Eating disorder : Classification and tratment

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

4. Anorexia Nervosa

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

8. 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.

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

10. 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

11. 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 ).

12. 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 .

13. 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.

14. 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

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

16. 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

17. T hank y ou Heba Essawy Website www. Hebaessawy.com Facebook Dr.hebaessawy Emai l [email protected]