Feeding and Eating

Disorders in
children and
adolescents
By: Dr Etsub Amha R3
Moderator: Dr Selamawit Alemayehu
(Assist. Professor of psychiatry)
Outlines
• Introduction
• DSM-5 classification
• Pica
• Rumination disorder
• Avoidant/restrictive feeding disorder
• Anorexia nervosa
• Bulimina Nervosa
• Binge eating disorder
• Other specified feeding and eating disorders
Objectives

By the end of this seminar we should be able:

• To understand the different eating disorders of childhood and

adolescence
• To identify the possible etiology of eating disorders in childhood
and adolescents
• To distinguish between the clinical features of the different eating
disorders in this age group.
• To recognize and implement the different treatment modalities of
eating disorder
Introduction
• The establishment of problem-free feeding requires the physical
ability, desire to feed, appropriate caregiver, and access to
suitable food.

• Individual, interpersonal, and environmental factors can

adversely affect feeding, with successful early feeding depending
on a range of factors coming together simultaneously.

• As children move into adolescence, food choices, eating

behavior, and mealtime interaction continue to be an important
context for testing individuation, self-expression, and
autonomy.
Screening for the presence of eating disorder

• They come to clinical attention in a range of healthcare settings.

• It is important to make distinctions between a feeding or eating

disturbance as a symptom of a medical condition; as problem
behavior; or as a mental disorder.

• It may remain undetected unless systematic screening occurs.

• In addition, it is important to note that its diagnosis cannot be

predicted simply by assessing weight or BMI.
• 3 Useful questions to consider if a child is presenting with a feeding
or eating problem :

1. Is the problem consistent with normal variation for the appropriate

developmental stage of the child?

2. Is there risk in relation to consequences if left unaddressed?

To establish whether there is impairment to development and
functioning, both psychological and physical.

3. Can the eating disturbance be primarily accounted for by a

medical condition?
• Given the prevalence and typical age of onset of eating disorders
in adolescence or young adulthood, the AAP recommends that
pediatricians ask all preteens and adolescents about eating
patterns and body image as well as screen for eating disorders
and be alert to potential signs and symptoms of disordered
eating (Hornberger et al. 2021).

• Increased occurrences is seen :

in patients with psychiatric treatment, those with history of
teasing/ bullying/ childhood sexual abuse, athletes, children with
celiac disease or T1DM and among transgender and gender non-
binary individuals than in those who identify as cisgender.
Initial evaluation of eating history
 APA recommends to include assessment of :

• height and weight history (e.g., max and min weight, recent
weight changes);
• presence of, pattern of eating like restrictive eating, food
avoidance, binge eating, and other eating-related behaviors ;
• presence of, patterns in compensatory and other weight control
behaviors and use of medication to manipulate weight;
• patterns and changes in food selection (e.g., breadth of food
variety, narrowing or elimination of food groups);
• amount of time preoccupied with food, weight, and body shape;
• Prior treatment and response to treatment for an eating disorder;
• psychosocial impairment 2º to eating or body image concerns or
behaviors; and
• family history of eating disorders, other psychiatric illnesses, and
other medical conditions (e.g., obesity, IBD, DM).
Screening questionnaires for eating disorders

Children's Eating Attitude Test (CHEAT)

Eating Disorder Screen for Primary Care (Cotton et al. 2003)
SCOFF Questionnaire (Morgan et al. 1999)
Screen for Disordered Eating (Maguen et al. 2018)
Quantitative measures
• APA recommends that the initial psychiatric evaluation of a
patient with a possible eating disorder include weighing the
patient and quantifying eating and weight control behaviors.
Identification of cooccurring
conditions
• It's recommended to identify co-occurring health conditions,
including co-occurring psychiatric disorders.

