In this video I describe the symptoms and prevalence of several disorders in the DSM-5 category of Feeding and Eating Disorders including Pica, Binge-Eating Disorder, Anorexia Nervosa, and Bulimia Nervosa. I also describe comorbid disorders and symptoms and how similar aspects of these disorders are differentiated in diagnosis. Please note that the symptoms described in this video are not comprehensive and there are other symptoms involved in diagnosis for each of these disorders.

Introduction to Eating Disorders video here.

Video Transcript

Hi I’m Michael Corayer and this is Psych Exam Review. In this video we’re going to look at the category of feeding and eating disorders in the DSM-5. Now I previously made a video introducing some eating disorders in the unit on hunger signaling and motivation and so I’ll post a link to that video in the description box.

I’d like to start with a disorder that I didn’t mention in that video and this is a feeding disorder known as pica. And pica is the Latin word for magpie and this is a reference to the birds indiscriminate eating habits and so what we see in pica is repeated and persistent eating of non-food substances, right? So in order to get this diagnosis, first, a person must be over the age of 2 and this is, of course, because babies tend to put just about anything in their mouths and so they often eat non-food substances but once a person’s a bit older if they’re continuing to eat these non-food substances then it might be symptomatic of pica.

Now it’s also important that the non-food items don’t have any sort of culturally accepted practice associated with them. So what this means is there are some beliefs about certain non-food items and and beliefs about eating these items that might mean that they are not symptomatic if a person is eating that. So the example that’s given in the DSM-5 or one of the examples is geophagy so that literally means eating earth, right? So eating soil or clay or dirt and there are some places where there are beliefs about eating certain types of clay, and the beliefs are that this will improve a woman’s skin. And so in these places we see that women often eat clay and yet this wouldn’t be considered to be a sign of pica even though it’s a non-food item. Whereas a person eating clay or dirt or soil in some other place, where they don’t have that culturally accepted belief, then that would be considered to be a sign of pica.

So other things that we see in pica are eating paper, soap, hair, string, soil, as I mentioned, chalk, paint, pebbles, etc.; basically any non-nutritive non-food items the person is persistently eating. And this is comorbid with autism spectrum disorder and it also is often comorbid with intellectual disability.

Okay next we’ll look at binge eating disorder and this is something I mentioned briefly in the previous video, but what we see in binge eating disorder are episodes of eating until the person is uncomfortably full and often with a feeling that they don’t have control over their eating behavior, that they’re not actually choosing how much they want to eat, but that they’ve lost control and they’re, you know, they feel they’re overwhelmed by the food or that they have, they’re not making a conscious decision about how much they’re eating. We also see a tendency to feel disgusted, depressed, or guilty after this episode of binge eating but it’s important to note that the person is not doing any compensatory behaviors to try to make up for this. And this is what’s going to help differentiate binge eating disorder from bulimia nervosa.

And I mentioned in the previous video that binge eating disorder is a new addition to the DSM-5 so you won’t find this disorder in earlier editions of the DSM but starting with the DSM-5 we have this new diagnosis of binge eating disorder. And when we talk about binge eating you might wonder what exactly qualifies as a binge? And this is hard to say because, what we say is well it’s an amount of food that’s much larger than normal. We’ve already seen in a previous video this concept of how we define what it means to be normal, but what we say in the case of binge eating is that it’s much more food than most people would eat in a similar setting. So what that means is there are some settings where most people will overeat; most people eat a lot more calories than normal. So on Thanksgiving people have a tendency to eat until they’re uncomfortably full or they may even feel a bit guilty after. The same could apply to something like going to an all-you-can-eat buffet where you maybe even feel this lack of control there’s, you know, have all this food available to just eat and eat and maybe you feel some regret or some guilt after. But that wouldn’t be considered to be symptomatic of binge eating disorder because most people do that. That’s a common thing in that setting. Whereas if you’re eating that amount of food in sort of a setting where most people eat a lot less, so if you’re eating you know two or three times the amount of calories that most people would eat at a particular meal, then that might be a sign that that’s an episode of binge eating.

