EATING AND FEEDING DISORDERS

GROUP- 1

PRESENTED BY
ANAM TARIQ
ARHUM HAKIM
NAIMA AZHAR
NAJEEBA NAZ
MAHNOOR MALIK
MARYAM TAHIR
Eating and Feeding
Disorders
 Persistent disturbance of eating or eating related disorder
 Which can disturb physical health or psychosocial functioning
Following disorders are included in eating and feeding disorder:

Pica disorder Anorexia nervosa

Rumination disorder Bulimia nervosa

Avoidant/restrictive food intake Binge eating disorder

disorder
 CRITERION A

 Pica is an eating disorder typically defined as the persistent

ingestion of nonnutritive, non food substance over a period of at
least 1 month
 People with pica eat nonfood items regularly. which may include:
 CRITERION B

 The eating of non nutritive substance is inappropriate to the

developmental level of individual
 DIFFERENTIAL DIAGNOSIS

 Anorexia nervosa:
Ingestion of nonnutritive, non food substance as a mean of
attempting to control appetite or obsessive desire to lose weight
 Factitious disorder:
Patients may intentionally ingest objects as part of pattern of
falsification of physical symptoms
RUMINATION DISORDER
 DIAGNOSTIC CRITERIA

Criterion A:
 Repeated regurgitation of food. Regurgitated food can be re chewed, re
swallowed or spit out.
(Regurgitation means the act of bringing swallowed food again to mouth)
 Time Duration: 1 month and more (Onset after the age of 3 months)
Criterion B:
 Regurgitation is not due to any medical condition (gastroesophageal reflux and
pyloric stenosis)
 MAJOR FEATURES

 Repeated regurgitation  Malnutrition

 Repeated re-chewing  No apparent feeling of Nausea,
 Show unusual movements like disgust
sucking movements with  Regurgitation becomes an habit
mouth, holding head back and and out of control for the client
tightening abdominal muscles
 Gain satisfaction from doing this
(mostly in infants)
 Adolescence or adults cover their
 Weight loss
mouth or cough during
regurgitation to hide it
 SPECIFIER

 In Remission:
Previously full criteria was met but for a period of time the criteria
has not been met
 DIFFERENTIAL DIAGNOSIS

 Gastrointestinal Conditions:
Before diagnosis, the psychologists should rule out that regurgitation is not due to
any medical condition through physical examination and laboratory tests.
 Anorexia Nervosa and Bulimia Nervosa:
In this disorder the client also regurgitates to spit out food with the concern of
weight gain while in rumination disorder there is no weight gain concern
AVOIDANT/RESTRICTIVE FOOD INTAKE
DISORDER
 DIAGNOSTIC CRITERIA

Criterion A:
 Avoidance of food intake is based on the sensory characteristics of food
(color, smell, texture, taste etc. and this behavior is known as selective
eating) or anticipation of an aversive consequence of eating and is
associated with any one of the following:
i. Significant weight loss
ii. Significant Nutritional deficiency
iii. Dependence on enteral feeding or nutritional supplements
iv. Marked interference with psychosocial functioning
Criterion B:
 Time duration: At least one month
 MAJOR SYMPTOMS

Physical Signs Behavioral Signs

 Weight loss  Sudden refusal to eat

 Failure to gain weight  Fear of choking
 Delayed growth  Difficulty eating meals with
others
 Picky or selective eating
Specifier:
 In Remission
 DIFFERENTIAL DIAGNOSIS

 Anorexia Nervosa:
In this, the client restricts taking food because of the fear of gaining weight while
in ARFID the client avoid food because of sensory characteristics or due to
negative experiences with food.
 Social Phobia:
Avoid eating in public due to negative evaluation (vomiting that can lead to
embarrassment)
Avoid intake due to anticipation of negative consequence with food or sensory
characteristics of food (smell, taste, etc.)
 Other Medical Conditions:
Avoid food intake because of physical symptoms (nausea, vomiting) and don’t
feel like eating
ANOREXIA NERVOSA

BY MAHNOOR MALIK
 CRITERION’S

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

low body weight in context of age, sex, developmental trajectory and physical
health.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that
prevents weight gain despite being underweight.
C. Distorted perception of body weight and shape, under influence of weight and
shape on self-worth or denial of the medical seriousness of one’s low body
weight.
 SPECIFIER

 Restricting type:
Weight loss achieved by restricting calories (dieting, fasting or excessive
exercise)
 Purging types (binge eating):
Weight loss achieved by vomiting, laxatives or diuretics.
Other Specifiers:
 Partial remission
 Full remission
 DIFFERENTIAL DIAGNOSIS

 Social anxiety disorder

 Body dysmorphic disorder
 Schizophrenia
 Bulimia nervosa
BULIMIA NERVOSA

BY NAJEEBA NAZ
 DIAGNOSTIC CRITERIA

Criterion A:
 Recurrent episodes of binge eating. An episode of binge eating is characterized
by both of the following:
1. Eating in a discrete amount of time (e-g: within a 2 hour period) an
amount of food that is definitely larger than what most individuals would eat
in a similar period of time under similar circumstances.
2. Sense of lack of control over eating during an episode.
Criterion B:
 Recurrent inappropriate compensatory behavior in order to prevent weight gain, such as
self-induced
vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive
exercise.
Criterion C:
 The binge eating and inappropriate compensatory behaviors both occur, on average, at
least once a week for three months.