• Some conditions may be a sequela of an eating disorder (e.g.,

GERD, IBD, gastroparesis, other GI motility disorders), whereas
others (e.g., DM, celiac disease, IBD) can place restrictions on
eating behaviors and dietary variety and can exacerbate or
increase the likelihood of developing an eating disorder.
• The most prevalent psychiatric comorbidities for EDs in general
are anxiety (~ 62%), mood (~ 54%), and substance use and
PTSD (~ 27%).

• ASD and ADHD also frequent in individuals with ARFID

• Suicide is the 2nd leading cause of death in AN, and rates of

suicidal behavior are elevated in BN and BED.

• A specific inquiry should also be made about the use or misuse of

prescribed or non-prescribed medications that suppress appetite
(e.g., OTC weight loss products, stimulants) or enhance
muscularity (e.g., supplements, androgens).
Initial review of systems
• APA recommends a comprehensive review of systems.

• The effects of malnutrition, binge eating, and purging can affect

every organ system in the body
 Signs and symptoms of eating disorders
Organ systems Related to nutritional restriction Related to purging
General Low weight, cachexia, Fatigue Weakness
Weakness Dehydration, Cold intolerance, low body
temperature
Hot flashes, sweating

Nervous system Anxiety, depression, or irritability Anxiety, depression, or irritability

Apathy Apathy
Poor concentration Poor concentration
Headache Headache
Seizures (in severe cases) Seizures (in severe cases)
Peripheral polyneuropathy (in severe cases) Paresthesia (due to electrolyte abnormalities)

Oropharyngeal Dysphagia Dental enamel erosion and decay

Enlarged salivary glands
Pharyngeal pain, Palatal scratches, erythema, or
petechiae

Gastrointestinal Abdominal discomfort Abdominal discomfort

Constipation Constipation, Diarrhea (due to laxative use),Abdominal
Nausea distention, bloating, Heartburn, gastroesophageal
Early satiety erosions or inflammation
Abdominal distention, bloating Vomiting, possibly blood-streaked
Rectal prolapse
Cardiovascular Dizziness, faintness, orthostatic hypotension Dizziness, faintness, orthostatic
Palpitations, arrhythmias , Bradycardia , Weak irregular hypotension, Palpitations, arrhythmias
pulse, Cold extremities, acrocyanosis, Chest pain,
Dyspnea

Reproductive/Endocrine Slowing of growth (in children or adolescents) Slowing of growth (in children or
Arrested development of 2º sex characteristics adolescents)
Low libido, Fertility problems Arrested development of 2º sex
Oligomenorrhea, 1º or 2º amenorrhea characteristics
Low libido
Oligomenorrhea

Musculoskeletal Proximal muscle weakness, wasting, or atrophy, Bone Muscle cramping

pain, Stress fractures Bone pain, Stress fractures
Slowed growth (relative to expected) Slowed growth (relative to expected)

Dermatological Dry, yellow skin Scarring on dorsum of hand (Russell’s

Change in hair including hair loss and dry and sign)
brittle hair, Lanugo ,Poor skin turgor Pitting edema (with Poor skin turgor, Pitting edema
refeeding)
Initial physical examination
• APA recommends assessment of vital signs, including T°, resting
PR, orthostatic PR, and BP, orthostatic BP; height, weight, and
BMI and physical appearance, including signs of malnutrition or
purging behaviors.
Initial laboratory assessment
• Recommended laboratory assessment include:
CBC and a comprehensive metabolic panel, including electrolytes,
liver enzymes, and renal function tests.

* Abnormal laboratory values do not occur in all individuals with an

eating disorder, and normal laboratory values do not rule out a
potential eating disorder.
Laboratory abnormalities related to nutritional restriction
or purging behaviors
DSM-5-TR 2022 classification

RUMINATION
ARFID PICA
DISORDER

ANOREXIA Classification of eating BULEMIA

NERVOSA disorders NERVOSA

OTHER UNSPECI
BINGE
SPECIFIED FIED
EATING
DISORDER
  Pica
• is characterized by eating nonnutritive substances, which may be
nonfood items or raw food ingredients eaten in large amounts.

