Download presentation
Presentation is loading. Please wait.
1
FEEDING AND EATING DISORDER
BY: FARAHANA NASIR MAHFUZAH MAT JUNOS 10th NOVEMBER 2015
2
TIMELINE Introduction DSM-4 vs DSM-5 Pica and rumination
Avoidant/restrictive food intake disorder Anorexia Nervosa Bulimia Nervosa Binge-eating disorder
3
INTRODUCTION Feeding disorder commonly in infancy or early childhood, a child's refusal to eat certain food groups, textures, solids or liquids for a period of at least one month, which causes them to not gain enough weight or grow naturally. Eating disorder is a group of condition by abnormal eating habit to detriment of an individual’s physical and mental health Insufficient food intake Excessive food intake
4
DSM-4 vs DSM-5 Anorexia nervosa Bulimia nervosa
Eating disorder not otherwise specific PICA Rumination Avoidance & Restrictive food intake disorder Binge-eating disorder Among the most substantial changes are recognition of binge eating disorder, revisions to the diagnostic criteria for anorexia nervosa and bulimia nervosa, and inclusion of pica, rumination and avoidant/restrictive food intake disorder. DSM-IV listed the latter three among Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence, a chapter that will not exist in DSM-5. In recent years, clinicians and researchers have realized that a significant number of individuals with eating disorders did not fit into the DSM-IV categories of anorexia nervosa and bulimia nervosa. By default, many received a diagnosis of “eating disorder not otherwise specified.” Studies have suggested that a significant portion of individuals in that “not otherwise specified” category may actually have binge eating disorder
5
Pica (DSM-5) 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 spectrum disorder), or during a medical condition (e.g. pregnancy), it is severe enough to warrant independent clinical attention. Note: Pica often occurs with other mental health disorders associated with impaired functioning * Eg non-nutritive substance, paper, clay, metal, chalk, soil, glass, sand * can lead to 1) toxixity 2) anemia / malnutrition 3) surgical emergency
6
RUMINATION DISORDER (DSM-5)
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. If occurring in the presence of another mental disorder (e.g. intellectual developmental disorder), it is severe enough to warrant independent clinical attention. Rumination vs binge-eating disorder vs purging - rumination, repeated regurgitation - binge-eating, excessive food intake - purging, induce vomite, laxative, want to take the food out again
7
AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER (DSM-5)
1. 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: Significant weight loss (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. 2. The disturbance is not better explained by lack of available food or by an associated culturally practice. 3. The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced [body image]. 4. The eating disturbance is not due to current medical condition or not better explained by another mental disorder. When it’s occur in the context of another condition or disorder, it warrants additional clinical attention.
8
ANOREXIA NERVOSA distorted body image and excessive dieting that leads to severe weight loss with a pathological fear of becoming fat 2 subdivision - Restrictive type: Eat little and exercise vigorously. More often with obsessive-compulsive traits. - Binge eating/purging type: Eat in binges followed by induced vomiting, laxatives, excessive exercise or diuretics. More with major depression and substance abuse. Female > male Common in thin figure profesional (ballet, cheerleader, figure skating, modelling, etc)
9
DSM-V DIAGNOSTIC CRITERIA
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. Intense fear of gaining weight or becoming fat, even though underweight. 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 denial of the seriousness of the current low body weight. The criteria cant be use in male or female using OCP
10
PHYSICAL FINDING AND COMPLICATION
Amenorrea Lanugo (fine body hair) Melanosis coli (laxative abuse) Leukopenia Osteoporosis Hypochloremic hyperkalemic alkalosis Hypercholesterolemia Arrhythmias Cardiac arrest
