Feeding and Eating Disorders

Feeding and eating disorders are characterized by eating behavior that results in health or psychosocial problems. Anorexia nervosa is characterized by restrictive eating that leads to dangerously low body weight and disturbances in self-perceived shape or weight. Bulimia nervosa is a disorder that includes episodes of binge eating and compensatory behaviors (e.g., purging, exercising) in individuals who are unduly influenced by shape and weight. Avoidant/restrictive food intake disorder (ARFID) is a newly defined disorder that describes rigid eating behavior that results in weight loss, nutritional deficiency, or psychosocial problems in individuals who are not preoccupied with shape or weight.

Anorexia affects 0.4% of females, while bulimia affects 1% to 1.5% of females. Though males can be affected by these disorders, it is much more uncommon and prevalence rates are not well defined.

Some individuals with anorexia nervosa may be able to continue to participate in social events, school, or work, while others became very socially isolated and unable to function in these settings and in expected roles (e.g., as a student, worker, parent).

Key features of bulimia nervosa include patterns of eating objectively large amounts of food in which an individual experiences the inability to stop their eating (a loss of control) combined with compensatory behaviors such as purging (i.e., self-induced vomiting), exercise, laxative or diuretic abuse to prevent weight gain. Individuals with bulimia maintain weight in the normal-to-overweight range. Bulimia is associated with medical symptoms related to the compensatory behaviors including potentially life-threatening fluid and electrolyte abnormalities, gastrointestinal tract damage and cardiac arrhythmias. Individuals with bulimia may be able to conceal behaviors and maintain social, academic and occupational functioning, while others cannot maintain function across these domains.

The key features of avoidant/restrictive food intake disorder (ARFID) are food avoidance or decreased food intake that leads to weight loss, nutritional deficiency or impaired functioning. The avoidance may be related to sensory issues or in anticipation of unpleasant experiences such as choking or vomiting. ARFID may be associated with lack of interest in eating, rigidity, and other features of anxiety or mood disorders. Individuals with this disorder may not be able to participate in social aspects of eating or may cause significant developmental or family disturbance when the pattern of eating limits ability to eat in different settings.

Key Features of Anorexia Nervosa

• Persistent restriction of calories because of fear of gaining weight
• Unhealthy compensatory behaviors (e.g., self-induced vomiting, abuse of laxatives or diuretics)
• Psychological and physical symptoms related to the state of semi-starvation including mood symptoms, obsessive-compulsive features, and abnormal vital signs and laboratory findings

Avoidance/Restricive Food Intake Disorder (ARFID) is a newly defined diagnositc category in the the DSM-5, that describes eating behavior that results in impairment in growth, nutrition or social interactions that is different from eating disorders related to body image. For example, individuals who fear choking, and then refuse to eat and lose weight due to that fear, would meet the criteria of ARFID. In children and adolescents, phobias of choking or vomiting are not uncommon and can lead to loss of weight and failure to thrive. The new ARFID category also includes many individuals already receiving treatment at our clinic for specific phobias, OCD and other anxiety disorders.

Dr. Eve Freidl and Dr. Blake Zakarin, with their expertise in the treatment of eating and feeding disorders, have expanded our services to treat ARFID and the range of eating disorders. We look forward to combining their knowledge with our expertise in CBT and anxiety related exposure work to develop a treatment program specifically for ARFID. To meet our growing need in this area, we would like to recruit postdoctoral fellows interested in this work to further building our treatment development team. Because ARFID is newly named disorder that groups together many individuals who restrict food for different reasons, little is known about how many people are affected by this disorder.

Key Features of Feeding or Eating Disorders

• Group of disorders that describes eating behavior that causes heath or social impairment
• Anorexia nervosa characterized by behavior that leads to starvation
• Bulimia nervosa characterized by binge eating and compensatory behaviors
• Avoidance Restrictive Food Intake Disorder is characterized by limiting food variety and/or quantity that is unrelated to body image