Other Risk Behaviors

Eating Disorders

Adolescence is the primary time for the development of eating disorders. The interaction of puberty and the issues surrounding body image place teens at risk. Early recognition of unhealthy eating habits makes treatment easier and improves outcomes. Counseling teens on nutrition and appropriate weight management may go a long way in preventing these disorders.

 In the past, the Diagnostic and Statistical Manual of Mental Disorders 4 (DSM-4) only specified two eating disorders, anorexia nervosa and bulimia nervosa. This left more than half of patients in the category of Eating Disorders Not Otherwise Specified (EDNOS). In the fifth edition of DSM-5, the chapter Feeding and Eating Disorders now includes the following six disorders: anorexia nervosa, bulimia nervosa, binge-eating disorder, avoidant/restrictive food intake disorder (ARFID), rumination disorder, and pica. EDNOS has been replaced with Other Specified Feeding or Eating Disorder and Unspecified Feeding or Eating disorders. This review will focus on anorexia nervosa and bulimia nervosa. 

Anorexia nervosa (AN)

The prevalence of anorexia nervosa among young females is approximately 0.4%. Females outnumber males 10:1. Anorexia nervosa occurs across culturally and socially diverse populations, though there is an increased risk among first-degree biological relatives of individuals with

More Info: Diagnostic Criteria Anorexia

A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental, trajectory and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.

B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.

C. Disturbance in the way in which one's body weight or shape is experienced, undu influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.

 Specify whether:

(F50.01) Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior. (i.e. self-induced vomiting or the misuse of laxitives, diuretics, enemas). This subtype describes presentations in which weght loss is accomplished primarily through dieting, fasting and/or excessive exercise.

(F50.02) Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating or purging behavior (i.e. self-induced vomiting or the misuse of laxitives, diuretics, enemas).

the disorder. Patients with anorexia nervosa are also at increased risk of suicide.

The primary features of anorexia nervosa include a severe energy intake restriction, an intense fear of gaining weight or becoming fat, and a disturbance in self-perceived weight or shape. The requirement for amenorrhea was eliminated in DSM-5, which increases the likelihood for diagnosis in males and premenarchal females. See below for full DSM-5 criteria.

Most laboratory tests in patients with eating disorders are normal, and may provide false reassurance to families and providers. Severe cardiac complications can still occur despite normal lab results. Findings which may support a diagnosis of anorexia nervosa include: leukopenia, electrolyte abnormalities, elevated liver enzymes, and a low T3 and low-normal T4. Sinus bradycardia on electrocardiography is common; prolonged QT and arrhythmias can also be seen.      

Treatment involves a multi-disciplinary approach involving physicians, mental health providers and registered dietitian nutritionists. Hospitalization may be necessary. Common psychotherapies used to treat patients include cognitive behavioral therapy (CBT) and family based therapy (FBT), with some evidence suggesting that FBT is the most effective treatment for adolescents.