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is\tbased\ton\tthe\tfrequency\tof\tepisodes\tof\tbinge\teating\t(see\tbelow).\nThe\tlevel\tof\tseverity\tmay\tbe\tincreased\tto\treflect\tother\tsymptoms\tand\tthe\tdegree\tof\tfunctional\ndisability.\nMild:\n\t1-3\tbinge-eating\tepisodes\tper\tweek.\nModerate:\n\t4-7\tbinge-eating\tepisodes\tper\tweek.\nSevere:\n\t8-13\tbinge-eating\tepisodes\tper\tweek.\nExtreme:
|
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] |
Severe:\n\t8-13\tbinge-eating\tepisodes\tper\tweek.\nExtreme:\n\t14\tor\tmore\tbinge-eating\tepisodes\tper\tweek.\nOther\tspecified\tfeeding\tand\teating\n\tdisorder\nThis\tcategory\tapplies\tto\tpresentations\tin\twhich\tsymptoms\tcharacteristic\tof\ta\tfeeding\tand\teating\ndisorder\tthat\tcause\tclinically\tsignificant\tdistress\tor\timpairment\tin\tsocial,\toccupational,\tor\tother
|
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] |
important\tareas\tof\tfunctions\tpredominate\tbut\tdo\tnot\tmeet\tthe\tfull\tcriteria\tfor\tany\tof\tthe\tdisorders\nin\tthe\tfeeding\tand\teating\tdisorders\tdiagnostic\tclass.\tThe\tother\tspecified\tfeeding\tand\teating\ndisorder\tcategory\tis\tused\tin\tsituations\tin\twhich\tthe\tclinician\tchooses\tto\tcommunicate\tthe\tspecific
|
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] |
reason\tthat\tthe\tpresentation\tdoes\tnot\tmeet\tthe\tcriteria\tfor\tany\tspecific\tfeeding\tand\teating
|
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] |
disorder.\tThis\tis\tdone\tby\trecording\t“other\tspecified\tfeeding\tor\teating\tdisorder”\tfollowed\tby\tthe\nspecific\treason\t(e.g.,\t“bulimia\tnervosa\tof\tlow\tfrequency”).\tExamples\tof\tpresentations\tthat\tcan\tbe\nspecified\tusing\n\tthe\t“other\tspecified”\tdesignation\tinclude\tthe\tfollowing:\n1.
|
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] |
the\t“other\tspecified”\tdesignation\tinclude\tthe\tfollowing:\n1.\t\nAtypical\tAN:\tAll\tof\tthe\tcriteria\tfor\tAN\tare\tmet,\texcept\tthat\tdespite\tsignificant\tweight\tloss,\nthe\tindividual’s\tweight\tis\twithin\tor\tabove\tthe\tnormal\trange.\n2.\t\nBN\t(of\tlow\tfrequency\tand/or\tlimited\tduration):\tAll\tof\tthe\tcriteria\tfrom\tBN\tare\tmet,\texcept
|
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] |
that\tthe\tbinge\teating\tand\tinappropriate\tcompensatory\tbehaviors\toccur,\ton\taverage,\n\tless\nthan\tonce\ta\tweek\tand/or\tfor\tless\tthan\t3\tmonths.\n3.\t\nBED\t(of\tlow\tfrequency\tand/or\tlimited\tduration):\tAll\tof\tthe\tcriteria\tfor\tBED\tare\tmet,\texcept\nthat\tthe\tbinge\teating\toccurs,\ton\taverage,\tless\tthan\tonce\ta\tweek\tand/or\tfor\tless\tthan\t3\nmonths.\n4.
|
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months.\n4.\t\nPurging\tdisorder:\tRecurrent\tpurging\tbehavior\tto\tinfluence\tweight\tor\tshape\t(e.g.,\tself-\ninduced\tvomiting;\tmisuse\tof\tlaxatives,\tdiuretics,\tor\tother\tmedications)\n\tin\tthe\tabsence\tof\nbinge\teating.\n5.\t\nNight\teating\tsyndrome:\tRecurrent\tepisodes\tof\tnight\teating,\tas\tmanifested\tby\teating\tafter
|
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awakening\tfrom\tsleep\tor\tby\texcessive\tfood\tconsumption\tafter\tthe\tevening\tmeal.\tThere\tis\nawareness\tand\trecall\tof\tthe\teating.\tThe\tnight\teating\tis\tnot\tbetter\texplained\tby\texternal\ninfluences\tsuch\tas\tchanges\tin\tthe\tindividual’s\tsleep-wake\tcycle\tor\tby\tlocal\tsocial\tnorms.\nThe\tnight\n\teating\tcauses\tsignificant\tdistress\tand/or\timpairment\tin\tfunctioning.\tThe
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disordered\tpattern\tof\teating\tis\tnot\tbetter\texplained\tby\tBED\tor\tanother\tmental\tdisorder,\nincluding\tsubstance\tuse,\tand\tis\tnot\tattributable\tto\tanother\tmedical\tdisorder\tor\tto\tthe\teffect\nof\tmedication.\nUnspecified\tfeeding\tor\teating\tdisorder\nThis\tcategory\tapplies\tto\tpresentations\tin\twhich\tsymptoms\tcharacteristic\tof\ta\tfeeding\n\tand\teating
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and\teating\ndisorder\tthat\tcause\tclinically\tsignificant\tdistress\tor\timpairment\tin\tsocial,\toccupational,\tor\tother\nimportant\tareas\tof\tfunctioning\tpredominate\tbut\tdo\tnot\tmeet\tthe\tfull\tcriteria\tfor\tany\tof\tthe\ndisorders\tin\tthe\tfeeding\tand\teating\tdisorders\tdiagnostic\tclass.\tThe\tunspecified\tfeeding\tand\teating
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] |
and/or\tenergy\tneeds\tassociated\twith\tone\t(or\tmore)\tof\tthe\tfollowing:\n1.\n\tSignificant\tweight\tloss\t(or\tfailure\tto\tachieve\texpected\tweight\tgain\tor\tfaltering\tgrowth\nin\tchildren).\n2.\n\tSignificant\tnutritional\tdeficiency.\n3.\n\tDependence\ton\tenteral\tfeeding\tor\toral\tnutritional\tsupplements.\n4.\n\tMarked\tinterference\twith\tpsychosocial\tfunctioning.\nB.