Specifiers:
 In partial remission:
After full criteria for bulimia nervosa was previously met, but now (some) not all of the
criteria have been met for a sustained period of time.
 In full remission:
After full criteria for bulimia nervosa were previously met, none of the criteria have
been met for a sustained period of time.
 SPECIFY CURRENT SEVERITY

The level of severity may be increased to reflect other symptoms and the degree of
functional disability:

 Mild: An average of 1-3 episodes of inappropriate compensatory behaviors per

week
 Moderate: An average of 4-7 episodes of inappropriate compensatory behaviors
per week
 Severe: An average of 8-13 episodes of inappropriate compensatory behaviors
per week
 Extreme: An average of 14 or more episodes of inappropriate compensatory
behaviors per week
 DIFFERENTIAL DIAGNOSIS

 Binge eating disorder

 Major depressive disorder ,with a typical feature
BINGE EATING DISORDER

By Anam Tariq
 INTRODUCTION

 BingeEating Disorder (BED) is commonly known by compulsive

overeating or consuming abnormal amounts of food while feeling
unable to stop and at loss of control.
 DIAGNOSTIC CRITERIA

Criterion A:
 Recurrent episodes of binge eating.
 An episode of binge eating is characterised by the following symptoms:
1. Eating in discrete period of time
2. Lack of control while eating
 DIAGNOSTIC CRITERIA

Criterion B:
Binge eating episodes are associated with three or more symptoms from the
following:
1. Eating much more rapidly than normal.
2. Eating until feeling uncomfortably ill.
3. Eating large amount of food when not feeling physically hungry.
4. Eating alone because of feeling embarrassed by how much one is eating.
5. Feeling disgusted with oneself, depressed or very guilty afterward.
 DIAGNOSTIC CRITERIA

Criterion C
 Duration:
Binge eating occurs at least once a week for 3 months.
 SPECIFIERS

The level of severity is based on frequency of episodes of binge eating per week
and according to this distribution, level of severity may be:
 Mild: 1-3 episodes/week
 Moderate: 4-7 episodes/week
 Severe: 8-13 episodes/week
 Extreme: 14 or more episodes/week
 DIFFERENTIAL DIAGNOSIS

1. Bulimia nervosa: The recurrent inappropriate compensatory behavior (purging,

driven exercise) seen in bulimia nervosa is absent in binge eating disorder.

2. Bipolar and depressive disorders: Increased eating in depressive disorders is

not associated with the loss of control that exists in binge eating disorder.
ETIOLOGY OF EATING
DISORDERS

By Naima Azhar
 BIOLOGICAL FACTORS

 Eating disorders are often biologically inherited and tend to run in families.
 Abnormalities in the structure or activity of the hypothalamus (a brain
structure responsible for regulating eating behaviors). Hypothalamus of
bulimics may not trigger a normal satiation (feeling full or finished) response.
So, even after a meal, these individuals do not feel full.
 The neurotransmitter serotonin affects binging behavior in bulimics. So, the
binge behavior of bulimics may also be a response to low serotonin levels in
the brain.
 PSYCHOLOGICAL & SOCIAL FACTORS

 Psychological factors like perfectionism (self-oriented perfectionism, which

involves setting unrealistically high expectations for yourself) and dissatisfied
body image (People who develop eating disorders are more likely to report higher
levels of body image dissatisfaction and an internalization of the appearance ideal)
also leads to eating disorders
 Teasing or bullying: Being teased or bullied – especially about weight - is
emerging as a risk factor in many eating disorders.
 According to Observational Model, maladaptive eating behaviors are learnt
through imitation. An individual imitating (copying) the models shown on media
to maintain ideal weight.
 OTHER FACTORS

 Traumatic Event:
Survivors of trauma like physical or sexual abuse can experience feelings of
shame, guilt, body dissatisfaction, and a feeling of lack of control. Eating
disorder behaviors can be a way for individuals to cope and manage feelings
and stress
 History of an anxiety disorder: Those with anorexia, showed signs of an
anxiety disorder (including generalized anxiety, social phobia, and OCD)
before the onset of their eating disorder.
 ASSESSMENT

 EDI (The Eating disorder inventory comprises 64 questions, divided into eight
subscales. Each question is on a 6-point scale (ranging from 'always' to 'never')
 EDE-Q (The Eating Disorder Examination Questionnaire is a 41 item self-report
questionnaire divided into four subscales . Each question is on a 7-point scale from 0-6.
 ACTA (Attitude toward change in Eating Disorder- An instrument used to assess
changes in patients cognitions, behaviors and emotions related to the disorder)
 EAT (Eating Attitudes Test (EAT, EAT-26), is a widely used test and consists of 26-
items. It measures the symptoms of Eating disorder.
 (EDDS) Eating Disorder Diagnostic Scale is a 22 item self-report questionnaire that
assesses the presence of three eating disorders; anorexia nervosa, bulimia
nervosa and binge eating disorder
 SCOFF questionnaire used to assess presence of eating disorders.
 OTHER ASSESMENT

 Physical Examination ( Checking body weight)

 Nutritional assessment (Eating pattern)
 INTERVENTION

 CBT
 Medical nutrition therapy
 DBT (Dielectric Behavior therapy is an approach toward healthier ways of
coping with emotional triggers that might cause eating disorder symptoms by
changing cognitions and push for positive behavioral changes)
 Art therapy (It can be a valuable part of the recovery process for those suffering
with eating disorders as it allows patients to express themselves through
creativity)
 Family Therapy
 Medications (Anti depressants)