PSYCH 705 ADVANCED ABNORMAL PSYCHOLOGY

FEEDING AND EATING

DISORDERS

Presented by: Arielle Kate Estabillo

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.
PICA
 PICA

Associated Features
• reported deficiencies in vitamins or minerals (e.g., zinc, iron)
• often no specific biological abnormalities found
• in some cases, pica comes to clinical attention only following general medical complications
Prevalence
• approximately 5% among school-age children
• roughly one-third of pregnant women, especially those with food insecurity
Development and Course
• childhood onset is most commonly reported
• can occur in otherwise normally developing children; in adults, it appears more likely to occur in the
context of intellectual developmental disorder or other mental disorders
• course can be protracted and can result in medical emergencies
• can potentially be fatal
 PICA

Risk and Prognostic Factors

• Environmental.
Culture-Related Diagnostic Issues
• believed to be of spiritual, medicinal, or other social value, or may be a culturally supported or
socially normative practice.
Sex- and Gender-Related Diagnostic Issues
• occurs in both genders.
• 28% prevalence rate during pregnancy and/or the postpartum period.
Diagnostic Markers
• Abdominal flat plate radiography, ultrasound, and other scanning methods may reveal obstructions
related to pica.
• Blood tests and other laboratory tests can be used to ascertain levels of poisoning or the nature of
infection.
 PICA

Functional Consequences of Pica

• Pica can significantly impair physical functioning, but it is rarely the sole cause of impairment in
social functioning.
• It often occurs with other disorders associated with impaired social functioning.
Differential Diagnosis
• Anorexia Nervosa.
• Factitious Disorder.
• Nonsuicidal self-injury and nonsuicidal self-injury behaviors in personality disorders
Comorbidity
• autism spectrum disorder
• intellectual developmental disorder
• schizophrenia and obsessive-compulsive disorder (to a lesser degree)
• trichotillomania and excoriation disorder CELLULOID JOURNAL

• avoidant/restrictive food intake disorder

January 1999

"The Death of Romance in Cinema"

by Barry Hedder
RUMINATION DISORDER
 RUMINATION DISORDER

Associated Features
• Infants display a characteristic position of straining and arching the back with the head held back, making
sucking movements with their tongue. Weight loss and failure to make expected weight gains are also
common; malnutrition may also occur
• Malnutrition might also occur in older children and adults, particularly when the regurgitation is
accompanied by restriction of intake. Adolescents and adults may attempt to disguise the regurgitation
behavior
Prevalence
• the disorder may occur in approximately 1%–2% of grade-school-age children (based on limited European
data)
Development and Course
• Onset can occur in infancy, childhood, adolescence, or adulthood
• The age at onset in infants is usually between ages 3 and 12 months.
• In infants, the disorder frequently remits spontaneously, but its course can be protracted and can result in
medical emergencies
• can potentially be fatal, particularly in infancy
• can have an episodic course or occur continuously until treated.
 RUMINATION DISORDER

Risk and Prognostic Factors

• Environmental. Psychosocial problems such as lack of stimulation, neglect, stressful life situations,
and problems in the parent-child relationship may be predisposing factors
Functional Consequences of Rumination Disorder
• Malnutrition secondary to repeated regurgitation may be associated with growth delay and have a
negative effect on development and learning potential.
• Some older individuals with rumination disorder deliberately restrict their food intake because of the
social undesirability of regurgitation
• In older children, adolescents, and adults, social functioning is more likely to be adversely affected.
 RUMINATION DISORDER

Differential Diagnosis
• Gastrointestinal conditions
• Anorexia nervosa and bulimia nervosa

Comorbidity
Regurgitation with associated rumination can occur in the context of a concurrent medical condition or
another mental disorder (e.g., generalized anxiety disorder).