|
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] |
4.\n\tMarked\tinterference\twith\tpsychosocial\tfunctioning.\nB.\t\nThe\tdisturbance\tis\tnot\tbetter\texplained\tby\tlack\tof\tavailable\tfood\tor\tby\tan\tassociated\nculturally\tsanctioned\tpractice.\nC.\t\nThe\teating\tdisturbance\tdoes\tnot\toccur\texclusively\tduring\tthe\tcourse\tof\tAN\tor\tBN,\tand
|
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another\tcondition\tor\tdisorder,\tthe\tseverity\tof\tthe\teating\tdisturbance\texceeds\tthat\troutinely\nassociated\twith\tthe\tcondition\tor\tdisorder\tand\twarrants\tadditional\tclinical\tattention.\nPica\nA.\t\nPersistent\teating\tof\tnonnutritive,\tnonfood\tsubstances\n\tover\ta\tperiod\tof\tat\tleast\t1\tmonth.\nB.
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over\ta\tperiod\tof\tat\tleast\t1\tmonth.\nB.\t\nThe\teating\tof\tnonnutritive,\tnonfood\tsubstances\tis\tinappropriate\tto\tthe\tdevelopmental\tlevel\nof\tthe\tindividual.\nC.\t\nThe\teating\tbehavior\tis\tnot\tpart\tof\ta\tculturally\tsupported\tor\tsocially\tnormative\tpractice.\nD.\t\nIf\tthe\teating\tbehaviors\toccur\tin\tthe\tcontext\tof\tanother\tmental\tdisorder\t(e.g.,\tintellectual
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] |
disability\t[intellectual\tdevelopmental\tdisorder],\tautism\n\tspectrum\tdisorder,\tschizophrenia)\nor\tmedical\tcondition\t(including\tpregnancy),\tit\tis\tsufficiently\tsevere\tto\twarrant\tadditional\nclinical\tattention.\nRumination\tdisorder\nA.\t\nRepeated\tregurgitation\tof\tfood\tover\ta\tperiod\tof\tat\tleast\t1\tmonth.\tRegurgitated\tfood\tmay\tbe
|
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] |
rechewed,\treswallowed,\tor\tspit\tout.\nB.\t\nThe\trepeated\tregurgitation\tis\tnot\tattributable\tto\tan\tassociated\tgastrointestinal\tor\tother\nmedical\tcondition\t(e.g.,\tgastroesophageal\treflux,\tpyloric\tstenosis).\nC.\t\nThe\teating\tdisturbance\tdoes\tnot\toccur\texclusively\tduring\tthe\tcourse\tof\tAN,\tBN,\tBED,\tor\navoidant/restrictive\tfood\tintake\tdisorder.\nD.
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avoidant/restrictive\tfood\tintake\tdisorder.\nD.\t\nIf\tthe\tsymptoms\toccur\tin\tthe\tcontext\tof\tanother\tmental\tdisorder\t(e.g.,\tintellectual\tdisability\n[intellectual\tdevelopmental\tdisorder]\tor\tanother\tneurodevelopmental\tdisorder),\tthey\tare
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] |
sufficiently\n\tsevere\tto\twarrant\tadditional\tclinical\tattention.\n*A\tchange\tto\tcriterion\tA\thas\tbeen\tproposed.\tThe\tstem\tincludes\tthe\tclause,\t“as\tmanifested\tby\tpersistent\nfailure\tto\tmeet\tappropriate\tnutritional\tand/or\tenergy\tneeds;”\thowever,\tcriterion\tA.4\tdoes\tnot\tdescribe\ta
|
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] |
manifestation\tof\ta\tnutritional\tproblem.\tThe\tAPA\tproposes\tto\tdelete\tthe\tclause\tin\tthe\tstem,\tso\tthat\tmarked\npsychosocial\n\timpairment\talone\twould\tsatisfy\tcriterion\tA.\t\nAmerican\tPsychiatric\tAssociation:\t\nDiagnostic\tand\tStatistical\tManual\tof\tMental\tDisorders,\n\ted\t5\n,\tArlington,\nVA,\t2013,\tAmerican\tPsychiatric\tAssociation.\nAnorexia\tnervosa
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VA,\t2013,\tAmerican\tPsychiatric\tAssociation.\nAnorexia\tnervosa\nEssential\tfeatures\tof\t\nanorexia\tnervosa\t(AN)\n\tinclude\tpersistent\tenergy\tintake\trestriction;\tintense\nfear\tof\tgaining\tweight\tor\tof\tbecoming\tfat\tor\tpersistent\tbehavior\tthat\tinterferes\n\twith\tmaintenance\tof
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] |
with\tmaintenance\tof\nappropriate\tweight;\tand\ta\tdisturbance\tin\tself-perceived\tweight\tor\tshape.\tThe\ttwo\tdiagnostic\nsubtypes\tare\trestrictive\teating\tonly\t(AN-R)\tand\trestrictive\teating\tinterspersed\twith\tbinge\teating\tor\npurging\n\t(AN-BP);\tcrossover\tbetween\tthe\tsubtypes\tis\tpossible\tover\tthe\tcourse\tof\tillness.\tThe\tDSM-5
|
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] |
allows\tclinicians\tto\tdocument\ta\tseverity\trating\tfor\ta\tcase\tof\tAN:\tmild,\tmoderate,\tsevere,\n\tand\nextreme.\tSeverity\tratings\tare\tdifferentiated\tbased\ton\tcurrent\tbody\tmass\tindex\t(BMI,\tadults)\tor\tBMI\npercentile\t(children/adolescents);\thowever,\tthe\trating\tmay\tbe\tincreased\tat\tthe\tclinician’s\tdiscretion
