Eating Disorders:

Eating disorders (EDs) are serious mental health conditions

characterized by abnormal eating habits, distorted body
image, and an obsessive focus on weight and food. These
disorders can significantly impact an individual's physical
and psychosocial well-being, affecting their overall health
and quality of life.
Diagnostic Criteria for Eating Disorders

Anorexia Nervosa (AN) Bulimia Nervosa (BN) Binge Eating Disorder

(BED)
Bulimia nervosa (BN) is marked
Anorexia nervosa (AN) is by recurrent episodes of binge Binge eating disorder (BED)
characterized by an intense eating followed by involves recurrent episodes of
fear of gaining weight or compensatory behaviors such binge eating without
becoming fat, a distorted body as self-induced vomiting, compensatory behaviors.
image, and significant excessive exercise, or misuse Individuals with BED may
restriction of energy intake of laxatives or diuretics. experience feelings of distress
leading to a significantly low Individuals with BN may and guilt after episodes of
body weight. Individuals with experience feelings of shame binge eating.
AN may engage in excessive and guilt after binge eating.
exercise, purging behaviors, or
both.
Subtypes of Anorexia Nervosa
Restricting Type Binge-Eating/Purging Type

Individuals with the restricting type of anorexia In contrast, individuals with the
nervosa primarily rely on calorie restriction, binge-eating/purging type of anorexia nervosa
dieting, and excessive exercise to maintain their engage in recurrent episodes of binge eating and
low body weight. They avoid binge eating and purging behaviors, such as self-induced vomiting,
purging behaviors. misuse of laxatives, diuretics, or enemas. These
behaviors are often employed to compensate for
binge eating episodes.
Anorexia Nervosa:
Diagnostic Criteria (A)

Criterion A
Energy intake restriction leading to significantly low
body weight, considering age, sex, developmental
trajectory, and physical health. This criterion is often
evaluated by comparing an individual's BMI to
established benchmarks. Significant weight loss can be a
crucial indicator of anorexia nervosa.
Anorexia Nervosa: Diagnostic Criteria (B &
C)

Criterion B Criterion C
An intense fear of gaining weight or of A disturbance in the way in which one's body
becoming fat, even though the individual is at weight or shape is experienced, undue
a significantly low weight. This fear is often influence of body weight or shape on self-
accompanied by a relentless pursuit of evaluation, or denial of the seriousness of the
thinness, which can lead to extreme calorie current low body weight. Individuals with AN
restriction, excessive exercise, or purging may have a distorted body image, perceiving
behaviors. themselves as overweight even when they are
significantly underweight. This distorted
perception can lead to feelings of shame,
anxiety, and low self-esteem.
Anorexia Nervosa: Severity Levels

Body Mass Index (BMI) Nutritional Deficiencies

The severity of anorexia nervosa is primarily Individuals with anorexia nervosa may
determined by the individual's body mass index experience severe nutritional deficiencies due to
(BMI), which reflects their weight in relation to their restrictive eating habits, leading to
their height. A lower BMI indicates a more physical complications and impacting their
severe level of weight loss. overall health.

Psychological Distress Impact on Daily Functioning

The psychological distress associated with Anorexia nervosa can significantly impact an
anorexia nervosa can vary in severity and can individual's daily life, affecting their ability to
include anxiety, depression, obsessive- work, study, maintain relationships, and
compulsive behaviors, and impaired social participate in social activities. The severity of
functioning. This distress can be exacerbated by these impairments can be a critical factor in
the physical consequences of the disorder. determining the overall severity of the disorder.
Anorexia Nervosa: Severity Levels

17 or less
Extreme
Individuals with extreme anorexia nervosa have a BMI of 17 or less, indicating a significantly low body weight and a high
risk for severe physical and psychological complications.

17-18.5
Severe
Individuals with severe anorexia nervosa have a BMI between 17 and 18.5, indicating a significant weight loss that can
compromise their health and well-being.

18.5-20
Moderate
Individuals with moderate anorexia nervosa have a BMI between 18.5 and 20, indicating a significant weight loss that can
impact their physical and psychological health.

