Feeding and Eating Disorder

1. Feeding and Eating Disorder
Heba Essawy , MD
Professor of Psychiatry
Ain Shams University

2. Roadmap
 Anorexia Nervosa
 Bulimia Nervosa
 Binge-eating disorder
 Rumination Disorder
 Pica
 Avoidant/Restricting
Food Intake Disorder
 Risk Factors
 Diagnosis
 Medical risks
 Treatment

3. Risk Factors for EDs
Perfectionism for AN
Early Puberty
Failed attempts to lose weight
Athletics
Beginning a diet
Family history of eating disorder,
substance abuse or mood disorder

5. Diagnosis AN (DSM-5):
 Restriction of energy intake relative to
requirements leading to a significantly low body
weight in the context of age, sex.
 Intense fear of gaining weight or becoming
fat, or persistent behavior that interferes
with weight gain.
 Disturbance in one's body weight or shape ,
persistent lack of recognition of the seriousness
of low body weight
 Specify:
 Restricting type
 Purging type/Binge Eating.

6. Subtypes AN (DSM-5):
Restricting Type: during last 3months,
the person has not engaged in recurrent
episodes of binge eating or purging
behavior
Binge-Eating/Purging Type: during last 3
months, the person engaged in
recurrent episodes of binge eating or
purging behavior

7. Medical Complication
 Death (hypokalemia , starvation, sudden cardiac
death)
 Hypometabolic state (bradycardia, hypotension,
hypothermia)
 Dehydration
 Arrhythmia, heart failure.
 Bone loss
 Peripheral edema
 Delayed sexual maturity
 Hair loss, brittle hair, Lanugo.
 On recovery: Re-feeding syndrome

9. Diagnostic Criteria for Bulemia
Nervosa DSM-5
 A. Recurrent episodes of binge eating:
(1) Eating large amount in a discrete
period of time
(2) lack of control over eating
B. Recurrent compensatory behavior in
order to prevent weight gain.
C. Binge eating and inappropriate
compensatory behaviors is at least once
a week for 3 months.

11. Medical Complication
 Electrolyte abnormalities
 Dental – loss of enamel, chipped teeth, cavities
 Parotid enlargement
 Conjunctival hemorrhages
 Esophagitis
 hematemesis
 Latxative-dependent: cathartic colon, melena,
rectal prolapse

12. Binge Eating Disorder
1. Eating much more rapidly than normal
2. Eating until feeling uncomfortably full
3. Eating large amounts of food when
not feeling hungry
4. feeling disgusted with oneself,
depressed, or very guilty afterwards

13. Pica
 Persistent eating of non-nutritive
substances for a period of at least one
month.
 The eating of non-nutritive substances is
inappropriate to the developmental level
of the individual.
 The eating behaviour is not part of a
culturally supported or socially normative
practice.
 If occurring in the presence of another
mental disorder (e.g. autistic ), or during
a medical condition (e.g. pregnancy).

14. Rumination Disorder
 Repeated regurgitation of food for a
period of at least one month
Regurgitated food may be re-chewed, re-
swallowed, or spit out.
 The repeated regurgitation is not due to
a medication condition (e.g.
gastrointestinal condition).
 The behaviour does not occur
exclusively in the course of Anorexia
Nervosa, Bulimia Nervosa, BED, or
Avoidant/Restrictive Food Intake
disorder.

15. Avoidant/Restrictive Food
Intake Disorder (ARFID)
 An Eating or Feeding disturbance as manifested by
persistent failure to meet appropriate nutritional and/or
energy needs associated with one (or more) of the
following:
 Significant loss of weight (or failure to achieve expected
weight gain or faltering growth in children).
 Significant nutritional deficiency
 Dependence on enteral feeding or oral nutritional
supplements
 Marked interference with psychosocial functioning
 The behavior is not better explained by lack of available
food or by an associated culturally sanctioned practice.

16. Eating Disorder Inventory
(EDI)
 The EDI is a 64 item, self-report for the
assessment of psychological and
behavioral traits common in anorexia
nervosa (AN) and bulimia.
 EDI consists of eight sub-scales
measuring: 1) Drive for Thinness, 2)
Bulimia, 3) Body Dissatisfaction, 4)
Ineffectiveness, 5) Perfectionism, 6)
Interpersonal Distrust, 7) Interoceptive
Awareness ,8) Maturity Fears

17. Treatment
 Determine inpatient vs. day treatment vs.
outpatient
 Multidisciplinary teams are ESSENTIAL!
Primary care provider
Psychiatrist
Individual therapist
Family therapist
Nutritionist
 1st: weight restoration
 2nd: psychological
 3rd: maintinance (long-term)

18. Drug Therapy
 High-dose Fluoxetine/Prozac (SSRI) – very
good evidence!
 Sertraline/Zoloft (SSRI) – some good
evidence
 Buproprion/Wellbutrin (other
antidepressant) – contraindicated! (risk of
seizures if history of purging)
 Topiramate/Topomax (mood stabalizer,
promotes weight loss) – some good
evidence, but use with caution esp if low-
weight

19. Thank you
Heba Essawy
Website www. Hebaessawy.com
Facebook Dr.hebaessawy
Email essawi_h@yahoo.com