|
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] |
to\treflect\tclinical\tsymptoms,\tdegree\tof\tfunctional\tdisability,\tand\tthe\tneed\tfor\tsupervision.\tIn\tthe\ngeneral\tpopulation,\tlifetime\tprevalence\tof\tAN\tis\tabout\t1%\tin\twomen\tand\tless\tthan\t0.5%\tin\tmen\n\t(\nHay\net\tal,\t2014\n).\tPresentation\ttypically\toccurs\tduring\tadolescence\tor\tyoung\tadulthood,\tbut\tprepubertal
|
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] |
and\tlate-onset\t(after\tage\t40)\tcases\thave\tbeen\tdescribed.\tAlthough\tAN\toccurs\tacross\tculturally\tand\nsocially\tdiverse\tpopulations,\tincreased\tprevalence\toccurs\tin\tpostindustrialized,\thigh-income\ncountries.\tWithin\tthe\tUnited\tStates,\tpresentation\tof\tweight\tconcerns\tamong\tindividuals\twith\tEDs\nmay\tvary\n\tacross\tcultural\tand\tethnic\tgroups\t(\nBecker,\t2016\n;
|
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] |
may\tvary\n\tacross\tcultural\tand\tethnic\tgroups\t(\nBecker,\t2016\n;\t\nSala,\t2013\n).\tBody\timage\tdissatisfaction,\ndangerous\tweight\tcontrol\tbehaviors,\tand\tEDs\tare\temerging\tissues\tfor\tlesbian,\tgay,\tbisexual,\ntransgender\tand\tqueer\t(LGBTQ)\tyouth\t(\nMcClain\tand\tPeebles,\t2016\n),\tbut\tprevalence\tand\tincidence
|
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0.08650728315114975,
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0.09973607957363129,
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0.03423129767179489,
0.05793614313006401,
0.05516470968723297,
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0.02459653839468956,
0.1097588837146759,
0.01703765243291855,
0.06331808120012283,
0.0058467150665819645
] |
McClain\tand\tPeebles,\t2016\n),\tbut\tprevalence\tand\tincidence\nrates\tfor\tAN\tin\tthese\tpopulations\tare\tnot\tcurrently\treported.\tRisk\tand\tprognostic\tfactors\tassociated\nwith\tAN\tinclude\tgenetic,\n\tphysiologic,\tenvironmental,\tand\ttemperamental\tcharacteristics\t(\nTable\n21.1\n).\tThe\tcrude\tmortality\trate\tis\tabout\t5%\tper\tdecade\twith\tdeath\tattributed\tto\tmedical
|
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0.020081128925085068,
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0.054416850209236145,
0.05663338303565979,
0.08962668478488922,
0.010362118482589722
] |
complications\tdirectly\trelated\tto\tAN\tor\tsuicide\t(\nAPA,\t2013\n).\nTABLE\t21.1\nRisk\tand\tPrognostic\tFactors\tAssociated\tWith\tAnorexia\tNervosa\tand\tBulimia\tNervosa\nDiagnosis\nTemperament\nEnvironment\nGenetic\tand\tPhysiologic\nAN\nObsessional\ttraits\nin\tchildhood\nAnxiety\ndisorders\nCultures/settings\tthat\tvalue\nthinness\nOccupations/avocations\nthat\tencourage
|
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] |
thinness\nOccupations/avocations\nthat\tencourage\nthinness,\t(e.g.,\nmodeling,\telite\nathletics)\nFirst-degree\tbiological\trelative\twith\tAN,\nBN,\tbipolar\tdisorder,\tor\tdepressive\ndisorder\nHigher\tconcordance\trates\tin\nmonozygotic\tvs.\tdizygotic\ttwins\nFunctional\n\timaging\tstudies\tindicate\ta\nrange\tof\tbrain\tabnormalities\tbut\nunclear\tif\tchanges\tare\tprimary
|
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0.10301084071397781,
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] |
range\tof\tbrain\tabnormalities\tbut\nunclear\tif\tchanges\tare\tprimary\nanomalies\tor\tsecondary\tto\nmalnutrition\nBN\nWeight\tconcerns\nLow\tself-\nesteem\nDepressive\nsymptoms\nSocial\tanxiety\ndisorder\nOveranxious\ndisorder\tof\nchildhood\nInternalization\tof\tthin\tbody\nideal\nIncreased\tweight\nconcerns\nChildhood\tsexual\tabuse\nChildhood\tphysical\tabuse
|
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] |
concerns\nChildhood\tsexual\tabuse\nChildhood\tphysical\tabuse\nChildhood\tobesity/large\tbody\tsize\nEarly\tpubertal\tmaturation\nGenetic\tvulnerabilities\nAN\n,\tAnorexia\tnervosa;\t\nBN\n,\tbulimia\tnervosa.\nAmerican\tPsychiatric\tAssociation:\t\nDiagnostic\tand\tStatistical\tManual\tof\tMental\tDisorders,\n\ted\t5,\tArlington,\tVA,\tAmerican\tPsychiatric\tAssociation,\n2013.