20-22
Mild
Individuals with mild anorexia nervosa have a BMI between 20 and 22, indicating a weight loss that may not be as severe
as other levels but still carries health risks.
Bulimia Nervosa
Binge Eating
Recurrent episodes of eating an amount of food in a
discrete period of time that is definitely larger than what
most people would eat during a similar period of time and
under similar circumstances.
Compensatory Behaviors
Recurrent inappropriate compensatory behaviors to
prevent weight gain, such as self-induced vomiting, misuse
of laxatives, diuretics, or enemas; fasting; or excessive
exercise.
Negative Self-Evaluation
Individuals with bulimia nervosa often experience feelings
of shame, guilt, and self-disgust after binge eating
episodes, reinforcing the cycle of disordered eating.
Bulimia Nervosa:

Bulimia nervosa (BN) is a serious eating disorder

characterized by recurrent episodes of binge eating followed
by compensatory behaviors aimed at preventing weight
gain.
Understanding Binge Eating Episodes

Characterized by Feeling of Shame and Distinct from Normal

Uncontrollable Eating Disgust Eating
Following a binge, individuals Binge eating episodes differ
Binge eating episodes are may experience intense significantly from normal
marked by a sense of losing feelings of guilt, shame, and eating patterns. They are
control over one's eating self-disgust. These emotions characterized by a marked
behavior. Individuals are often linked to the lack of control and the
experiencing a binge often perceived loss of control and consumption of an excessive
feel unable to stop eating, the discrepancy between the amount of food in a discrete
even when they feel full or actual need for food and the period. Normal eating, in
uncomfortable. This can lead amount consumed during the contrast, involves mindful
to consuming an unusually binge. consumption and a sense of
large amount of food in a satisfaction after eating.
short period.
Compensatory Behaviors:

Self-Induced Vomiting Laxative Misuse Excessive Exercise

Self-induced vomiting, also known Laxative misuse is another Excessive exercise is often
as purging, is a common common compensatory behavior employed as a compensatory
compensatory behavior in used to eliminate food and behavior to burn off calories
bulimia. This involves deliberately prevent weight gain. However, consumed during binge eating.
making oneself vomit after a laxatives do not target calories This can involve engaging in
binge episode to try to counteract consumed during a binge, and prolonged, strenuous physical
the calories consumed. While this their overuse can disrupt the activity even when feeling
method may seem effective in the body's natural digestive process, physically exhausted. However,
short term, it can lead to serious leading to dehydration, mineral excessive exercise can lead to
health complications, including deficiencies, and digestive injuries, overtraining, and an
tooth decay, electrolyte problems. unhealthy relationship with
imbalance, and esophageal physical activity.
damage.
DSM-5 Criteria for Bulimia Nervosa

Recurrent Episodes of Binge Eating Lack of Control Over Eating

The individual engages in recurrent episodes of The individual experiences a sense of lack of
binge eating, characterized by eating, in a discrete control over eating during the episode (e.g., feeling
period of time, an amount of food that is definitely that they cannot stop eating or control what or how
larger than what most people would eat in a similar much they are eating).
period of time and under similar circumstances.

Recurrent Compensatory Behaviors Frequency and Duration

The individual regularly engages in recurrent Both binge eating and inappropriate compensatory
inappropriate compensatory behaviors to prevent behaviors occur, on average, at least once a week
weight gain, such as self-induced vomiting, misuse for 3 months.
of laxatives, diuretics, or other medications,
fasting, or excessive exercise.
Severity Levels in Bulimia Nervosa

Mild
1
Individuals with mild bulimia nervosa engage in compensatory behaviors an average of 1-3 times per week.

Moderate
2
In moderate bulimia nervosa, compensatory behaviors occur an average of 4-7 times per week.

Severe
3 Individuals with severe bulimia nervosa experience compensatory
behaviors an average of 8-13 times per week.

Extreme
4 The most severe form of bulimia nervosa involves
compensatory behaviors occurring an average of 14 or
more times per week.
Prevalence and Demographics of Bulimia
Nervosa

Lifetime Prevalence Lifetime Prevalence Typical Onset Age Prevalence Across

in Women in Men Nations
The onset of bulimia
While less common than nervosa typically occurs Bulimia nervosa is a
Research suggests that in women, bulimia in late adolescence or global health concern,
the lifetime prevalence of nervosa also affects men. early adulthood, with the with similar prevalence
bulimia nervosa in Studies have found a majority of individuals rates observed in
women is estimated to be lifetime prevalence rate experiencing symptoms industrialized nations
around 1.5% to 3.5%, of approximately 0.5% to between the ages of 15 worldwide. This suggests
indicating that a 1% in men, highlighting and 25. that societal pressures
significant portion of the the importance of and cultural factors play a
female population recognizing and significant role in the
experiences this eating addressing this disorder development of this
disorder. in all genders. eating disorder.
Bulimia Nervosa and Anorexia Nervosa: The
Connection

Crossover Between Disorders Reversion from AN to BN Multiple Crossovers

While individuals with AN may Individuals may experience
A notable aspect of eating present with a more restrictive multiple crossovers between BN
disorders is the potential for eating pattern, a portion of them and AN throughout their lives. This
individuals to transition between may revert to binge-eating and dynamic nature of eating
different diagnoses. In particular, purging behaviors, leading to a disorders highlights the
there is a significant overlap diagnosis of BN. This transition complexity of these conditions and
between Bulimia Nervosa (BN) and can be influenced by various the need for comprehensive
Anorexia Nervosa (AN), with a factors, including psychological assessment and individualized
considerable proportion of distress, changes in body image, treatment plans.
individuals experiencing and social pressures.
symptoms of both disorders.
Risk and Prognostic Factors for Bulimia Nervosa

Genetic Predisposition
Family history of eating disorders and other mental health conditions increases the
1 risk of developing bulimia nervosa. Genetic factors may influence personality
traits, neurochemical imbalances, and susceptibility to environmental triggers.