11
Variable (complete, fluctuate, deteriorate) Mortality 10% due to:
DDX Major depression Bulimia Somatization Schizophrenia COURSE AND PROGNOSIS Variable (complete, fluctuate, deteriorate) Mortality 10% due to: Starvation Suicide Electrolye disturbance Cardiac failure
12
TREATMENT - Food - hospitalization - behavioral, family (Maudsley approach), supervise wt-gained program - SSRI (paroxetine: help the comorbid depression) - low dose 2nd gen. antipsychotic - benzodiazepam *refeeding syndrome Food. The caloric intake, 1st to stabilize wt, then wt gain Hospitalization : if the wt more than 20% below ideal body wt or if there’s serious medical/psychiatric complication. Maudsley approach : SSRI show unaffective due to inadequate dietary intake for trypton (serotonin precursor) Refeeding syndrome: cardiovascular collapse, starvation-induced hypophosphatemia, and dangerous fluctuations in potassium, sodium, and magnesium levels
13
PREPARED BY : MAHFUZAH BINTI MD JUNOS
14
BULIMIA NERVOSA An eating disorder which is characterized by recurrent binge eating, followed by compensatory behaviors such as - vomiting - use of laxatives,enemas,diuretics - excessive exercise Patients are embarrassed of their binge eating and overly concern with body weight however they usually maintain a normal weight or even overweight There are two subcategories of bulimia : - PURGING TYPE : involve vomiting,enemas ,diuretics - NON PURGING TYPE : involve excessive exercise or fasting
15
DIAGNOSIS ( DSM – 5 ) Recurrent episodes of binge eating.
Recurrent inappropriate attempts to compensate for overeating and prevent weight gain These behaviors occur at least once a week for 3 months. Perception of self-worth is excessively influenced by body weight and shape.
16
PHYSICAL FINDINGS AND COMPLICATIONS :
Dental enamel erosion Salivary glands hypertrophy (sialadenosis ) Calloused Aspiration Electrolyte imbalance (hypochloremic hypokalemic alkalosis) Laxative dependence ( metabolic acidosis )
18
COMORBID PSYCHIATRY DISORDER
Mood disorders Anxiety disorder Personality disorders Substance abuse
19
EPIDEMIOLOGY Lifetime prevalence : 1-4% > common in female
Onset in late adolescence or early adulthood More common in developed countries High incidence associated with other psychiatric disorder
20
COURSE AND PROGNOSIS Chronic and relapsing illness
Better prognosis than anorexia nervosa Symptoms exacerbated by stressful conditions Half patients recover fully with treatment Half patients have chronic course with fluctuating symptoms
21
TREATMENT : 1. PHARMACOTHERAPY : - SSRIs are first line treatment ( Fluoxetine ) - TCAs THERAPY - Cognitive behavior therapy - Interpersonal psychotherapy - Group therapy - Family therapy
23
BINGE- EATING DISORDER
An eating disorder characterized by periods of extreme over-eating, but here they DO NOT try to control their weight by purging or restricting calories as do anorexics or bulimics,so they usually are obese Patients with this disorder suffer emotional distress over their binge eating. BINGE-EATING : defined as excessive food intake within a 2-hour period accompanied by a sense of lack of control
24
DIAGNOSIS ( DSM – 5 ) Recurrent episodes of binge eating
Severe distress over binge eating Binge eating occur at least once weekly for the last 3months and is not associated with compensatory behavior Three of followings are present : Eating very rapidly - Eating until uncomfortably full - Eating large amount when not hungry - Eating alone due to embarrassment over eating habit - Feeling disgusted , depressed, guilty after overeating
25
WHAT TRIGGER BINGE EATING :
Dysphoric mood Interpersonal stressors Intense hunger after dietary restrain
26
TREATMENT : Individual psychotherapy and behavioral therapy with strict diet and exercise program. Comorbid mood disorders or anxiety disorders should be treated. Pharmacotherapy: used adjunctively to promote weight loss. Include: -Stimulants: phentramine and amphetamine. (suppress appetite) -Orlistat : Xenical ( inhibit pancreatic lipase – decrease amount of fat absorbed ) -Sibutramine : Meridia ( inhibit reuptake of norepinephrine ,serotonin and dopamine
Similar presentations
© 2025 SlidePlayer.com Inc.
All rights reserved.