|
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ed\t5,\tArlington,\tVA,\tAmerican\tPsychiatric\tAssociation,\n2013.\nBulimia\tnervosa\nFeatures\tof\t\nbulimia\tnervosa\t(BN)\n\tinclude\trecurrent\tepisodes\tof\tbinge\teating\tfollowed\tby\ninappropriate\tcompensatory\tbehaviors\n\tin\tan\teffort\tto\tprevent\tweight\tgain,\tand\tself-evaluation\tthat\tis\nunduly\tinfluenced\tby\tbody\tshape\tand\tweight\t(\nAPA,\t2013\n).\tA\t\nbinge
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unduly\tinfluenced\tby\tbody\tshape\tand\tweight\t(\nAPA,\t2013\n).\tA\t\nbinge\n\tconsumption\tis\tan\tepisode\tof\nuncontrollable\teating\tof\tan\texcessive\tamount\tof\tfood\tin\ta\tdiscrete\tperiod\tof\ttime.\tInappropriate\ncompensatory\tmechanisms\tinclude\tself-induced\tvomiting,\tmisuse\tof\tlaxatives,\tdiuretics,\tfasting,\tand\nexcessive\texercise.\tAn\tindividual\tmay\temploy
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excessive\texercise.\tAn\tindividual\tmay\temploy\n\tone\tor\tmore\tmethods.\tThe\tDSM-5\tincludes\tfour\tlevels\nof\tseverity\tratings\tbased\ton\tfrequency\tof\tinappropriate\tcompensatory\tbehaviors:\tmild,\tmoderate,\nsevere,\textreme.\tAlthough\tthe\tdefault\tlevel\tof\tseverity\tis\tbased\ton\tthe\tfrequency\tof\tthese\tepisodes,
|
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the\tlevel\tof\tseverity\tmay\tbe\tincreased\tat\tthe\tclinician’s\tdiscretion\tto\treflect\tother\tsymptoms\tand\tthe\ndegree\tof\tfunctional\tdisability.\tLifetime\tprevalence\n\tof\tBN\tis\tapproximately\t2%\tin\twomen\tand\t0.5%\tin
|
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men\t(\nHay\tet\tal,\t2014\n).\tInitial\tpresentation\ttypically\toccurs\tduring\tadolescence\tor\tyoung\tadulthood;\nprepubertal\tand\tlate\tonset\t(after\tage\t40)\tcases\tare\tuncommon.\tDiagnostic\tcrossover\tfrom\tBN\tto\tAN\noccurs\tin\t10%\tto\t15%\tof\tcases.\tHowever,\tindividuals\twho\tcross\tover\tto\tAN\toften\trevert\tback\tto\tBN,\nand\tsome\texperience\tmultiple\tcrossovers\tbetween\tthese
|
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] |
and\tsome\texperience\tmultiple\tcrossovers\tbetween\tthese\n\tdisorders.\tBN\toccurs\tat\tsimilar\tfrequencies\nin\tindustrialized\tcountries\t(\nAPA,\t2013\n).\tThe\tprevalence\tof\tBN\tis\tsimilar\tamong\tethnic\tgroups\t(\nAPA,\n2013\n).\tRisk\tand\tprognostic\tfactors\tassociated\twith\tBN\tinclude\tgenetic,\tphysiologic,\tenvironmental,\nand\ttemperamental\tcharacteristics\t(see
|
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0.12789511680603027,
0.08009083569049835,
0.08276690542697906,
-0.02057492733001709
] |
and\ttemperamental\tcharacteristics\t(see\t\nTable\t21.1\n).\tBN\tis\tassociated\twith\ta\tsignificantly\televated\nrisk\tfor\tmortality\t(all-cause\tand\tsuicide),\twith\ta\tcrude\n\tmortality\trate\tof\tapproximately\t2%\tper\tdecade\n(\nAPA,\t2013\n).\nBinge\teating\tdisorder\nA\tmajor\tchange\tin\tthe\tDSM-5\tis\tthe\tofficial\trecognition\tof\t\nbinge\teating\tdisorder\t(BED)\n\tas\ta
|
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] |
binge\teating\tdisorder\t(BED)\n\tas\ta\nclinical\tdisorder.\tAlthough\tBED\twas\tincluded\tin\tthe\tDSM-IV\t(\nAPA,\t2000\n),\tthose\tcriteria\twere\nestablished\tonly\tfor\tresearch\tpurposes.\tThe\tessential\tfeature\tof\tBED\tis\trecurrent\tepisodes\tof\tbinge\neating\twithout\tinappropriate\n\tcompensatory\tmeasures\t(such\tas\tpurging)\tintended\tto\tprevent\tweight
|
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] |
compensatory\tmeasures\t(such\tas\tpurging)\tintended\tto\tprevent\tweight\ngain.\tBED\tdiagnostic\tcriteria\tinclude\tfour\tlevels\tof\tseverity\tratings\t(mild,\tmoderate,\tsevere,\tand\nextreme)\tthat\tare\tbased\ton\tthe\tfrequency\tof\tbinge\tepisodes.\tThe\tlevel\tof\tseverity\tmay\tbe\tincreased
|
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at\tthe\tclinician’s\tdiscretion\tto\treflect\tother\tsymptoms\tas\twell\tas\tthe\tdegree\tof\tfunctional\tdisability.\nThe\tlifetime\tprevalence\tof\tBED\n\tis\tapproximately\t3.5%\tin\twomen\tand\t2%\tin\tmen\t(\nHay\tet\tal,\t2014\n).\nBED\toccurs\tat\tsimilar\tfrequencies\tin\tmost\tindustrialized\tcountries.\tIn\tthe\tUnited\tStates,\tprevalence
|
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] |
rates\tappear\tcomparable\tamong\tCaucasians,\tLatinos,\tAsians,\tand\tAfrican\tAmericans.\tBED\tis\tmore\nprevalent\tamong\tindividuals\tseeking\tweight\tloss\ttreatment\tthan\tin\tthe\tgeneral\tpopulation.\tCrossover\nfrom\tBED\tto\tother\tEDs\tis\tuncommon.\tBinge\n\teating\tdisorder\tappears\tto\trun\tin\tfamilies,\twhich\tmay\nreflect\tadditive\tgenetic\tinfluences\t(\nAPA,\t2013
|
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reflect\tadditive\tgenetic\tinfluences\t(\nAPA,\t2013\n);\tless\tis\tknown\tabout\ttemperamental\tand\nenvironmental\trisk\tand\tprognostic\tfactors.\nOther\tspecified\tfeeding\tor\teating\tdisorder\nOther\tspecified\tfeeding\tor\teating\tdisorder\t(OSFED)\n\tapplies\tto\tatypical\tAN\t(restrictive\teating\tin\nthe\tpresence\tof\tnormal\tweight),\tatypical\tBN\tand\tatypical\tBED\t(episodes
|
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] |
are\tless\tfrequent\tor\tof\nlimited\tduration),\tpurging\tdisorder\t(i.e.,\trecurrent\tpurging\tin\tthe\tabsence\tof\tbinge\teating),\tand\tnight\neating\tsyndrome.\tTreatment\tof\tsubclinical\tAN,\tBN,\tand\tBED\tis\tsimilar\tto\tthat\tused\tfor\tfull\tcriteria\npresentation,\tbut\tthe\tfrequency\tof\ttherapeutic\tinterventions\t(e.g.,\tpsychotherapy,\tnutrition\ttherapy,
|
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medical\tmanagement)\tand\tthe\ttreatment\tsetting\t(e.g.,\tinpatient\thospitalization,\n\tday\thospital/partial\nhospitalization,\tintensive\toutpatient\ttreatment,\toutpatient\ttreatment)\tmay\tdiffer.\tPatients\twith\ta\npurging\tdisorder\tand\tnight\teating\tsyndrome\toften\tbenefit\tfrom\tpsychotherapeutic\tapproaches\tused\nin\tthe\ttreatment\tof\tBN\tand\tBED.