• In children is more frequent in the context of ASD or IDD

• It’s not diagnosed where the ingestion of nonfood items is part of

a culturally sanctioned practice, or when chronological or
developmental age is below 2 years, as mouthing of objects with
some ingestion is common.
Epidemiology

• Prevalence is unclear.

• It is more common among children and adolescents with ASD and

IDD(15%).

• Appears to affect both sexes equally.

ETIOLOGY
• Nutritional deficiencies in minerals such as zinc or iron have been
reported rarely.

• Severe child maltreatment in the form of parental neglect and

deprivation has also been reported.

• Lack of supervision, as well as inadequate feeding of infants and

toddlers may increase the risk .
DIAGNOSIS AND CLINICAL FEATURES

• Eating non-edible substances repeatedly after 2 years of age.

• The clinical implications can be benign or life-threatening,

depending on the objects ingested.

• Serious complications include:

lead poisoning (usually from lead-based paint), intestinal parasites,
anemia and zinc deficiency after ingestion of clay, severe iron
deficiency after ingestion of large quantities of starch and
intestinal obstruction from the ingestion of hair balls, stones, or
gravel.
COURSE AND PROGNOSIS

• Usually resolves with increasing age.

• Typically, in children with normal intellectual function, it remits

spontaneously.

• In some adults with pica, particularly those who also have ASD
and IDD, it can continue for years.

• Generally, prognosis is usually good.

 Treatment
• No definitive treatment exists for pica per se; most treatment is
aimed at education and behavior modification.

• First, determine the specific cause/ situation.

• When it occurs in the context of child neglect or maltreatment,

clearly those circumstances must be immediately corrected.
• When it persists in the absence of any toxic manifestations,
behavioral techniques can be utilized.

• Positive reinforcement, modeling, behavioral shaping, and

overcorrection treatment have been used. Increasing parental
attention, stimulation, and emotional nurturance may yield
positive results.

• Medical complications (e.g., lead poisoning) that develop

secondarily to the pica must also be treated.
  Rumination Disorder
• Latin word ruminare = “to chew the cud.”
Greek equivalent is merycism = the act of regurgitating food
from the stomach into the mouth.

• is an effortless and painless regurgitation of partially digested

food into the mouth soon after a meal, which is either swallowed
or spit out.

• It can be observed in developmentally normal infants who put

their thumb or hand in the mouth, suck their tongue rhythmically,
and arch their back to initiate regurgitation.
• It is considered a functional gastrointestinal disorder.

• In infants, typically occurs between 3 and 12 months of age, rare

in older children, adolescents, and adults.

• Failure to thrive is not a necessary criterion of this disorder, but it

is sometimes a sequela.

• In its most severe form, the disorder can cause malnutrition and
be fatal.
EPIDEMIOLOGY

• Very rare.

• Male >: female infants and emerges between 3 months and 1

year of age.

• It persists more frequently among children, adolescents, and

adults with ID.

• Adults with rumination usually maintain a normal weight.

ETIOLOGY

• Biological and psychological causes are believed to have a role.

• Biologically it is associated with high intragastric pressure and

the ability to contract the abdominal wall to cause retrograde
movement of the gastric contents into the esophagus.

• Studies have revealed other GI symptoms such as GERD that

may accompany rumination.
• Psychologically, this behavior pattern may be observed in infants
who receive inadequate emotional interaction and have learned
to soothe and may stimulate themselves through rumination.

• In youth with ASD or IDD, it may serve as a self-stimulatory

behavior.
DIAGNOSIS AND CLINICAL FEATURES

• repeated regurgitation and re-chewing of food for a period of at

least 1 month after a period of normal functioning.

• Partially digested food is brought up into the mouth without

nausea, retching, or disgust; on the contrary, it may appear to be
pleasurable.

• A characteristic position of straining and arching of the back, with

the head held back, is observed.

