Clinical Features
What is Disordered Eating
Joy-Based: body acceptance, flexible eating, healthy weight
Mid: restricting, fasting, yo-yo dieting, excessive exercising, preoccupation
Fear-Based: anorexia, bulimia, binge eating disorder
Minnesota Semi-Starvation Study
36 young men (20-33 years-old), conscientious objectors to WW2, physically healthy, intellectually superior, emotionally well-balanced
Binge Eating: what does it look like
usually over two-hour time span
rapid pace with lack of control
uncomfortably full
emotional reactions: disgust, guilt, depression, embarrassment
other considerations: secrecy, amount is variable
Diet Culture
Worships thinness, promotes weight loss, demonizes certain ways of eating, normalized discontent, oppresses people who don't match up with its supposed picture of "health"
OSFED
Other Specified Feeding or Eating Disorder (OSFED), Person meets all diagnostic criteria, except for 1-2 symptoms
Anorexia Nervosa
Behavioral features: restrictive eating, excessive exercise
Cognitive features: fear of fat/weight gain, denial of seriousness of low weight, weight and shape essential to self-evaluation
Physical features: low body weight, anenorrhea, medical complications
Minnesota Study Phases
Control Phase: 12 wks, observation by study staff
Semi-Starvation Phase: 24 wks, restricted diet, mean weight loss 24%
Restricted Rehabilitation Phase: 12 wks, refeeding diet
Unrestricted Rehabilitation Phase: 8 wks
Path of Binge Eating Disorder (BED)
1959: BED first identified
1987: BED mentioned in DSM
1994: BED included in DSM4, part of "eating disorder not otherwise specified"
2008: BED Association formed
2013: BED formally recognized in DSM5
2015: FDA approves use of lisdexamfetamine dimesylate (Vyvanse) for the treatment of BED
Relationship with Food & Body
Total amount of time awake spent thinking about food, weight, and hunger
Anorexia: 90-100%
Bulimia: 70-90%
Disordered eating: 20-65%
"Typical" eating: 10-15%
UFED
Unspecific Feeding or Eating Disorder
clinically significant distress due to feeding/eating issues, but unclear diagnostic presentation
can also be used as a placeholder when there is not enough time to gather full history
Bulimia Nervosa
Behavioral features: binge eating, compensatory behaviors, dieting is common, average 1x/week for 3 months
Cognitive features: weight and shape essential to self-evaluation
Physical features: usually within ~10% of "set point" weight, medical complications
Physical Effects of Semi-Starvation
Cold intolerance
decreased pulse, blood pressure, body temperature
low energy
delayed reflexes
What matters most
Eating disorder: majority focused on body roughly 65%, the rest being family, friends, school/grades, and future goals
no eating disorder: all roughly equal, family is the bigger focus followed by friends then school/grades, then future goals and body being last
Refeeding
During unrestricted rehabilitation phase: average more caloric intake than eating pre-study, occasional intakes as high as 4x typical caloric intake
OSFED Diagnoses
Atypical Anorexia Nervosa
Binge Eating Disorder: <1x/week, <3 months
Bulimia Nervosa: <1x/week, <3 months
Purging Disorder
Night Eating Syndrome
Binge Eating Disorder
Behavioral feature: binge eating, no compensatory behaviors, average 1x/week for 3 months
Cognitive features: distress about binge eating, concerned about shape and weight
Food dreams, collecting recipes, vicarious enjoyment
Course of Illness
Anorexia & Bulimia: chronic if untreated; treatment response: ~30-50%
Binge eating disorder: variable (can remit even untreated); treatment response: >50%
Treatment seeking is low; earlier treatment = better prognosis
Follow Up on Study
19 participants followed for several years
sustained weight and eating problems: increase in "set point" weight, 31% took 2+ years to return to baseline weight, 16% never did
Poor insight & perception of fatness
Medical Complications of Anorexia
Brain and Nerves: can't think right, hair: thinning, heart: low blood pressure, heart failure, blood: anemia, muscles, joints, and bones: weak muscles, swollen joints, kidneys: kidney failure, body fluids, intestines: constipation, hormones: periods stop, problems growing, skin: bruise easily, dry skin
Subtypes of Anorexia and Bulimia
Anorexia: restricting type: no regular binge eating or purging, binge eating/ purging type: regular binge eating or purging
Bulimia: purging type: vomiting, laxatives, diuretics, or enemas; non-purging type: fasting or excessive exercise
Emotional and Social Changes
Anxiety, irritability: "I had a very close friend there and often I'd speak sharply to him and I'd find myself going to him almost every night and apologizing."
Depression: "When I tried to smile it was a grimace and I didn't feel like smiling and never laughed."
"Obesity" Research
Correlation not equal to causation
Epidemiologic studies don't typically control for: fitness/activity, nutrition intake, socioeconomic status, body image, weight cycling, which is associated with: inflammation, hypertension, insulin resistance
What was Learned from this
malnutrition (on its own) can lead to physical and psychological changes, these resemble what we see in individuals who have eating disorders, starvation effects mimic EDs - but don't necessarily cause EDs
Medical Complications of Bulimia
headaches, dental damage, swollen glands
electrolyte abnormalities (e.g., low potassium)
heart damage (use of Ipecac)
colon damage (use of laxatives)