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in\tthe\ttreatment\tof\tBN\tand\tBED.\nAvoidant/restrictive\tfood\tintake\tdisorder\nPatients\twith\t\navoidant/restrictive\tfood\tintake\tdisorder\t(ARFID)\n\texhibit\trestrictive/avoidant\neating\tbehaviors\n\tthat\tresult\tin\tsignificant\tweight\tloss,\timpaired\tgrowth,\tnutritional\tdeficiencies,\tand
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reliance\ton\tenteral\tfeedings/supplements,\tas\twell\tas\timpaired\tpsychosocial\tfunctioning\t(\nNorris\tet\tal,\n2016\n).\tThese\trestrictive\teating\tbehaviors\tare\tnot\tassociated\twith\tbody\timage\tdissatisfaction\tor\tfear\nof\tweight\tgain.\tCompared\twith\tpatients\twith\tAN\tand\tBN,\tthese\tindividuals\ttend\tto\tbe\tyounger\tand\nhave\thigher
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] |
have\thigher\n\tproportion\tof\tmales;\tbe\tselective\t(picky)\teaters\tsince\tearly\tchildhood;\thave\tfears\tof\nchoking\tor\tvomiting;\tand\tavoid\tfoods\tbased\ton\ttheir\tappearance,\ttexture,\tand\tsmell\t(\nFisher\tet\tal,\n2014\n).\nClinical\tcharacteristics\tand\tmedical\tcomplications
|
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] |
2014\n).\nClinical\tcharacteristics\tand\tmedical\tcomplications\nAlthough\tEDs\tare\tclassified\tas\tpsychiatric\tillnesses,\tthey\tare\tassociated\twith\tsignificant\tmedical\ncomplications,\tmorbidity,\tand\tmortality.\tNumerous\n\tphysiologic\tchanges\tresult\tfrom\tthe\tdysfunctional\nbehaviors\tassociated\twith\tAN,\tBN,\tand\tBED.\tSome\tare\tminor\tchanges\trelated\tto\texcessive\tor
|
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] |
inadequate\tnutrient\tintake;\tsome\tare\tpathologic\talterations\twith\tlong-term\tconsequences;\ta\tfew\nrepresent\tpotentially\tlife-threatening\tconditions.\nAnorexia\tnervosa\nInitially,\tindividuals\twith\tAN\tmay\tsimply\tappear\tunderweight.\tAs\tthe\tdisease\tprogresses,\tpatients\nappear\tincreasingly\tcachectic\tand\tprepubescent\tin\ttheir\tappearance\t(\nFig.\t21.1
|
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] |
Fig.\t21.1\n).\tCommon\tphysical\nfindings\tat\tthis\tstage\tinclude\tlanugo\t(i.e.,\ta\tsoft,\tdowny\thair\tgrowth\ton\tthe\tface\tand\textremities),\tdry\nskin\tand\thair,\tcold\tintolerance,\tcyanosis\tof\tthe\textremities,\tedema,\tand\tprimary\tor\tsecondary\namenorrhea.\tThe\tdegree\tof\tsymptomatology\tvaries\tperson\tto\tperson\tand\twith\tduration\tof\tillness;\tfor\nexample,
|
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] |
example,\n\tsome\twomen\twith\tanorexia\texperience\tamenorrhea,\tsome\tdo\tnot.
|
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] |
FIG.\t21.1\nPhysical\tand\tclinical\tsigns\tand\tsymptoms\tof\tbulimia\tnervosa\tand\tanorexia\tnervosa.\t\nDTRs\n,\tDeep\ntendon\treflexes;\t\nECG\n,\telectrocardiogram;\t\nWBC\n,\twhite\tblood\tcell.\nCardiovascular\tcomplications\tmay\tinclude\tbradycardia,\torthostatic\thypotension,\tcardiac
|
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0.02132692001760006,
0.002628206042572856
] |
arrhythmias,\tand\tpericardial\teffusion.\tProtein-energy\tmalnutrition\t(PEM)\twith\tresultant\tloss\tof\tlean\nbody\tmass\tis\tassociated\twith\treduced\n\tleft\tventricular\tmass\tand\tsystolic\tdysfunction;\thowever,\ncardiac\tfunction\tis\tlargely\treversible\twith\tnutritional\trehabilitation\tand\tweight\trestoration.
|
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] |
Gastrointestinal\tcomplications\tsecondary\tto\tstarvation\tinclude\tdelayed\tgastric\temptying,\ndecreased\tsmall\tbowel\tmotility,\tand\tconstipation.\tComplaints\tof\tabdominal\tbloating\tand\ta\tprolonged\nsensation\tof\tabdominal\tfullness\tcomplicate\tthe\trefeeding\n\tprocess.\tLactose\tintolerance\tmay\tdevelop
|
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] |
process.\tLactose\tintolerance\tmay\tdevelop\nsecondary\tto\tmalnutrition\tand\twill\tusually\tresolve\tafter\tweight\tgain.\tOral\tenzyme\tsupplements\tand\nlactose-free\tdairy\tproducts\tmay\tbe\tbeneficial\tduring\tthe\trefeeding\tprocess.\tA\tnationwide\tstudy\nconducted\tin\tSweden\tfound\ta\tpositive\tassociation\tbetween\tceliac\tdisease\t(CD)\tand\tAN\tboth\tbefore
|
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] |
and\tafter\tCD\tdiagnosis\t(\nMarild\tet\tal,\t2017\n);\tthis\tbidirectional\tassociation\n\tmay\tbe\tattributed\tto\nmisdiagnosis,\tshared\trisk\tfactors,\tand\tshared\tgenetic\tsusceptibility.\nOsteopenia,\tosteoporosis,\tand\tincreased\trisk\tof\tbone\tfractures\toccur\tin\tmales\tand\tfemales\twith\tAN\n(\nWestmoreland\tet\tal,\t2016
|
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] |
(\nWestmoreland\tet\tal,\t2016\n).\tAdolescents\twith\tAN\thave\tdecreases\tin\tbiochemical\tmarkers\tof\tboth\nbone\tformation\tand\tresorption,\tindicative\tof\treduced\tbone\tturnover,\twhereas\tadults\twith\tAN\thave\ndecreased\tbone\tformation\n\tand\tincreased\tresorption\tmarkers,\tindicative\tof\tan\tuncoupling\tof\tbone
|
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] |
turnover,\tboth\tof\twhich\tlead\tto\treductions\tin\tbone\tmineral\tdensity\t(BMD)\t(\nRobinson\tet\tal,\t2017\n).\tIn\ta\nsample\tof\tpredominantly\tfemale\tadults,\tosteopenia\twas\tdiagnosed\tin\t25.9%\tof\tAN-R\tpatients\tand\n34.8%\tof\tAN-BP\tpatients\tand\tosteoporosis\twas\tdiagnosed\tin\t34.3%\tof\tAN-R\tand\t21.1%\tof\tAN-BP\npatients\t(\nMehler\tet\tal,\t2018\n).\tAlthough
|
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] |
patients\t(\nMehler\tet\tal,\t2018\n).\tAlthough\n\tweight\tgain\tand\tresumption\tof\tmenses\tin\tAN\tpatients\tare\nassociated\twith\tincreased\tspine\tand\thip\tBMD,\tpermanent\tdeficits\tare\tlikely.\tNo\tspecific\ttherapies\tare\ncurrently\tapproved\tfor\ttreatment\tof\tosteoporosis\tsecondary\tto\tAN.