• Usually, the infant is irritable and hungry between episodes of

rumination.
DIFFERENTIAL DIAGNOSIS

• Medical illnesses: 1º GI congenital anomalies, infections, Pyloric

stenosis.
• Stereotypic behaviors and eating disturbances seen in ASD and
IDD.
• AN & BN.
COURSE AND PROGNOSIS
• A high rate spontaneous remissions are common, but secondary
complications can develop, such as progressive malnutrition,
dehydration, and lowered resistance to disease.

• Many cases may develop and remit without ever being

diagnosed.

• Limited data are available about the prognosis

TREATMENT

• combination of education and behavioral techniques.

• Sometimes, an evaluation of the mother–child relationship

reveals deficits that can be influenced by offering guidance to the
mother.

• Behavioral interventions, such as habit-reversal are aimed at

reinforcing an alternate behavior that becomes more compelling
than the behaviors leading to regurgitation.
• Anatomical abnormalities, such as hiatal hernia, are common,
and must be evaluated, in some cases leading to surgical repair.

• In severe cases in which malnutrition and weight loss have

occurred, that should also be corrected by insertion of jejunal
tube.

• Medication is not a standard part of the treatment of rumination.

  Avoidant/Restrictive Food Intake
Disorder
• is characterized by a lack of interest in food, or its avoidance
based on the sensory features of the food or the perceived
consequences of eating.

• formerly known as feeding disorder of infancy or early childhood

but now has also been expanded to include adolescents and
adults.

• It may take the form of outright food refusal, food selectivity,

eating too little, food avoidance, and delayed self-feeding.
• Infants and children with the disorder may be withdrawn,
irritable, apathetic, or anxious.

• Because of the avoidant behavior during feeding, touching and

holding between mothers and infants are diminished during the
entire feeding process compared with other children.

• Some reports suggest that food avoidance or restriction may be

relatively long-standing.
DIAGNOSIS AND CLINICAL FEATURES
EPIDEMIOLOGY

• In nursery school children’s study revealed a prevalence of 4.8 %

with equal gender distribution.

• Data from community samples estimate a prevalence of failure to

thrive syndromes in ~ 3 % of infants, with ~ 50 % of those
infants exhibiting feeding disorders.
DIFFERENTIAL DIAGNOSIS

• Medical conditions
• Different neurological, structural, or congenital disorders
• Reactive attachment disorder
• Specific phobia, other type with a fear of vomiting
• AN
• MDD
• Schizophrenia

* When the eating problem itself becomes the primary focus of

clinical attention, a diagnosis of ARFID is warranted
COURSE AND PROGNOSIS

• Those identified within the first year of life and who receive
treatment do not go on to develop malnutrition, growth delay, or
failure to thrive.

• When onset is later, 2 to 3 years of age, growth and development

can be affected when the disorder lasts for several months.

• ~ 70 % of infants who persistently refuse food in the first year of

life continue to have some eating problems during childhood.
TREATMENT

• Most interventions are aimed at optimizing the interaction between

the mother and infant during feedings.

• In rare cases, an infant or a child may require hospitalization until

adequate nutrition on a daily basis is accomplished, for those with
failure-to-thrive syndromes.

• Medication is not a standard component of treatment

 What is
Failure-to-
thrive
syndromes?
  Anorexia nervosa
• is derived from the Greek term for “loss of appetite” and a Latin
word implying nervous origin.

• It is a syndrome characterized by 3 essential criteria.

 The first is self-induced starvation to a significant degree—a
behavior.
 The second is a relentless drive for thinness or a morbid fear of
fatness—a psychopathology.
 The third criterion is the presence of medical signs and
symptoms resulting from starvation—a physiological
symptomatology.
• It is often, but not always, associated with disturbances of body
image, the perception that one is distressingly large despite
obvious medical starvation.

• The theme in all AN subtypes is the highly disproportionate

emphasis placed on thinness and overexercising and
perfectionistic traits are also common.
 Subtypes:

• Two subtypes of anorexia nervosa exist: restricting and

binge/purge.