Physiological Factors
2 Biological factors like hormonal imbalances, neurotransmitter dysfunction,
and altered brain activity may contribute to the development of bulimia
nervosa. These factors can influence appetite regulation, mood, and body
image.
Environmental Factors
Cultural pressures, societal ideals of thinness, and media portrayals of body
3
image can significantly influence the risk of developing bulimia nervosa.
Exposure to these factors can create a sense of dissatisfaction with one's
body and increase the likelihood of engaging in unhealthy eating behaviors.
Temperamental Factors
Personality traits like perfectionism, impulsivity, and low self-
4 esteem are often associated with an increased risk of developing
bulimia nervosa. These temperamental factors can contribute to a
heightened sensitivity to criticism, difficulty regulating emotions,
and a greater susceptibility to societal pressures.
Mortality and Bulimia Nervosa
Elevated Mortality Risk
Suicide Mortality
Individuals with bulimia nervosa face a significantly
elevated risk of mortality compared to the general Another crucial aspect of mortality risk in bulimia
population. This increased mortality risk is primarily nervosa is the heightened risk of suicide. Individuals with
attributed to the complications associated with the eating disorders, including bulimia nervosa, experience
disorder, including malnutrition, electrolyte imbalances, significant psychological distress and a higher likelihood
and suicide. of suicidal thoughts and behaviors.

1 2 3

All-Cause Mortality
Studies have consistently shown that individuals with
bulimia nervosa have a higher all-cause mortality rate.
This increased risk is linked to the physical health
consequences of the disorder, such as heart problems,
gastrointestinal issues, and dental problems.
 Treatment Outcomes for Bulimia Nervosa

50
Partial Remission
Around 50% of individuals with Bulimia Nervosa experience partial remission, indicating a significant improvement in symptoms
but not a complete absence.

25
Full Remission
Approximately 25% of individuals achieve full remission, characterized by a sustained absence of binge eating and compensatory behaviors.

10-20
Relapse Rates
Relapse rates for Bulimia Nervosa can range between 10% and 20%, highlighting the ongoing nature of the disorder and the
need for long-term management.

5
Chronic Bulimia Nervosa
A small percentage, around 5%, may experience chronic Bulimia Nervosa, with persistent symptoms despite treatment efforts.
Binge Eating Disorder

Definition Recurrent Binge Eating

Binge eating disorder (BED) is characterized by Individuals with BED experience recurrent
recurrent episodes of binge eating without episodes of binge eating, defined as eating an
compensatory behaviors such as vomiting, amount of food that is definitely larger than what
excessive exercise, or misuse of laxatives. most people would eat during a similar period of
time and under similar circumstances. These
episodes are often associated with feelings of loss
of control over eating.
Lack of Compensatory Behaviors Distress and Impairment
Unlike bulimia nervosa, individuals with BED do BED can significantly impact an individual's life,
not engage in compensatory behaviors to prevent leading to distress, shame, and impairment in
weight gain after binge eating. They may various areas of functioning, such as social
experience feelings of guilt, shame, and distress relationships, work, and overall well-being.
after episodes, but they do not attempt to purge
or restrict their calories.
Seeking Help and Resources

Professional Help
Seeking professional help is crucial for individuals struggling with EDs. Consult a qualified
1 mental health professional such as a psychiatrist, psychologist, or therapist specializing in
EDs.

Support Groups
2 Support groups offer a safe space for individuals with EDs and their families to
connect with others who understand their struggles, share experiences, and offer
mutual support.

Online Resources
Various online resources provide information, support, and guidance
3 for individuals with EDs and their loved ones. Reputable organizations
like the National Eating Disorders Association (NEDA) offer
comprehensive resources, including helplines, online forums, and
educational materials.
Binge Eating Disorder

ESSENTIAL FEATURE LEVELS OF SEVERITY RATINGS PREVALENCE

The essential feature of BED BED diagnostic criteria The lifetime prevalence of
is recurrent episodes of binge include four levels of severity BED is approximately 3.5% in
eating without inappropriate ratings (mild, moderate, women and 2% in men.
compensatory measures severe, and extreme) that
(such as purging) intended to are based on the frequency
prevent weight gain. of binge episodes.
Binge Eating Disorder

Prevalence Family History

BED is more prevalent among individuals Binge eating disorder appears to run in
seeking weight loss treatment than in the families, which may reflect additive genetic
general population influences.