|
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currently\tapproved\tfor\ttreatment\tof\tosteoporosis\tsecondary\tto\tAN.\nPatients\twith\tAN\thave\tthyroid\thormones\tlevels\tconsistent\twith\tthe\tnonthyroidal\tillness\tsyndrome:\nthyroxin\t(T4)\tand\ttriiodothyronine\t(T3)\tare\tlow\tor\tlow\tnormal,\treverse\tT3\n\tis\televated,\tand\tthyroid-\nstimulating\thormone\t(TSH)\tis\tnormal\tor\televated\t(\nWinston,\t2012
|
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] |
stimulating\thormone\t(TSH)\tis\tnormal\tor\televated\t(\nWinston,\t2012\n).\tThis\tsyndrome\tis\tlikely\tan\nadaptive\tresponse\tto\tconserve\tenergy\tduring\tchronic\tundernutrition,\tand\tthese\tabnormalities\ntypically\tnormalize\twith\tweight\tgain.\nAbnormal\tliver\tfunction\ttests\tmay\toccur\tin\tAN\t(\nMehler\tet\tal,\t2018\n).\tHepatic\tchanges\tare\tgenerally
|
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] |
Mehler\tet\tal,\t2018\n).\tHepatic\tchanges\tare\tgenerally\nasymptomatic\tand\tself-limiting,\tbut\trare\tcases\tof\n\tliver\tdamage\tand\tliver\tfailure\thave\tbeen\treported.\nElevated\tenzymes\tthat\tresult\tfrom\tmalnutrition\twill\timprove\tduring\tnutritional\trehabilitation.\tLess\nfrequently,\televated\tliver\ttransaminases\tsecondary\tto\tsteatosis\tmay\toccur\tduring\tthe\trefeeding
|
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] |
process\t(\nWestmoreland\tet\tal,\t2016\n).\nRenal\tcomplications\tinclude\trenal\tinsufficiency,\tdecreased\trenal\tconcentrating\tability,\tincreased\nurine\toutput,\tproteinuria,\n\tand\thematuria.\tIn\tgeneral,\tthese\tsymptoms\tameliorate\twith\tadequate\nhydration\tand\ttreatment\tof\tmalnutrition\t(\nCampbell\tand\tPeebles,\t2014\n).
|
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] |
Campbell\tand\tPeebles,\t2014\n).\nHematologic\tabnormalities\tinclude\tanemia,\tleukopenia,\tand\tthrombocytopenia.\tAnemia\treportedly\noccurs\tin\t20%\tto\t40%\tof\tmalnourished\tAN\tpatients,\tyet\tiron\tdeficiency\tis\tnot\ttypically\tfound\t(\nMehler\net\tal,\t2018\n;\t\nWestmoreland\tet\tal,\t2016\n).\nBulimia\tnervosa
|
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] |
Clinical\n\tsigns\tand\tsymptoms\tof\tBN\tare\tmore\tdifficult\tto\tdetect\tbecause\tpatients\tare\tusually\tof\nnormal\tweight\tand\tsecretive\tin\tbehavior.\tWhen\tvomiting\toccurs,\tthere\tmay\tbe\tclinical\tevidence\tsuch\nas\t(1)\tscarring\tof\tthe\tdorsum\tof\tthe\thand\tused\tto\tstimulate\tthe\tgag\treflex,\tknown\tas\t\nRussell’s\tsign\n(\nFig.\t21.2
|
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] |
Russell’s\tsign\n(\nFig.\t21.2\n);\t(2)\tparotid\tgland\tenlargement;\tand\t(3)\terosion\tof\tdental\tenamel\twith\tincreased\tdental\ncaries\tresulting\n\tfrom\tthe\tfrequent\tpresence\tof\tgastric\tacid\tin\tthe\tmouth.\nFIG.\t21.2\nRussell’s\tsign.\tCalluses\ton\tthe\tknuckles\tor\tthe\tback\tof\tthe\thand\tresulting\tfrom\trepeated\tself-induced\nvomiting\tover\ta\tlong\tperiod\tof\ttime.