CELLULOID JOURNAL

January 1999

"The Death of Romance in Cinema"

by Barry Hedder
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER
 AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER

Associated Features
• Very young infants may present with food refusal, gagging, or vomiting.
• In older children and adolescents, food avoidance or restriction may be associated with more generalized
emotional difficulties that do not meet diagnostic criteria for an anxiety, depressive, or bipolar disorder,
sometimes called “food avoidance emotional disorder.”
Prevalence
• a study in Australia reported a frequency of 0.3% among individuals age 15 years or older
Development and Course
• most commonly develops in infancy or early childhood and may persist in adulthood
• avoidance based on sensory characteristics of food tends to arise in the first decade of life but may persist
into adulthood
• avoidance related to aversive consequences can arise at any age
• In infants, children, and prepubertal adolescents, this may be associated with growth delay, and the resulting
malnutrition negatively affects development and learning potential.
• In older children, adolescents, and adults, social functioning tends to be adversely affected.
 AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER

Risk and Prognostic Factors

• Temperamental
• Environmental
• Genetic and physiological
Culture-Related Diagnostic Issues
• Presentations similar to this disorder occur in various populations, including in the United States,
Canada, Australia, Europe, Japan, and China.
Sex- and Gender-Related Diagnostic Issues
• appears to be approximately equally common in boys and girls, but ARFID comorbid with ASD has a
male predominance.
Functional Consequences of Avoidant/Restrictive Food Intake Disorder
• Associated developmental and functional limitations include impairment of physical development
and social difficulties that can have a significant negative impact on family function.
 AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER

Differential Diagnosis
• Other medical conditions (e.g., gastrointestinal disease, food allergies and intolerances, occult malignancies)
• Obsessive-compulsive and related disorder due to pediatric acute-onset neuropsychiatric syndrome
• Specific neurological/neuromuscular, structural, or congenital disorders and conditions associated with
feeding difficulties
• Reactive attachment disorder
• Autism spectrum disorder
• Specific phobia, social anxiety disorder, and other anxiety disorders
• Anorexia nervosa
• Obsessive-compulsive disorder
• Major depressive disorder
• Schizophrenia spectrum disorders
• Factitious disorder or factitious disorder imposed on another
• Developmentally normal behavior CELLULOID JOURNAL
January 1999

"The Death of Romance in Cinema"

by Barry Hedder
 AVOIDANT/RESTRICTIVE FOOD
INTAKE DISORDER

Comorbidity
• anxiety disorders
• obsessive-compulsive disorder
• neurodevelopmental disorders (specifically autism spectrum disorder, attention-deficit/hyperactivity disorder,
and intellectual developmental disorder)
ANOREXIA NERVOSA
ANOREXIA NERVOSA
 ANOREXIA NERVOSA

Associated Features
• The semistarvation of anorexia nervosa, and the purging behaviors sometimes associated with it, can
result in significant and potentially life-threatening medical conditions
• When seriously underweight, many individuals with anorexia nervosa have depressive signs and
symptoms
• Obsessive-compulsive features, both related and unrelated to food, are often prominent
• Other features sometimes associated with this disorder include concerns about eating in public, feelings
of ineffectiveness, a strong desire to control one’s environment, inflexible thinking, limited social
spontaneity, and overly restrained emotional expression
• Those with binge-eating/purging type have higher rates of impulsivity and are more likely to abuse
alcohol and other drugs than those with restricting types.
• Some individuals with anorexia nervosa show excessive levels of physical activity.
• Individuals with anorexia nervosa may misuse medications, such as by manipulating dosage, in order to
achieve weight loss or avoid weight gain.
 ANOREXIA NERVOSA

Prevalence
• the 12-month prevalence of anorexia nervosa ranges from 0.0% to 0.05% with much higher rates in women
than in men. By contrast, one study of adolescents found similar rates in both genders.
• it appears to be most prevalent in post-industrialized, high-income countries such as in the US, many
European countries, Australia, New Zealand, and Japan.
Development and Course
• It commonly begins during adolescence or young adulthood
• It rarely begins before puberty or after age 40, but cases of both early and late-onset have been described
• The onset of this disorder is often associated with a stressful life event
• The course and outcome of anorexia nervosa are highly variable.
• Many individuals have a period of changed eating behavior prior to full criteria for the disorder being met.
• The crude mortality rate for anorexia nervosa is approximately 5% per decade
 ANOREXIA NERVOSA

Risk and Prognostic Factors

• Temperamental
• Environmental
• Genetic and physiological
Culture-Related Diagnostic Issues
• Anorexia nervosa occurs across culturally and socially diverse populations, although available
evidence suggests cross-cultural variation in its occurrence and presentation
Association With Suicidal Thoughts or Behavior
• Suicide risk is elevated in anorexia nervosa.
Functional Consequences of Anorexia Nervosa
• Individuals with anorexia nervosa may exhibit a range of functional limitations associated with the
disorder (such as significant social isolation and/or failure to fulfill academic or career potential)
CELLULOID JOURNAL

