MDU ch 5/6/7

distaste towards the sensory components of the food, such as texture, taste and temperature lack of interest in eating food an aversive event, such as food poisoning or choking

Answer 1: ARFID Answer 2: anorexia nervosa, restricting subtype or anorexia nervosa, binge/purge subtype Answer 3: anorexia nervosa, binge/purge subtype Answer 4: anorexia nervosa, restricting subtype or ARFID

Answer 1: ARFID Answer 2: anorexia nervosa, restricting subtype or anorexia nervosa, binge/purge subtype Answer 3: anorexia nervosa, binge/purge subtype Answer 4: anorexia nervosa, restricting subtype or ARFID

As discussed in Update on eating disorders: current perspectives on avoidant/restrictive food intake disorder in children and youth, in the "Picky Eating" subsection, neophobia is the fear of trying new food.

significant weight loss growth compromise reliance on nutritional supplements to meet daily energy requirements nutritional deficiency marked interference with the psychosocial functioning

Gastroesophageal Reflux Disease

familial anxiety -autism spectrum disorder -obsessive-compulsive disorder gastroesophageal reflux disease -family history of eating disorders (.25/1) While we can't rule out a "family history of eating disorders" being a risk factor for ARFID, it is not currently identified as one.

as

the potential for overpathologizing normal eating behavior in younger children

Impairment in psychosocial functioning

-pica -rumination -unspecified

-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. -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. -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. - 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.

Pica does appear to be more common in children, in those with OCD and schizophrenia (Dumaguing, Singh, Sethi & Devanand, 2003), autistic and/or intellectually disabled individuals (Clark, Vandermeer, Simonetti & Buka, 2010; Martindale, Bunker, & Noble, 2010), however rumination disorder is higher among intellectually disabled adults and children, ranging from 6-10% (Papadopoulos & Mimidis, 2007).

Pica can have a variety of significant medical consequences; ingesting sharp objects (e.g., nails, glass) may cause dental injury or intestinal perforation, while ingesting toxic substances (e.g., lead-based paint and household cleaners) can lead to respiratory distress, seizures, or metabolic abnormalities (Hui Liu, Pesch, Lumeng, & Stein, 2015). In extreme cases, pica can result in poisoning, chronic abdominal pain, anemia, constipation, intestinal obstruction and perforation, and frequent hospitalizations (Kelly, Shank, Bakalar & Tanofsky-Kraff, 2014). -both answer choices

true "Pediatric clinicians recognize that hand-tomouth exploration in toddlers is a normal developmental stage; it drives our interest in anticipatory guidance to insure a safe environment and monitoring activities of young children. As emphasized in both commentaries, clinically significant pica continues to be a risk in children with developmental delays and cognitive impairments. Direct questions to caregivers if often necessary; Emily was fortunate that her foster mother recognized the importance of bringing pica to the attention of her clinician."

gastrointestinal disorder

- A minority of the OSFED/USFED cases received clinical attention (less than 15%) From Mustelin, Lehtokari, & Keski-Rahkonen's 2016 article: "Residual diagnostic categories are frequently dismissed as "not really serious" despite substantial evidence to the contrary. In our setting, only 11% of cases had received clinical attention. Yet, we found that residual eating disorder categories carry substantial morbidity. In many women with OSFED/UFED, symptoms were quite longstanding, and over a third suffered from comorbid psychiatric disorders, which means that psychiatric comorbidity was nearly as common as among individuals with full-syndrome eating disorders. The modest 5-year probability of recovery of 60% was comparable to those of DSM-5 AN (72%) and BN (55%) in our setting."

False From Dr. Johnson's encyclopedia article: "Pica has been reported throughout the world and, in fact, is an accepted practice in some cultures. Geophagia, the ingestion of dirt, clay, and soil, has specifically been associated with pregnancy in some societies, including regions of Southern United States..."

Behavioral Treatments From Dr. Johnson's 2016 article, there is limited evidence for the efficacy of pharmacological and nutritional treatments for pica. Behavioral approaches have been the most common for individuals with pica and ASD and/or ID.

Behavioral weight loss therapy

The ideal body image for boys is lean and muscular

---Sam, who barely eats but is not depressed or dissatisfied with her body Bill, who eats a lot even when he doesn't feel hungry Ray, who exercises heavily even when he feels tired or sick Alex, who eats a lot but has high levels of anxiety, depression, and body dissatisfaction

Symptoms in adolescents can be confused for puberty

false

Questionnaires about attitudes toward food BMI measure Arm circumference ---All of these choices

PCPs have more chances to diagnose a patient

Coping skills Attitude toward food Body image --All of the above

false

Adolescents with eating disorders who are not underweight can still suffer the same complications as underweight adolescents

Inform patients of their weight Physicians should weigh patients they are evaluating for eating disorders with them facing away from the scale so that they cannot observe their own weight. Harrington, B. C., Jimerson, M., Haxton, C., & Jimerson, D. C. (2015). Initial evaluation, diagnosis, and treatment of anorexia nervosa and bulimia nervosa. American family physician, 91(1), 46-43.

-possibly efficious -experimental -well established -probably efficious

Answer 1: empirically supported treatments Answer 2: evidence based practice

interpersonal therapy and cognitive behavioral therapy

Answer 1: well-established treatment Answer 2: possibly efficacious treatment

no

Applied Behavioral Analysis

use of a single subject design that could not demonstrate experimental control.

It is possible that some individuals with chronic anorexia nervosa may be forced into treatment, despite having a realistic understanding of the outcome of their decision.

.5/1 -The quality and form of treatment varies widely across centers - Some programs do not have the expertise to treat coexisting medical or psychiatric problems -Some treatment approaches offered have little or no scientific evidence behind them There are not enough studies showing the residential program's efficacy - Rules vary from site to site and are not consistent

offer support and reassurance to help the patient return to healthier and more normal eating behaviors challenge behaviors that promote weight loss, like choosing a majority of "low-energy density" foods help the patient meet their nutritional requirements and returnt to a healthy weight -all of these answers