Food-restricting type: present in ~ 50 % of cases, food intake is

highly restricted (usually with attempts to consume fewer than
300 to 500 calories per day and no fat grams), and the patient
may be relentlessly and compulsively overactive.

 Purging type: Patients alternate attempts at rigorous dieting

with intermittent binge or purge episodes.
EPIDEMIOLOGY

• Increasing frequency in prepubertal girls and in boys.

• Common ages of onset are the mid-teens (14-18 years), but up to
5 % of anorectic patients have the disorder onset in their early
20s.
• estimated to occur in about 0.5 to 1% of adolescent girls.
• initially reported most often among the upper classes, recent
epidemiological surveys do not show that distribution
• M:F= 1:10-20xs.
COMORBIDITY

• It is associated with depression in 65 % of cases, social phobia in

35 % of cases, and obsessive-compulsive disorder in 25 % of
cases.

• Also substance use disorder is common.

ETIOLOGY

• Biological, social, and psychological factors are implicated in the

causes.

Starvation results in many biochemical changes: hypercortisolemia

and non suppression by dexamethasone, suppressed thyroid
function, lowered FSH, LH, GnRH, and lowered endogenous opioids.

 Social factors: could support their practices by emphasis on thinness

and exercise.

Psychologically: Many experience their bodies as somehow under the

control of their parents, so self-starvation may be an effort to gain
validation as a unique and special person.
Clinical feature and diagnosis
When do Patients usually
come to medical
attention?
DIFFERENTIAL DIAGNOSIS

• Medical conditions (tumors, endocrine, infectious)

• Substance use disorders
• Bulimia nervosa
• ARFID
• MDD
• OCD
• Body dysmorphic syndrome
• Schizophrenia
COURSE AND PROGNOSIS
• varies greatly—spontaneous recovery without treatment,
recovery after a variety of treatments, a fluctuating course of
weight gains followed by relapses, and a gradually deteriorating
course resulting in death caused by complications of starvation.

• The short-term response of patients to almost all hospital

treatment programs is good.

• In general, the prognosis is not good.

• MR is 5 to 18 %

• Indicators of a good outcome are;

admission of hunger, lessening of denial and immaturity, and
improved self-esteem.

• Indicators of poor outcome include;

parental conflict, BN , vomiting, laxative abuse, and various
behavioral manifestations (e.g., obsessive-compulsive, hysterical,
depressive, psychosomatic, neurotic, and denial symptoms)
TREATMENT

• A comprehensive treatment plan, including hospitalization when

necessary and both individual and family therapy, is
recommended.

• Behavioral, interpersonal, and cognitive approaches are used.

• Medication may also be indicated.

Hospitalization

• Indications: those < 20 % of the expected wt/ht

< 30 % of their expected wt/ht require psychiatric
hospitalization for 2 to 6 months.

• The goal is to restore patients’ nutritional state; dehydration,

starvation, and electrolyte imbalances which can seriously
compromise health and, in some cases, lead to death.

• Inpatient psychiatric programs for patients with AN generally use:

a combination of a behavioral management approach,
individual psychotherapy, family education and therapy, and, in
some cases, psychotropic medications.
• Patients should be weighed daily, early in the morning after
emptying the bladder.
• The daily fluid intake and urine output should be recorded.
• If vomiting is occurring, serum electrolyte levels should be
monitored regularly and watch for the development of
hypokalemia.
• Constipation in these patients is relieved when they begin to eat
normally.
• Stool softeners may occasionally be given, but never laxatives.
• Patients are given ~ 500 calories in 6 equal feedings throughout
the day so that patients need not eat a large amount of food at
one sitting.
Psychotherapy

CBT : found effective for inducing weight gain.

• Monitoring is an essential component where Patients are taught
to monitor their food intake, their feelings and emotions, their
binging and purging behaviors, and their problems in IP
relationships.

 Dynamic Psychotherapy: but their resistance may make the

process difficult and painstaking.