And it’s also important that this binge eating occurs within a discrete time period and so this helps to distinguish this from just overeating. So you might eat many more calories than you need over the course of the day and gradually gain weight but that’s not necessarily binge eating unless it’s happening all within one sitting or one meal, or, you know, within an hour or two. So if you are snacking all day and you’re also eating large meals at the end of the day, you may have overeaten, eaten more calories than you need, but you haven’t necessarily had an episode of binge eating. Whereas if that one meal you take in, you know, thousands of calories all at once within an hour or two then that might qualify as an episode of binge eating.

And in order to get the diagnosis of binge eating disorder the person needs to have at least one episode of binge eating per week and this needs to persist for at least 3 months, so at least one episode per week or more and then for at least 3 months and that would meet the criteria for diagnosis. The DSM-5 gives an estimated 12-month prevalence for binge eating disorder of about 1.6% for females and about 0.8 % for males.

Okay next we’ll look at anorexia nervosa which I mentioned in the previous video and the main symptom that we see in anorexia nervosa is a fear of gaining weight or becoming fat, right? A person has this persistent fear or phobia related to gaining weight or becoming fat and as a result they have a tendency to severely restrict their calories. So they have this extreme restriction of their energy intake, they’re taking in many fewer calories than they actually need to function in a healthy way. And as a result of this extreme restriction, so when I say extreme I mean this is not just, you know, dieting or trying to cut back on certain foods, but eating very little food or perhaps not eating food at all for extended periods of time.

And as a result of this the person tends to have low body mass index. So I introduced body mass index in a previous video when talking about hunger and the low end of normal body mass index is a score of 18.5 and so we often see in anorexia nervosa a BMI below 18.5, perhaps as low as 15 or even lower in very severe cases.

And in addition to this low body mass index the person shows a distorted perception of their body weight and shape. So even though they’re underweight, they’re very thin, their ribs are showing, or you know other bones, they have very low body mass, they often report feeling that they’re fat or looking in the mirror and saying, you know, they need to lose a few more pounds and that they’re they’re still so overweight or fat, even though, I mean, it should be obvious that they aren’t overweight, that they’re actually very underweight. So we have this distorted perception of their own body.

And then we have some other symptoms that the person might not necessarily show all of these but other symptoms that often go along with anorexia nervosa or depressed mood. We also see social withdrawal. This might also have to do with the fact that a lot of socializing has to do with food and eating meals and so if you’re trying to hide from people that you’re not eating or that you’re eating a very small quantity of food you might withdraw from those types of social situations. We also tend to see insomnia, low sex drive, a loss of bone mineral density. So what happens is because they’re restricting the nutrients and minerals that they’re taking in because they’re not eating enough, their body actually starts to leach mineral out of their bones in order to continue functioning. And in many cases women will show amenorrhea which refers to a loss of their menstrual cycle; they stop having their menstrual cycle and this is because they are not taking in enough energy and their body’s essentially shutting down this reproductive process.

Okay now what I didn’t mention in the previous video is that there are two different types of anorexia nervosa. So it can be differentiated into what’s called the restricting type and the binge eating purging type. What this refers to is in the restricting type is that the person is just restricting their calories, so they’re just not eating they’re not taking in food. Whereas in the binge eating purging type they have episodes of binge eating followed by some sort of purging behavior. Now this should sound a lot like bulimia nervosa, which I’m going to talk about next but what differentiates this is their low body mass index, right? So if somebody basically has this binge eating and purging, this compensatory behavior, and they’re very low body weight then they’d be diagnosed with anorexia nervosa with the binge eating or purging type. And so this, in the past, they were often comorbid you’d get a diagnosis of anorexia but if you were also binge eating you might get a diagnosis of bulimia nervosa and so instead of giving these, sort of, little bit of confusion there with which disorder you actually have, it’s considered to be anorexia nervosa if you have low body mass index and then you have these binge eating episodes followed by purging. Versus the restricting type where you’re just restricting your calories or eating very little no food.

