Feeding and eating disorders

F50/F98

FEEDING AND EATING DISORDERS

DESCRIPTION

These disorders are characterised by a persistent disturbance of eating or eating-related behaviour that results in the altered consumption or absorption of food and has an impact on physical health or psychosocial functioning. The more common types include pica, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa and binge-eating disorder.

PICA

F98.3

DESCRIPTION

This is the persistent eating of non-nutritive, non-food substances for more than a month, inappropriate to developmental level. The ingestion is out of keeping with cultural and social norms.

GENERAL AND SUPPORTIVE MEASURES

  • Vitamin and mineral deficiencies e.g. zinc, iron should be excluded.
  • Physical examination.
  • Explore co-morbid conditions e.g. autism spectrum disorder(ASD), intellectual disability, schizophrenia, OCD, and impulse control disorders.

AVOIDANT/RESTRICTIVE FOOD INTAKE DISORDER

F50.8

DESCRIPTION

This is an eating or feeding disturbance that manifests by a persistent failure to meet appropriate nutritional and/or energy requirements. There may be lack of interest in food, food avoidance due to sensory sensitivity or concerns about the aversive consequences of eating. Criteria include one or more of: failure to make the expected weight gains, nutritional deficiency, dependence on enteral feeding or nutritional supplements or marked interference with psychosocial functioning. There is no lack of food, socially acceptable practice present or perceptual disturbance of body weight or shape.

GENERAL AND SUPPORTIVE MEASURES

  • Exclude medical, neurological or neuromuscular disorders.
  • Exclude other psychiatric disorders e.g. OCD, MDD, factitious disorder imposed on another (previously termed Munchausen’s by proxy).

ANOREXIA NERVOSA

F50.01/F50.02

DESCRIPTION

This disorder presents with restricted energy intake relative to requirements leading to a low body weight, an intense fear of gaining weight or becoming fat or behaviour that limits weight gain and a disturbance in body weight/shape perception, with poor insight into the seriousness of the low body weight. Children and adolescents may fail to make expected weight gains or maintain normal growth patterns e.g. increased height without weight gain. The Centre for Disease Control has used Body Mass Index (BMI)-for-age below the 5th percentile as being underweight. Physiological disturbances should also be considered.

The semi-starvation and purging can result in medical sequelae, even medical emergencies e.g. arrhythmias.
Co-morbid psychiatric disorders are common e.g. MDD, OCD.

GENERAL AND SUPPORTIVE MEASURES

  • A thorough physical examination.
  • Blood investigations including FBC, U&E, CMP, TSH.
  • Cardiac investigation: ECG.
  • Suicide risk assessment.

MEDICATION TREATMENT

  • Supportive measures for medical complications.
  • Refer to paediatrician for severe medical complications.
  • Refer to psychiatrist for psychiatric management.
  • Medication such as fluoxetine and olanzapine should be initiated by a psychiatrist.

BULIMIA NERVOSA

F50.2

This disorder is characterised by recurrent episodes of binge eating in which the individual eats large amounts of food in a short period with a sense of lack of control over the eating. Compensatory behaviours then follow e.g. self-induced vomiting or laxative usage. These behaviours occur at least once a week for three months. The individual’s self-evaluation is influenced by body shape and weight and their BMI may be within the normal to overweight range.

GENERAL AND SUPPORTIVE MEASURES

  • A thorough physical examination.
  • Blood investigations including FBC, U&E, CMP, TSH.
  • Cardiac investigation: ECG.
  • Suicide risk assessment.
  • Supportive measures for medical complications.

REFERRAL

  • Refer to a paediatrician for severe medical complications.
  • Refer to a psychiatrist for psychiatric management.