 Family Therapy: A family analysis should be done for all

patients with AN who are living with their families
Pharmacotherapy
• No medication identified that yields definitive improvement of
the core symptoms.
• Some reports support the use of cyproheptadine, a drug with
antihistaminic and antiserotonergic properties, and amitriptyline
for patients with the restricting type of AN.
• variable results seen in clomipramine, pimozide, and
chlorpromazine.
• Trials of fluoxetine have resulted in some reports of weight gain.
  Bulimia Nervosa

• Greek for “ox-hunger” and “nervous involvement” in Latin.

• is characterized by episodes of binge eating combined with

inappropriate ways of stopping weight gain.

• They typically maintain a normal body weight.

• Physical discomfort—for example, abdominal pain or nausea—
terminates the binge eating, which is often followed by feelings
of guilt, depression, or self-disgust.

• Regardless of the reason, eating binges provoke panic as

individuals feel that their eating has been out of control.

• The unwanted binges lead to 2º attempts to avoid the feared

weight gain through a variety of compensatory behaviors, such
as purging or excessive exercise.
EPIDEMIOLOGY

• Onset is often later in adolescence than that of AN.

• more prevalent than AN.
• Estimates range from 1 - 4 % of young women.
• M<F
• ~ 20 % of college women experience transient bulimic symptoms
at some point during their college years.
• Although it is often present in normal-weight young women, they
sometimes have a history of obesity.
 ETIOLOGY

• Biological, social, and psychological factors are implicated in the causes.

Biological Factors: Increased frequency is found in first-degree
relatives of persons with the disorder. Also, serotonin, norepinephrine,
and endorphin have been implicated.

 Social Factors: They tend to be high achievers and to respond to

societal pressures to be slender. Their families are generally less close
and more conflictual than the families of those with AN. Patients with BN
describe their parents as neglectful and rejecting.

 Psychological Factors: They lack superego control. Their difficulties in

controlling their impulses are often manifested by substance dependence
and self-destructive sexual relationships in addition to the binge eating
and purging that characterize the disorder.
DSM-5
Clinical features
• Vomiting is common
• The acid content of vomitus can damage tooth enamel.
• Depression, sometimes called post- binge anguish, often follows
the episode.
• During binges, patients eat food that is sweet, high in calories,
and generally soft or smooth textured, such as cakes and
pastries.
• Some patients prefer bulky foods without regard to taste.
• The food is eaten secretly and rapidly and is sometimes not even
chewed.
• Most patients are within their normal weight range, but some may
be underweight or overweight.
• Most are sexually active, compared with AN patients, who are not
interested in sex.
• BN occurs in persons with high rates of mood disorders, impulse
control disorders, substance-related disorders, and a variety of
personality disorders.
• They also have increased rates of anxiety disorders, bipolar I
disorder, dissociative disorders, and histories of sexual abuse.
Subtypes

 Purging type: Those who purge differ from those who do not in
that the latter tend to have less body-image disturbance and less
anxiety concerning eating.
• They may be at risk for certain medical complications such as
hypokalemia from vomiting or laxative abuse and hypochloremic
alkalosis, also gastric and esophageal tears, although these
complications are rare.

 Non-purging type: tend to be obese.

DIFFERENTIAL DIAGNOSIS

• Medical condition(with vomiting or diarrhea)

• AN
• Binge eating disorder
• Kleine- Levine syndrome
• MDD with atypical features
COURSE AND PROGNOSIS

• characterized by higher rates of partial and full recovery

compared with AN.
• ~ 30 % continued to engage in recurrent binge-eating or purging
behaviors and 40 % of women were fully recovered at follow-up.
• A history of substance use problems and a longer duration of the
disorder at presentation predicted worse outcome.
• The MR for BN has been estimated at 2 % per decade according
to DSM-5.
TREATMENT

• Most do not require hospitalization as they are not as secretive

about their symptoms as patients with AN.

• Hospitalization may become necessary when eating binges are

out of control, outpatient treatment does not work, or a patient
exhibits such additional psychiatric symptoms as suicidality and
substance abuse.

