastrointestinal or other medical condition (e.g.,
gastroesophageal reflux, pyloric stenosis).

• If the symptoms occur in the context of another mental

disorder (e.g., intellectual disability [intellectual developmental
disorder] or another neurodevelopmental disorder), they are
sufficiently severe to warrant additional clinical attention.
CLINICAL CHARACTERISTICS AND MEDICAL
COMPLICATIONS
Anorexia Nervosa
• Cardiovascular complications may include
– Bradycardia
– Orthostatic hypotension
– Cardiac arrhythmias
– Pericardial effusion

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• Gastrointestinal complications secondary to starvation
include
– Delayed gastric emptying,

– Decreased small bowel motility,

– Constipation.

• Complaints of abdominal bloating and a prolonged sensation

of abdominal fullness complicate the refeeding process.

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• Bone loss occurs frequently

• Bone density of males with AN actually may be worse than

their female counterparts

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Renal complications include
• Renal insufficiency,

• Decreased renal concentrating ability

• Increased urine output
• Proteinuria,

• Hematuria.
• In general, these symptoms become better with adequate
hydration and treatment of malnutrition
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• Hematologic abnormalities include

• Anemia

• Leukopenia
• Thrombocytopenia

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 Bulimia Nervosa
• Clinical sign And symptoms are difficult to
detect

Normal weight Secretive in behavior

 Gastrointestinal complaints
• Common for individuals who use vomiting as a
purging method
 Acute
gastric
dilation

Esophageal Serious GI Gastric

rupture complications rupture

Mallory-
Weiss
esophageal
tear
• Symptoms associated with laxative misuse vary
with type, dose, and duration of use.
• Patients may present with diarrhea, abdominal
cramping, rectal bleeding.
• Vomiting, laxative misuse, and diuretic misuse are
associated with fluid and acid-base imbalances.
 Menstrual Mistaken Unable to
irregularity belief conceive
 Unplanned
pregnancy

Low birth
weight

Smaller head
circumference
 Binge Eating Disorder
• In many cases, but not all, this binge eating
results in overweight or obesity, yet causes
greater functional impairment, decreased
quality of life, and greater levels of psychiatric
comorbidity than obesity without BED.
• Ingestion of large amounts of food may cause considerable
upper and lower gastrointestinal distress.

• Symptoms include abdominal pain, fullness, delayed gastric

emptying, bloating, acid regurgitation, heartburn,
dysphagia, nausea, diarrhea, constipation, hard or loose and
watery stools, fecal urgency, fecal incontinence, and anal
blockage.
 Treatment
Psychologic
Severity of
illness

Psychiatric Treatment Medical

Nutrition
interventions
 Psychologic Management
• The long-term goals of psychosocial interventions in AN are

1. To help patients understand and cooperate with their nutritional and

physical rehabilitation

2. To help patients understand and change behaviors and dysfunctional

attitudes related to their EDs

3. To improve interpersonal and social functioning

4. To address psychologic conflicts that reinforce or maintain eating-

disordered behaviors
• Once acute malnutrition has been corrected and weight
restoration is underway, the AN patient is more likely to
benefit from psychotherapy.

• Psychotherapy can help the patient understand and

change core dysfunctional thoughts, attitudes, motives,
conflicts, and feelings related to his or her ED.
• Dialectical behavioral therapy (DBT), a skill-based therapy that focuses

on mindfulness, distress tolerance, emotion regulation, may be helpful

in BN cases in which co-morbid psychiatric disorders (e.g., depression

and mood disorders, personality disorders, and substance abuse

disorders), self-injurious behaviors (e.g., cutting), are evident.

• In some instances, an antidepressant medication (typically a selective

serotonin reuptake inhibitor [SSRI] such as fluoxetine) is prescribed

adjunctive to psychotherapy.
DBT SKILLS!

DBT includes four behavioral skill modules, with two acceptance-

oriented skills (mindfulness and distress tolerance) and two change-
oriented skills (emotion regulation and interpersonal effectiveness).

• Mindfulness: the practice of being fully aware and present in this

one moment
• Distress Tolerance: how to tolerate pain in difficult situations, not
change it
• Interpersonal Effectiveness: how to ask for what you want and say
no while maintaining self-respect and relationships with others
• Emotion Regulation: how to decrease vulnerability to painful
emotions and change emotions that you want to change
 Nutrition Management

Assessment Intervention

Role of RDN

Monitoring Evaluation
Nutrition assessment

Biochemical
Diet history assessment
NA
Energy Anthropometric
expenditure measurements

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Thank you