Cross over Other Factors

Crossover from BED to other eating BED less is known about temperamental
disorders is uncommon. and environmental risk and prognostic
factors.
DSM-5 for Binge Eating Disorder

Binge Eating
A. Recurrent episodes of binge eating. An
episode of binge-eating is characterized by both
of the following:

Eating, in a discrete period of time (e.g., within

any 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.

A sense of lack of control over-eating during the

episode (e.g., a feeling that one cannot stop
eating or control what or how much one is
eating).
Binge Eating Disorder is associated with atleast 3 of following:

1 Eating more rapidly than normal.

2 Eating until feeling uncomfortably full..

3 Eating large amount of food when not physically h

4 Feeling disgusted with oneself, depresse

or very guilty afterward.
DSM-5 Criteria

C Marked distress regarding binge eating is present.

D The binge eating occurs, on average, at least

once a week for 3 months. .

The binge eating is not associated with the recurrent use of

E inappropriate compensatory behavior as in bulimia nervosa
and does not occur exclusively during the course of bulimia
nervosa or anorexia nervosa. .
Binge Eating Disorder: Severity Levels

Mild:
1-3 binge-eating episodes per week.

Moderate
4-7 binge-eating episodes per week.

Severe
8-13 binge-eating episodes per week.

Extreme
14 or more binge-eating episodes per week
Unspecified Feeding
or Eating Disorder
This category applies to presentations in which
symptoms characteristic of a feeding and eating
disorder that cause clinically significant distress or
impairment in social, occupational, or other
important areas of functioning predominate but do
not meet the full criteria for any of the disorders in
the feeding and eating disorders diagnostic class.
Sub-categories of Unspecified Feeding
or Eating Disorder
Avoidant/Restrictive Food Intake Disorder
Avoidant/Restrictive Food Intake Disorder
A. An eating or feeding disturbance (e.g., 1. Significant weight loss (or failure to achieve
apparent lack of interest in eating or food; expected weight gain or faltering growth in
avoidance based on the sensory children).
characteristics of food; concern about aversive 2. Significant nutritional deficiency.
consequences of eating) as manifested by 3. Dependence on enteral feeding or oral
persistent failure to meet appropriate nutritional supplements.
nutritional and/or energy needs associated 4. Marked interference with psychosocial
with one (or more) of the following: functioning.
Sub-categories of Unspecified Feeding
or Eating Disorder
Avoidant/Restrictive Food Intake Disorder
Avoidant/Restrictive Food Intake Disorder
B. The disturbance is not better explained by D. The eating disturbance is not attributable to
lack of available food or by an associated a concurrent medical condition or not better
culturally sanctioned practice. explained by another mental disorder. When
C. The eating disturbance does not occur the eating disturbance occurs in the context of
exclusively during anorexia nervosa or bulimia another condition or disorder, the severity of
nervosa, and there is no evidence of a the eating disturbance exceeds that routinely
disturbance in the way in which one’s body associated with the condition or disorder and
weight or shape is experienced. warrants additional clinical attention.
PICA:

Duration Consequences Behaviour Medical Issues

C. Eating behavior is D. If eating behaviors

A. Persistent eating of B. The eating of non-
not part of a culturally occur in the context of
non-nutritive, nonfood nutritive, nonfood
supported or socially another mental disorder
substances over a substances is
normative practice. [intellectual
period of at least 1 inappropriate to the
developmental disorder],
month. developmental level of
autism spectrum
the individual.
disorder, schizophrenia)
or medical condition
(including pregnancy), it
is sufficiently severe to
warrant additional
Rumination Disorder

A. Recurrent Episodes B. Diagnosis

Repeated regurgitation of food over a The repeated regurgitation is not
period of at least 1 month. attributable to an associated gastro-
Regurgitated food may be re-chewed, intestinal or other medical condition
re-swallowed, or spit out. (e.g., gastroesophageal reflux,
pyloric stenosis).

C. Eating disturbance D. Mental Disorder

If the symptoms occur in the context of
The eating disturbance does not
another mental disorder (e.g., intellectual
occur exclusively during anorexia
disability [intellectual developmental
nervosa, bulimia nervosa, binge
disorder] or another neurodevelopmental
eating disorder, or avoid
disorder), they are sufficiently severe to
ant/restrictive food intake disorder.
warrant additional clinical attention.