January 1999

"The Death of Romance in Cinema"

by Barry Hedder
 ANOREXIA NERVOSA

Differential Diagnosis
• Medical conditions (e.g., gastrointestinal disease, hyperthyroidism, occult malignancies, and acquired
immunodeficiency syndrome [AIDS])
• Major depressive disorder
• Schizophrenia
• Substance use disorders
• Social anxiety disorder, obsessive-compulsive disorder, and body dysmorphic disorder
• Bulimia nervosa
• Avoidant/restrictive food intake disorder
Comorbidity
• Bipolar, depressive, and anxiety disorders commonly co-occur with anorexia nervosa.
• Alcohol use disorder and other substance use disorders may also be comorbid with anorexia nervosa,
especially among those with the binge-eating/purging type
BULIMIA NERVOSA
 BULIMIA NERVOSA

Associated Features
• Individuals with bulimia nervosa typically are within the normal weight or overweight range
• The disorder occurs but is uncommon among obese individuals.
• Between eating binges, individuals with bulimia nervosa typically restrict their total caloric consumption and
preferentially select low-calorie (“diet”) foods while avoiding foods that they perceive to be fattening or likely to
trigger a binge.
• Menstrual irregularity or amenorrhea often occurs among females with bulimia nervosa
• It is uncertain whether such disturbances are related to weight fluctuations, to nutritional deficiencies, or to
emotional distress
Prevalence
• the 12-month prevalence of bulimia nervosa ranges from 0.14% to 0.3%, with much higher rates in women than in
men
• The reported prevalence of bulimia nervosa is highest in populations residing in high-income industrialized
countries, such as the US, Canada, Australia, New Zealand, and many European countries
• The prevalence of bulimia nervosa appears to be gradually increasing in many low- and middle-income countries
 BULIMIA NERVOSA

Development and Course

• Bulimia nervosa commonly begins in adolescence or young adulthood.
• Onset before puberty or after age 40 is uncommon.
• The binge eating frequently begins during or after an episode of dieting to lose weight.
• Experiencing multiple stressful life events also can precipitate onset of bulimia nervosa.
• Disturbed eating behavior persists for at least several years in a high percentage of clinical samples.
• The course may be chronic or intermittent, with periods of remission alternating with recurrences of binge
eating.
• Significantly elevated risk for mortality (all-cause and suicide) has been reported for individuals with bulimia
nervosa.
• The crude mortality rate (ratio of the number of deaths during the year to the average population in that year)
for bulimia nervosa is nearly 2% per decade.
• Diagnostic crossover from initial bulimia nervosa to anorexia nervosa occurs in a minority of cases (10%–
15%).
 BULIMIA NERVOSA

Risk and Prognostic Factors

• Temperamental
• Environmental
• Genetic and physiological
• Course modifiers
Sex- and Gender-Related Diagnostic Issues
• Bulimia nervosa is much more common in girls and women than in boys and men.
Association With Suicidal Thoughts or Behavior
• Suicide risk is elevated in bulimia nervosa.
Functional Consequences of Bulimia Nervosa
• A minority of individuals report severe role impairment, with the social-life domain most likely to be
adversely affected by bulimia nervosa.
CELLULOID JOURNAL

January 1999

"The Death of Romance in Cinema"

by Barry Hedder
 BULIMIA NERVOSA

Differential Diagnosis
• Anorexia nervosa, binge-eating/purging type
• Binge-eating disorder
• Kleine-Levin syndrome
• Major depressive disorder, with atypical features
• Borderline personality disorder
Comorbidity
• There is an increased frequency of depressive symptoms (e.g., low self-esteem) and bipolar and depressive
disorders (particularly depressive disorders) in individuals with bulimia nervosa.
• There may also be an increased frequency of anxiety symptoms (e.g., fear of social situations) or anxiety
disorders.
• The lifetime prevalence of substance use disorder, particularly alcohol use disorder or stimulant use disorder, is at
least 30% among individuals with bulimia nervosa.
• A substantial percentage of individuals with bulimia nervosa also have personality features that meet criteria for
one or more personality disorders, most frequently borderline personality disorder.
BINGE-EATING DISORDER
 BINGE-EATING DISORDER

