Eating Disorders

What are the signs of Anorexia Nervosa?

• 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. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

• Intense fear of gaining weight or of becoming “fat”, or persistent behavior that interferes with weight gain.

• Disturbance in the way in which one’s body weight or shape is experienced, ie Body Dysmorphia.

What are the subtypes of Anorexia Nervosa?

• Restricting Type: Weight loss is primarily accomplished through dieting, fasting, and/or excessive exercise

• Binge-eating/purging type

What is Bulimia Nervosa?

• Recurrent episodes of binge eating- an episode of binge eating is characterized by both 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, and 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).

  • Recurrent inappropriate behaviors in order to prevent weight gain, such as self-induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.

What is Binge Eating Disorder?

• Recurrent episodes of binge eating. An episode of binge eating is characterized by both 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 people 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 one is eating).

  • The binge-eating episodes are associated with three (or more) of the following: Eating much more rapidly than normal, eating until feeling uncomfortably full, eating large amounts of food when not feeling physically hungry, eating alone because of feeling embarrassed by how much one is eating, feeling disgusted with oneself, depressed, or very guilty afterward, and/or marked distress regarding binge eating is present.

  • The binge eating is not associated with the recurrent use of inappropriate compensatory behaviour as in bulimia nervosa

What is ARFID?

• 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, or marked interference with psychosocial functioning.

• The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.

• 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.

• The eating disturbance is not attributable to a concurrent medical condition or not better explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.

OSFED applies to presentations of Eating Disorders in which the individual experiences significant distress or impairment in social, occupational, or other areas of functioning, but does not meet the full criteria for any other Feeding or Eating Disorder.

Examples of these presentations include

Atypical Anorexia Nervosa:All of the criteria for anorexia nervosa are met, except that despite significant weight loss, the individual’s weight is within or above the normal range.

Bulimia Nervosa (of low frequency and/or limited duration): All of the criteria for bulimia nervosa are met, except that the binge eating and inappropriate compensatory behaviors occur, on average, less than once a week and/or for less than 3 months.

Binge-Eating Disorder (of low frequency and/or limited duration): All of the criteria for binge-eating disorder are met, except that the binge eating occurs, on average, less than once a week and/or for less than 3 months.

Purging Disorder: Recurrent purging behavior to influence weight or shape (e.g., self-induced vomiting: misuse of laxatives, diuretics, or other medications) in the absence of binge eating.

Night Eating Syndrome: Recurrent episodes of night eating, as manifested by eating after awakening from sleep or by excessive food consumption after the evening meal. There is awareness and recall of the eating. The night eating is not better explained by external influences such as changes in the individual’s sleep-wake cycle or by local social norms. The night eating causes significant distress and/or impairment in functioning. The disordered pattern of eating is not better explained by binge-eating disorder or another mental disorder, including substance use, and is not attributable to another medical disorder or to an effect of medication

Diabulimia: an Eating Disorder in which the individual withholds insulin in order to lose weight. People who have diabulimia may have any number of disordered eating behaviors, such as purging, or they may only reduce or withhold their insulin dosages and otherwise have healthy eating patterns.

Orthorexia Nervosa:

An obsessive focus on “healthy: eating as a dietary theory or set of beliefs whose specific details may vary; marked by significant emotional distress in relation to food choices perceived as “unhealthy”. May include compulsive behaviors, severe food rules, and “cleanses” in the name of health.

What is pica?

• Persistent eating of nonnutritive, nonfood substances over a period of at least 1 month.

• The eating of nonnutritive, nonfood 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 the eating behavior occurs in the context of another mental disorder (e.g., intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.

What is Body Dysmorphic Disorder?

• Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

• At some point during the course of the disorder, the individual has performed repetitive behaviours (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns.

• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The appearance preoccupation is not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.