Review of DSM5 Mental Disorders for NCMHCE Study

1. Anorexia Nervosa2. Avoidant/Restrictive Food Intake Disorder3. Binge Eating Disorder4. Bulimia Nervosa5. Pica6. Rumination Disorder7. Other Specified/Unspecified Type

ComorbiditySocial PhobiaOCDGADPTSDSchizophrenia

S4. TreatmentsCBT Relaxation TherapyDBT Dialectical Behavioral TherapyTransdiagnostic ApproachIPP Interpersonal TherapyFamily TherapyACGT Active Comparison TherapyNutritional Support

AnorexiaNot eating due to fear of weight gainMay include purging

Avoidant /RestrictiveNot eating due to disinterest or aversionNo purging

Both undereating

Binge Eating1 time weekly for 3 months

Bulimia 1 time weekly for 3 months Purging to avoid weight gain

Both overeating out of control

Diagnosis I1. Eating or feeding disturbance Lack of interest; avoidance of certain textures, etc; concern about consequencesMay have physical reactions (retching, gagging)2. Failure to meet nutritional or energy needs Significant weight lossNutritional deficiency Dependence on dietary supplements or feeding tube3. Interference with psychosocial functioning 4. Most commonly develops in infancy or early childhood and can persist into adulthood

S4. TreatmentsCBT Systematic DesensitizationRelaxation TherapyPsychoeducation

Diagnosis 1. Terrified of gaining weight despite being underweightUnable to maintain a minimally acceptable body weightRestricts calorie/food intake2. Distorted body imageSelf esteem and self evaluation based on weight and body shape3. Engages in extremes (excessive working out; use of laxatives/ weight loss supplements; etc.)4. Can develop in children and adolescentsAmenorrhea if absence of 3 consecutive menstrual cycles

Monitor severity based on BMI (mild, moderate, severe or extreme) to determine disability and treatment course

Note mild, moderate, severe, extreme

Diagnosis II ComorbidityBulimia NervosaBipolarDepressive disordersAnxiety disordersAlcohol Use Disorders

S1. Find Out S2. Assess & ReferQEWP-R Questionnaire on Eating and Weight Patterns-RevisedEDEQ Eating Disorder Exam Questionnaire

S4. TreatmentsMultidisciplinaryCBTDBT Dialectical Behavioral TherapyTransdiagnostic ApproachInterpersonal TherapyFamily TherapyACGT Active Comparison Therapy

Diagnosis1. Recurrent episode of binge eating of large amounts of food over short period of timeLack of control and cannot stopCan be of normal weight; overweight/underweight2. Engages in episodes at least 1x/week for 3 months3. Self induced vomiting, laxatives, fasting, exercise to compensateSigns of tooth enamel erosion/finger or pharynx bruisingFluid or electrolyte disturbances4. Develops late adolescence through adulthoodNote mild, moderate, severe, extreme

ComorbidityDepressive symptomsBipolar

S1. Find Out S2. Assess & ReferPsychiatric evaluationTestsEating Disorder InventoryMSE Mental Status ExamHAM-DBDIMDQECGSMAST

S4. TreatmentsFocus on therapeutic allianceIdentify triggers for eatingDBT Dialectical Behavior TherapyCBTIndividual, group, marital and family therapyBehavior modification Nutritional supportMedical supportMonitor severity Psychoeducation

Diagnosis1. Eating portions larger than normalLack of control over eatingMarked distress over eating2. Binge eating episodes have 3 or more of the following: Eating more rapidlyUntil uncomfortably fullLarge amounts when not hungryEmbarrassed by amountsDisgusted, depressed or guilty after eating3. Occurs at least 1x/week for 3 months

S5. Monitoring ProgressImproved diet

S6. Termination

S4. TreatmentDBT Dialectical Behavior TherapyCBT

Diagnosis IRequires:Persistent eating of non-nutritive, non-food substancesOver a period of 1 monthMight include: paper, soap, cloth, hair , paint, gum, soil, pebbles, iceTypically no aversion to food in generalMinimum age of 2yrs old for diagnosis

Co-occurring:Intellectual disabilityAutism spectrum disorderSchizophreniaAnorexia nervosa Nonsuicidal self-injuryAnxiety disorders

S4. TreatmentsApplied behavior therapy (ABT)

S1. Diagnosis I1. Repeated regurgitation and rechewing of food (or spitting out) Habitual or outside of their control2. Frequent, many times per week or daily3. Period of at least 1 month following period of normal functioning4. Not due to medical condition or exclusively during the course of Anorexia Nervosa or Bulimia Nervosa

Co-occurring:Intellectual disability

S4. TreatmentsHabit Reversal Behavior TherapyMild Aversion Therapy, if intellectually disabledMedicationProton Pump Inhibitors, if esophagus is damaged