• In addition, electrolyte and metabolic disturbances resulting from

severe purging may necessitate hospitalization.
Psychotherapy
• CBT : should be considered the benchmark, first-line treatment
for BN . It implements a number of cognitive and behavioral
procedures to
(1) interrupt the self-maintaining behavioral cycle of binging and
dieting and
(2) alter the individual’s dysfunctional cognitions; beliefs about
food, weight, body image; and
(3) overall self-concept.
Pharmacotherapy

• Antidepressant medications have been shown to be helpful in

treating bulimia.
• This includes the SSRIs, such as fluoxetine (Prozac).
• Antidepressant medications can reduce binge eating and purging
independent of the presence of a mood disorder.
• This may be based on elevating central 5-hydroxytryptamine
levels
• Thus, antidepressants have been used successfully for
particularly difficult binge-purge cycles that do not respond to
psychotherapy alone.
• Imipramine, desipramine, trazodone, and MAOIs have been
helpful.
  BINGE EATING DISORDER

• Is recurrent binge eating characterized by eating an abnormally

large amount of food over a short time.

• Unlike BN, they do not compensate in any way after a binge

episode (e.g., laxative use).

• Binge episodes often occur in private, and generally include

foods of dense caloric content, and, during the binge, the person
feels he or she cannot control his or her eating.
Epidemiology

• It’s the most common eating disorder.

• Age of onset is typically late adolescent and early adulthood.

• It appears in ~ 25 % of patients who seek medical care for

obesity and in 50 - 75 % of those with severe obesity (BMI > 40).

• It is more common in females (4 %) than in males (2 %).

Etiology

• The cause of binge eating disorder is unknown.

• Impulsive and extroverted personality styles are linked to the

disorder.

• Binge eating may also occur during periods of stress.

• It may be used to reduce anxiety or alleviate depressive moods.

Clinical features
• ~ 50% are obese.

• They are also more likely to have an unstable weight history with
frequent episodes of weight cycling (the gaining or losing of more
than 10 kg).

• The disorder may be associated with insomnia, early menarche,

neck or shoulder and lower back pain, chronic muscle pain, and
metabolic disorders.
Course and Prognosis

• Little is known about the course of binge eating disorder.

• Severe obesity is a long-term effect in over 3 % of patients with

the disorder.
Treatment

• Psychotherapy:
 CBT is the most effective psychological treatment for binge eating
disorder. It has been shown to lead to decreases in binge eating and
associated problems (e.g., depression); however, studies have not
shown marked weight loss as a result of CBT, and CBT combined
with psychopharmacological treatments such as SSRIs show better
results than CBT alone.

 Exercise has also shown a reduction in binge eating when

combined with CBT.

 IPT has also shown to be effective; however, therapy focuses more

on the IP problems that contribute to the disorder rather than
disturbances in eating behavior.
Psychopharmacotherapy

• Symptoms of binge eating may benefit from medication

treatment with several SSRIs, desipramine, imipramine,
topiramate, and sibutramine.

• SSRI medications that have demonstrated improvement in mood

as well as binge eating include fluvoxamine, citalopram, and
sertraline.
  OTHER SPECIFIED FEEDING OR
EATING DISORDER
• can be used for eating conditions that may cause significant
distress but do not meet the full criteria for a classified eating
disorder.

• Conditions in this category include night eating syndrome,

purging disorder, and subthreshold forms of anorexia nervosa,
bulimia nervosa, and binge eating disorder.

• The age of onset of most of these disorders is during early

adulthood.
 References
• The American Psychiatric Association Practice Guideline for the
Treatment of Patients With Eating Disorders 4th EDITION
• KAPLAN & SADOCK’S SYNOPSIS OF PSYCHIATRY 11th EDITION
• IACAPAP e-Textbook of Child and Adolescent Mental Health
• LEWIS’S CHILD AND ADOLESCENT PSYCHIATRY A Comprehensive
Textbook 5th edition
• DSM-5 TR