|
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] |
vomiting\tover\ta\tlong\tperiod\tof\ttime.\nGastrointestinal\tsymptoms\toccur\tin\tindividuals\twith\tBN\twho\tuse\tvomiting\tas\ta\tpurging\tmethod\n(\nWestmoreland\tet\tal,\t2016\n).\tThese\tinclude\tsore\tthroat,\tdysphagia,\tgastrointestinal\treflux,\nesophagitis,\tmild\thematemesis\t(vomiting\tof\tblood),\tand\tmore\n\tserious\tbut\tconsiderably\tless\tfrequent
|
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serious\tbut\tconsiderably\tless\tfrequent\ncomplications\tlike\tMallory-Weiss\tesophageal\ttears,\tesophageal\trupture,\tand\tacute\tgastric\tdilation\tor\nrupture.\tSymptoms\tassociated\twith\tlaxative\tmisuse\tvary\twith\ttype,\tdose,\tand\tduration\tof\tuse.\nPatients\tmay\tpresent\twith\tdiarrhea,\tabdominal\tcramping,\trectal\tbleeding,\tand\trectal\tprolapse.\tAbuse
|
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0.12314744293689728,
0.07194536924362183,
0.06156712397933006,
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] |
of\tstimulant\tlaxatives\t(i.e.,\tthose\tcontaining\tbisacodyl,\tcascara,\n\tor\tsenna)\tcan\tdamage\tintestinal\nnerve\tfibers\tin\tthe\tbowel\twall,\twhereby\tthe\tcolon\tbecomes\tincreasingly\tdependent\ton\tthese\nstimulants\tto\tpropulse\tfecal\tmaterial;\tthis\tresults\tin\tcathartic\tcolon\tsyndrome\t(\nWestmoreland\tet\tal,\n2016
|
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] |
Westmoreland\tet\tal,\n2016\n).\tCessation\tof\tlaxatives,\tparticularly\tof\tthe\tstimulant\ttype,\tmay\tresult\tin\tsevere\trebound\nconstipation\tthat\trequires\tongoing\tmedical\tmanagement.\nSelf-induced\tvomiting\n\tand\tabuse\tof\tstimulant\tlaxatives\taccount\tfor\t90%\tof\tthe\tpurging\tbehaviors\nfound\tin\tBN\t(\nWestmoreland\tet\tal,\t2016
|
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] |
found\tin\tBN\t(\nWestmoreland\tet\tal,\t2016\n).\tVomiting\tresults\tin\tdecreased\tpotassium\t(hypokalemia),\ndecreased\tchloride,\tand\tincreased\tbicarbonate,\tresulting\tin\tmetabolic\talkalosis.\tExcessive\tlaxative\nabuse\tinitially\tresults\tin\thyperchloremic\tmetabolic\tacidosis;\thowever,\tthis\treverts\tto\ta\tstate\tof\nmetabolic\talkalosis\tafter\ta\tchronic
|
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] |
metabolic\talkalosis\tafter\ta\tchronic\n\tvolume\tdepleted\tstate\tevolves\t(\nWestmoreland\tet\tal,\t2016\n).\nHypokalemia\talso\toccurs\tsecondary\tto\tlaxative\tmisuse.\tHypokalemia\tfrom\tpurging\tis\tassociated\twith\nincreased\trisk\tof\tatrial\tand\tventricular\tarrhythmias\t(\nTrent\tet\tal,\t2013\n).
|
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] |
Trent\tet\tal,\t2013\n).\nIndividuals\twith\tBN\tmay\texperience\tmenstrual\tirregularity,\tleading\tto\tthe\tmistaken\tbelief\tthat\tthey\nare\tunable\tto\tconceive.\tUnplanned\tpregnancies,\tmiscarriages,\tand\n\tbabies\tborn\twith\ta\tlower\nbirthweight\tand\tsmaller\thead\tcircumference\tare\tdocumented\tin\tBN\tpatients\t(\nKoubaa\tet\tal,\t2013\n;\nLinna\tet\tal,\t2013
|
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] |
Koubaa\tet\tal,\t2013\n;\nLinna\tet\tal,\t2013\n).\tIt\tis\tunknown\tif\tnegative\toutcomes\tare\tassociated\twith\tmalnutrition,\tinadequate\nprenatal\tcare,\tor\tanother\tmechanism\tspecific\tto\tbulimic\tbehavior.\nBinge\teating\tdisorder\nThe\tpredominant\tfeature\tof\tBED\tis\tepisodes\tof\texcessive\teating.\tIn\tmany\tcases,\tbut\tnot\n\tall,\tthis
|
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] |
all,\tthis\nbinge\teating\tresults\tin\toverweight\tor\tobesity,\tyet\tcauses\tgreater\tfunctional\timpairment,\tdecreased\nquality\tof\tlife,\tand\tgreater\tlevels\tof\tpsychiatric\tcomorbidity\t(depression\tand\tanxiety)\tthan\tobesity\nwithout\tBED\t(\nKornstein\tet\tal,\t2016\n).\tIngestion\tof\tlarge\tamounts\tof\tfood\tmay\tcause\tconsiderable
|
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] |
).\tIngestion\tof\tlarge\tamounts\tof\tfood\tmay\tcause\tconsiderable\nupper\tand\tlower\tgastrointestinal\tdistress.\tSymptoms\tinclude\tabdominal\tpain,\tfullness,\tdelayed\ngastric\temptying,\tbloating,\tacid\tregurgitation,\theartburn,\tdysphagia,\tnausea,\tdiarrhea,\tconstipation,
|
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] |
fecal\turgency,\tfecal\tincontinence,\tand\tanal\tblockage.\tBED\tis\tassociated\twith\tan\tincreased\tlifetime\nrisk\tof\ttype\t2\tdiabetes,\thypertension,\tand\tmetabolic\tsyndrome\t(\nKornstein\tet\tal,\t2016\n).\nTreatment\tapproach
|
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] |
Treatment\tof\tEDs\trequires\ta\tmultidisciplinary\tapproach\tthat\tincludes\tpsychiatric,\tpsychological,\nmedical,\tand\tnutrition\tinterventions,\tideally\tprovided\tat\ta\tlevel\tof\tcare\tappropriate\tto\tthe\tseverity\tof\nthe\tillness.\tLevels\tof\tcare\toffered\tby\tfacilities\tin\tthe\tUnited\tStates\tinclude\tinpatient\thospitalization,
|
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] |
residential\ttreatment,\tpartial\tor\tday\thospitalization,\tintensive\toutpatient\ttreatment,\tand\toutpatient\ntreatment\t(\nAPA,\t2006\n;\t\nSteinglass\tet\tal,\t2016\n).\tTreatment\tguidelines\tand\tpolicy\tstatements\n\ton\tthe\nnecessary\tcomponents\tof\ttreatment\tare\tavailable\tfrom\tthe\tAPA\t(\nAPA,\t2006\n;\t\nAPA,\t2012\n),\tthe\tSociety\nfor\tAdolescent\tHealth\tand\tMedicine\t(SAHM)\t(
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] |
APA,\t2012\n),\tthe\tSociety\nfor\tAdolescent\tHealth\tand\tMedicine\t(SAHM)\t(\nSAHM,\t2015\n),\tthe\tAmerican\tAcademy\tof\tPediatrics\n(\nRosen\tand\tAmerican\tAcademy\tof\tPediatrics\tCommittee\ton\tAdolescence,\t2010\n),\tthe\tAcademy\tof\nNutrition\tand\tDietetics\t(\nOzier\tet\tal,\t2011\n),\tand\tthe\tRoyal\tAustralian\tand\tNew\tZealand\tCollege\tof\nPsychiatrists\t(\nHay\tet\tal,\t2014\n).