Associated Features
• BED occurs in normal-weight/overweight and obese individuals.
• It is reliably associated with overweight and obesity in treatment-seeking individuals.
• Nevertheless, it is distinct from obesity. Most obese individuals do not engage in recurrent binge eating.
Prevalence
• the 12-month prevalence of BED ranges from 0.44% to 1.2%, with rates two to three times higher in women
than in men
• It has a roughly similar prevalence in most high-income industrialized countries, including the United States,
Canada, many European countries, Australia, and New Zealand, with 12-month prevalence in high-income
countries ranging from 0.1% to 1.2%
• Although fewer data are available from populations in low- and middle-income countries, BED prevalence in
some regions of Latin America appears to be at least as high as in the US and Europe. Mexican Americans in
the US have a higher prevalence of binge-eating disorder than their counterparts in Mexico
 BINGE-EATING DISORDER

Development and Course

• Little is known about the development of binge-eating disorder.
• Both binge-eating and loss-of-control eating without objectively excessive consumption occur in
children and are associated with increased body fat, weight gain, and increases in psychological
symptoms.
• Binge eating is common in adolescent and college-age samples.
• Dieting follows the development of binge eating in many individuals with BED.
• BED typically begins in adolescence or young adulthood but can begin in later adulthood.
• Individuals with binge-eating disorder who seek treatment usually are older than individuals with
either bulimia nervosa or anorexia nervosa who seek treatment.
• Remission rates are higher for BED than for bulimia nervosa or anorexia nervosa
• The course of BED is variable and as yet incompletely understood
• Crossover from BED to other eating disorders is uncommon.
 BINGE-EATING DISORDER

Risk and Prognostic Factors

• Genetic and physiological
Association With Suicidal Thoughts or Behavior
• Suicidal ideation has been reported to occur in approximately 25% of individuals with binge-eating
disorder.
Functional Consequences of Anorexia Nervosa
• social role adjustment problems
• impaired health-related quality of life and life satisfaction
• increased medical morbidity and mortality
• associated increased health care utilization compared with body mass index (BMI)–matched control
subjects
• an increased risk for weight gain and the development of obesity CELLULOID JOURNAL
January 1999

"The Death of Romance in Cinema"

by Barry Hedder
 BINGE-EATING DISORDER

Differential Diagnosis
• Bulimia nervosa
• Obesity
• Bipolar and depressive disorders
• Borderline personality disorder
Comorbidity
• The most common comorbid disorders are major depressive disorder and alcohol use disorder.
• The psychiatric comorbidity is linked to the severity of binge eating and not to the degree of obesity.
 THE CASE OF ERIN
Erin is a 26-year-old doctoral candidate in English literature. In your intake, she tells you she thinks she is “fat” and has
been self-conscious about her body since the sixth grade, at which time she began menstruating and developing breasts
earlier than the other girls in her class. She was teased for needing a bra and remembers feeling “chubby, too big, and just
wanting to be small like [her] younger sister.” She started dieting in the seventh grade, following strict rules for weeks
(e.g., she recalls the egg-only diet), then transitioning into what she called “bad” weeks. During these times, she would
stock up on candy bars and other snack foods and eat them, often in her bedroom late at night. Her parents became
concerned and tried to strictly limit her dieting. This led to eating “normal” during the day and binging on those candy
bars she kept hidden in her bedroom at night if she felt sad, scared, or mad. She grew into a habit of eating to feel better –
relief that was only temporary, as she would feel ashamed about what she had done and resolve to not do it again. In
college, her pattern of emotional eating continued, which felt more distressing to her because of the pressure to look “as
pretty and thin as the other girls.” (continued on the next page)
 THE CASE OF ERIN
In the first semester of her freshman year, she experimented with throwing up after the late-night eating and found that, at
least in the minutes that followed, she felt like she had much more control and believed this would help her to prevent the
weight gain she so dreaded. She fell into a vicious cycle of late-night binges (typically consuming about 7 candy bars in
15 minutes, during which times Erin described feeling very out of control) followed by making herself throw up. In
college, she engaged in these binge-purge episodes about 6 nights/week. At present, she is having a harder time hiding the
episodes because she lives with her boyfriend; she estimates that they occur about 4 nights per week. The times when she
feels the most compelled to binge and purge are when she has a major presentation coming up in her doctoral program and
when she gets in a fight with her boyfriend. Her BMI is in the normal range, but she says she needs to lose weight. She
wants to stop binging and purging because she does not want her boyfriend to find out, but she is also afraid that if she
stops, she will gain weight.
 DON'T FORGET TO RESPOND!
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