Okay the estimated 12-month prevalence for anorexia nervosa in the DSM-5 is, amongst young women, estimated to be about 0.4% and the ratio between males and females, this is a case where it’s much more common in females. So we see about 10 to 1 is the estimate the DSM-5 gives for the prevalence of anorexia nervosa. And it tends to be comorbid with depressive disorders and anxiety disorders and also bipolar disorder. And it’s considered to be one of the deadliest of mental illnesses because the increase in mortality for somebody diagnosed with anorexia nervosa is 6 times higher than somebody who doesn’t have this diagnosis. And these deaths can occur from starvation but many of these deaths about 1 in 5 anorexia deaths are from suicide.

Okay lastly we’ll look at bulimia nervosa. So I’ve already introduced it in the previous video and I’ve mentioned it a few times in this video, where what we see in bulimia nervosa is episodes of binge eating but then these are followed by inappropriate compensatory behaviors. And so these often take the form of vomiting, that’s sort of the one most people are familiar with, but the compensatory behaviors can come in other forms like fasting for extended periods of time or using laxatives in order to try to expel these excess calories that the person is taking in. Or if you’re taking diuretics to reduce the water in the body and also try to flush out some of these extra calories. Or through the use of medications, especially stimulants, which I’ll talk about at the end and even through excessive exercise, right? This is known as exercise bulimia and when I say excessive here this is not like, as I mentioned the previous video, is not like “oh I you know ate extra dessert last night so I should you know spend a few more it’s at the gym tomorrow” but you know this is where somebody spending hours and hours and hours at the gym each day. Where they’re not giving their bodies time to recover they’re actually damaging their body by the amount of exercise that they’re doing.

And so in order to get the diagnosis of bulimia nervosa they have to have at least one episode of binge eating and then purging behavior once per week for at least 3 months. So similar to what we saw with binge eating disorder except we also have these compensatory behaviors trying to make up for the extra calories that the person has taken in, but in what we would consider be inappropriate ways. In addition to these main symptoms here with the binging and purging behavior, we also tend to see negative evaluation of the self, negative evaluation of their own body shape and weight, and this brings us back to the differentiation with anorexia nervosa in that people with bulimia nervosa tend to be normal to overweight. So if they have low body mass index, if they’re underweight then they’d get diagnosed with anorexia nervosa, but if they’re normal to overweight then they get the diagnosis of bulimia nervosa.

Another common symptom is that they feel a lack of control over their behavior, very similar to binge eating disorder, where they often say you know they they feel like the food has control, you know, they’re somewhere and they just can’t stop themselves from continuing to eat. This is also part of the reason why they feel guilty after; they feel that they’ve lost control over their own behavior.

The estimated 12-month prevalence for bulimia nervosa in the DSM-5 is about 1-1.5% amongst females and this is mostly young females, so this is a disorder where it mostly affects girls in their teenage years to early 20s whereas once a woman is older than that her risk drops considerably. So if she’s not suffering from this disorder and she’s say 40 years old her likelihood of suddenly developing the disorders is quite low, compared to a woman who’s maybe you know 20 years old. And again we see this similar ratio with anorexia nervosa where it’s estimated to be about 10 times more common in women compared to men. And it’s comorbid with depressive symptoms. It’s also comorbid with other types of mood disturbing and with certain types of substance abuse, most commonly the use of stimulants. And this is to try to you burn more calories to try to make up for, this sort of use of stimulants is often part of an inappropriate compensatory behaviors. They’re taking you know caffeine pills or other stimulants or maybe things like amphetamines to try to make up for the episodes of binge eating.

Okay, so those are some of the feeding and eating disorders in the DSM-5 hope you found this helpful, if so, please like the video and subscribe to the channel for more. Thanks for watching!