|
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outpatient\tcare.\tPsychotherapist,\tmedical\tdoctor,\tand\tregistered\tdietitian\tnutritionist\t(RDN)\nappointments\tare\ttypically\tscheduled\tat\tdifferent\ttimes\tand\tlocations;\tthis\tnecessitates\ta\tcoordinated\neffort\tat\tcommunication\tamong\tall\tclinicians.\tThe\tAPA\t(2006,\t2012)\tlevel\tof\tcare\tguidelines\nrecommends
|
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] |
recommends\n\tthat\tthe\ttreatment\tsetting\tbe\tselected\tin\taccordance\twith\ta\tpatient’s\tmedical\tstatus,\nsuicidality,\tbody\tweight,\tmotivation\tto\trecover,\tpresence\tof\tcomorbid\tconditions,\tneed\tfor\tsupervision\nand\tstructure,\tability\tto\tcontrol\tcompulsive\texercising,\tand\tpurging\tbehavior.\nPsychologic\tmanagement
|
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] |
Psychologic\tmanagement\nEDs\tare\tcomplex\tpsychiatric\tillnesses\tthat\trequire\tpsychological\tassessment\tand\tongoing\ttreatment.\nEvaluation\n\tof\tthe\tpatient’s\tcognitive\tand\tpsychological\tstage\tof\tdevelopment,\tfamily\thistory,\tfamily\ndynamics,\tand\tpsychopathologic\tcondition\tis\tessential\tfor\tthe\tdevelopment\tof\ta\tcomprehensive\npsychosocial\ttreatment\tprogram.
|
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psychosocial\ttreatment\tprogram.\nThe\tlong-term\tgoals\tof\tpsychosocial\tinterventions\tin\tAN\tare\t(1)\tto\thelp\tpatients\tunderstand\tand\ncooperate\twith\ttheir\tnutritional\tand\tphysical\trehabilitation,\t(2)\tto\thelp\tpatients\tunderstand\n\tand\nchange\tbehaviors\tand\tdysfunctional\tattitudes\trelated\tto\ttheir\tEDs,\t(3)\tto\timprove\tinterpersonal\tand
|
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social\tfunctioning,\tand\t(4)\tto\taddress\tpsychopathologic\tand\tpsychological\tconflicts\tthat\treinforce\tor\nmaintain\teating-disordered\tbehaviors\t(\nAPA,\t2006\n).\nIn\tthe\tacute\tstage\tof\tillness,\tmalnourished\tAN\tpatients\tare\tobsessive\tand\tnegativistic,\tmaking\tit\ndifficult\tto\tconduct\tformal\tpsychotherapy.\n\tIt\tis\ttherefore\trecommended\tthat\tintensive,\thighly
|
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] |
It\tis\ttherefore\trecommended\tthat\tintensive,\thighly\nstructured\tpsychological\ttherapies\tbe\tinitiated\tafter\tthe\tmedical\tand\tcognitive\teffects\tof\tacute\nstarvation\thave\tbeen\tstabilized\t(\nHay\tet\tal,\t2014\n).\nBehavioral\tmanagement\tis\toften\tused\tfor\tindividuals\twith\tlow\tweight\tand\trestrictive\teating\nbehaviors\t(\nAttia\tand\tWalsh,\t2009\n;
|
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behaviors\t(\nAttia\tand\tWalsh,\t2009\n;\t\nSteinglass\tet\tal,\t2016\n).\tThese\tprotocols\tencourage\tthe\nachievement\tof\tnormal\n\tweight\tand\thealthy\teating\tthrough\tthe\tuse\tof\treinforcements\tfor\thealthy\nbehavioral\tchoices.\tTreatment\ttypically\tincludes\tthe\tsupervision\tof\tall\tmeals\tand\tsnacks,\tas\twell\tas
|
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postmeal\tpsychological\tsupport\tfor\t“having\teaten”\tand\tmonitoring\tto\tprevent\tcompensatory\nbehaviors\tlike\tvomiting,\tstanding,\tand\texercising.\tBehavioral\tmanagement\tcan\tbe\tused\tin\tinpatient,\nresidential,\tand\toutpatient\ttreatment\n\tsettings;\thowever,\teffectiveness\tdepends\ton\tconsistency\tof
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] |
settings;\thowever,\teffectiveness\tdepends\ton\tconsistency\tof\nexpectations\tand\tsupervision,\twhich\tcan\tbe\tmore\tchallenging\ton\tan\toutpatient\tbasis.\nOnce\tacute\tmalnutrition\thas\tbeen\tcorrected\tand\tweight\trestoration\tis\tunderway,\tthe\tAN\tpatient\tis\nmore\tlikely\tto\tbenefit\tfrom\tpsychotherapy.\tPsychotherapy\tcan\thelp\tthe\tpatient\tunderstand\tand
|
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change\tcore\tdysfunctional\tthoughts,\tattitudes,\tmotives,\tconflicts,\n\tand\tfeelings\trelated\tto\tthe\tED.\nAssociated\tpsychiatric\tconditions,\tincluding\tdeficits\tin\tmood,\timpulse\tcontrol,\tand\tself-esteem,\tas\nwell\tas\trelapse\tprevention,\tshould\tbe\taddressed\tin\tthe\tpsychotherapeutic\ttreatment\tplan.
|
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No\tconsensus\thas\tbeen\treached\ton\tthe\tbest\toverall\tapproach\tto\tpsychotherapy\tin\tAN;\thowever,\nstudies\tsuggest\tthat\t\nfamily-based\ttherapy\t(FBT)\n\tis\tthe\ttreatment\tof\tchoice\tin\tadolescents\n\twith\nrelatively\tbrief\tAN\t(\nGur\tet\tal,\t2018\n).\tFBT\tfor\tAN\tis\ta\t3-phase\tmanualized\toutpatient\ttreatment
|
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