Demystifying Disorders: The Nuances of Eating Disorders

Hi everyone and welcome to today's episode . I'm Dr

I'll tell you , linton , those exams love throwing curveballs , where you have to tell apart disorders that seem pretty similar at first . So today we're here to clear things up and give you tools to tell the difference on your exam and to help your future clients .

All right , let's kick things off with anorexia nervosa . The DSM

It's all about those binge eating episodes followed by compensatory behaviors like vomiting , over-exercising or misusing laxatives . For a diagnosis , this needs to happen at least once a week for three months , and how clients see themselves is heavily tied to their weight and shape .

Then there's binge eating disorder . This one involves binge eating without the purging or other compensatory stuff that you see in bulimia . It's about quickly eating a ton of food while feeling out of control Like the others . It must happen at least once a week for three months to meet diagnostic criteria .

Another important disorder is avoidant restrictive food intake

When it comes to what these disorders look like clinically . Anorexia often shows up with extreme weight loss , cold intolerance and amenorrhea . In females , these clients may wear loose clothes to hide their bodies and obsessively count calories or develop food rituals . These behaviors often stem from a need for control and can cause significant distress if interrupted .

Bulimia can be tricky because clients usually have normal weight , but you might notice calluses on their knuckles , which is also known as Russell's sign , dental erosion from vomiting or swollen parotid glands . They often feel ashamed and work hard to keep their behaviors secret .

Okay , so you're assuming I know what the parotid gland is ? Give me a clue ? No , problem .

The parotid glands are salivary glands located on either side of your face and extend from the cheek to below the jawline . If they're swollen , you might consider bulimia . You also might see that description in a mental status exam , so it might be a clue to the diagnosis

Binge eating disorder , however , looks different . Clients might be overweight or obese , but not always . They often talk about eating until they're uncomfortably full , embarrassed about eating alone and guilty afterward . Unlike bulimia , there's no purging involved .

That's an interesting question , linton . But now that you bring it up , I do notice that sometimes I eat until I'm stuffed . Part of it is wanting to get my money's worth , but afterward I do feel kind of bad , like maybe I overdid it . And yeah , if I'm eating alone I sometimes feel a little self-conscious , like people might be watching me .

That makes sense and , honestly , you're not alone in feeling that way . I think it's something both of us can work on . Speaking of food challenges , have you ever heard of avoidant restrictive food intake disorder ?

Sure have Lintz Avoidant . Restrictive food intake disorder stands out because there's no distress about body shape or weight . Instead , clients avoid certain foods because of sensory issues or fears like choking . This can cause weight loss or nutritional problems like anorexia , but for totally different reasons when it comes to treatment for anorexia .

family-based treatment , also known as the Maudsley approach , works really well for teens

Bulimia responds well to CBT-E2 . It targets what keeps the disorder going and works for most people . Interpersonal psychotherapy can also help if relationship issues are fueling the behavior's .

For binge eating disorder . Cbt is super effective in that it helps clients figure out what triggers their binges and teaches them healthier coping strategies . And don't forget that dialectical behavior therapy can also work well if emotional struggles are driving the binging .

Treatment for avoidant , restrictive food intake disorder often uses adapted CBT approaches that gradually expose clients to feared foods while teaching them how to manage anxiety around eating . Sensory integration techniques can also be helpful when sensory issues are part of the problem .

No matter which disorder you're treating , keeping an eye on medical stability is crucial . Working with a physician , dietitian and sometimes a psychiatrist as part of a team is key , for anorexia especially . Getting weight back up is often step one before engaging in deeper psychological work .

Motivational interviewing can be helpful , since recovery ambivalence is common with eating disorders . Instead of pushing too hard against resistance , roll with it and help clients connect with values beyond their appearance , across all eating disorders .

Cognitive restructuring is huge . Helping clients challenge distorted thoughts like thin equals happy by having the client look at evidence for and against those beliefs .

Exposure therapy is another approach , whether it's eating feared foods , tolerating fullness sensations or looking at their body in the mirror , you'll gradually guide them through

Food journaling can be really eye-opening . It helps clients track what they eat , along with their thoughts and feelings , so they can spot patterns and triggers .

Body image work might involve mirror exercises where clients describe their body neutrally instead of critically or questioning assumptions like my worth depends on how I look .

Mindful eating exercises are great for reconnecting with hunger and fullness , cues that might have been ignored for years . Starting with simple foods like raisins helps them slow down and notice textures and tastes without judgment For binge eating and bulimia .

Especially emotion regulation skills are key , helping clients identify emotions , tolerate distress without turning to food and find healthier ways to self-soothe when they're upset .

When it comes to assessments , the eating disorder examination is indicated . It looks at behavioral and psychological features over the past month and gives valuable diagnostic information .

The eating disorder inventory is another great tool . It's a self-report measure that digs into traits like drive for thinness or body dissatisfaction .

If you need something quicker for screening purposes , check out the SCOFF questionnaire . It's just five questions , but super effective in spotting potential issues early on .

The eating attitudes test is another solid option . It flags symptoms characteristic of eating disorders when scores hit a certain threshold .

Body checking behaviors like obsessively weighing yourself or looking in mirrors can keep someone stuck in a preoccupation with their weight or shape On the flip side body avoidance , like wearing baggy clothes or avoiding mirrors altogether , also reinforces those negative thoughts tied to eating disorders reinforces those negative thoughts tied to eating disorders .