📘 Essential for Psychiatric Nursing, Mental Health, Nutrition, and Community Health Exams
🔰 Definition:
Anorexia Nervosa is a psychological eating disorder characterized by an intense fear of gaining weight, distorted body image, and persistent restriction of food intake, leading to significantly low body weight.
✅ It is classified under Feeding and Eating Disorders (DSM-5).
“It’s not just about food — it’s about control, fear, and distorted perception.”
🧭 Types of Anorexia Nervosa:
🟩 1. Restricting Type
Weight loss achieved through dieting, fasting, excessive exercise
No binge eating or purging
🟨 2. Binge-Eating/Purging Type
Regular binge eating followed by purging (vomiting, laxatives, enemas)
🧠 Core Features (DSM-5 Criteria):
Restriction of energy intake leading to significantly low body weight
Q5. Which antipsychotic is sometimes used in anorexia to aid weight gain? 🅰️ Haloperidol 🅱️ Risperidone ✅ 🅲️ Olanzapine 🅳️ Quetiapine Answer: ✅ (c)
🍽️🧠 Bulimia Nervosa
📘 Essential for Psychiatric Nursing, Mental Health, Nutrition, and Staff Nurse Exams
🔰 Definition:
Bulimia Nervosa is an eating disorder characterized by repeated episodes of binge eating followed by compensatory behaviors such as self-induced vomiting, excessive exercise, fasting, or misuse of laxatives to prevent weight gain.
✅ It involves distorted body image, preoccupation with weight, and feelings of guilt and shame.
“In bulimia, food is not nourishment — it becomes guilt and punishment.”
🧭 Core Features (DSM-5 Diagnostic Criteria):
Recurrent episodes of binge eating 🔹 Eating a large amount in a short time 🔹 Feeling out of control during the episode
Mental health assessment: mood, self-harm, suicidal ideation
Lab investigations: potassium, ECG, CBC
💊 Interventions:
Build non-judgmental therapeutic relationship
Encourage journaling and reflection post binge episodes
Monitor weight, vitals, food intake, bathroom use (to prevent purging)
Educate on nutrition and dangers of purging
Promote positive body image and self-worth
Support referrals to psychologist, psychiatrist, and dietitian
📚 Golden One-Liners for Revision:
🟨 Bulimia = binge eating + compensatory behavior
🟧 Fluoxetine is FDA-approved for bulimia
🟥 Russell’s sign and dental erosion = key physical indicators
🟩 CBT is first-line therapy
🟦 Suicide risk is high, monitor closely
🟨 Patients are usually normal weight (vs. anorexia)
✅ Top 5 MCQs for Practice:
Q1. A distinguishing feature of bulimia nervosa is: 🅰️ Severe underweight ✅ 🅱️ Binge eating followed by purging 🅲️ Refusal to eat at all 🅳️ Night eating Answer: ✅ (b)
Q2. Which is a physical sign seen in bulimia nervosa? 🅰️ Lanugo 🅱️ Short stature ✅ 🅲️ Dental erosion and parotid swelling 🅳️ Joint stiffness Answer: ✅ (c)
Q3. Russell’s sign refers to: 🅰️ Menstrual pain ✅ 🅱️ Calluses on knuckles from self-induced vomiting 🅲️ Tooth grinding 🅳️ Anxiety tremor Answer: ✅ (b)
Q5. Which drug is FDA-approved for treating bulimia nervosa? 🅰️ Sertraline 🅱️ Diazepam ✅ 🅲️ Fluoxetine 🅳️ Olanzapine Answer: ✅ (c)
🍔🧠 Binge Eating Disorder (BED)
📘 Essential for Mental Health Nursing, Psychiatric Nursing, Nutrition & Staff Nurse Exams
🔰 Definition:
Binge Eating Disorder (BED) is a mental health disorder characterized by recurrent episodes of uncontrollable overeating (binges) without compensatory behaviors like vomiting, fasting, or excessive exercise.
✅ It is the most common eating disorder and is classified under Feeding and Eating Disorders (DSM-5).
“In BED, food becomes a way to cope — but it leads to guilt and distress.”
🧭 DSM-5 Diagnostic Criteria for BED:
Recurrent binge eating episodes (at least once/week for 3 months):
Eating a large quantity of food in a short time
Feeling loss of control over eating
Episodes are associated with ≥3 of the following:
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not physically hungry
Eating alone due to embarrassment
Feeling disgusted, depressed, or guilty afterward
Marked distress regarding binge eating
No compensatory behaviors (unlike bulimia)
🧪 Clinical Features:
🟩 Physical:
Overweight or obesity
High cholesterol, hypertension, type 2 diabetes
Fatigue, joint pain
Gastrointestinal issues (bloating, reflux)
🟨 Psychological:
Low self-esteem
Depression, anxiety
Shame or guilt about eating
Social withdrawal
Emotional eating (to cope with sadness, anger, stress)
SSRIs (e.g., fluoxetine, sertraline) for depression
Topiramate – reduces binge frequency
Anti-obesity meds (with caution)
🟧 3. Nutritional Counseling:
Structured meal planning
Avoid skipping meals or restrictive diets
Support intuitive eating & healthy food relationship
🟥 4. Lifestyle Modifications:
Regular exercise
Sleep hygiene
Stress management (e.g., yoga, journaling)
👩⚕️ Nursing Management:
🩺 Assessment:
Binge patterns (frequency, triggers)
Weight, BMI, comorbidities (HTN, DM)
Psychological status: anxiety, depression, body image
Labs: blood sugar, lipids
💊 Interventions:
Build non-judgmental therapeutic rapport
Educate on balanced eating and meal regularity
Encourage journaling & emotion tracking
Coordinate with dietitians, psychologists, physicians
Support patient through relapse prevention strategies
📚 Golden One-Liners for Revision:
🟩 BED = binge eating without purging
🟨 Most common eating disorder in both men and women
🟧 CBT-E = first-line therapy
🟥 Lisdexamfetamine = FDA-approved drug for BED
🟦 Unlike bulimia → no vomiting or excessive exercise
✅ Top 5 MCQs for Practice:
Q1. A key feature of binge eating disorder is: 🅰️ Binge eating with purging ✅ 🅱️ Binge eating without purging 🅲️ Only nighttime eating 🅳️ Eating very little Answer: ✅ (b)
Q2. First-line psychotherapy for BED is: 🅰️ Hypnotherapy 🅱️ Psychoanalysis ✅ 🅲️ CBT-E (Cognitive Behavioral Therapy – Enhanced) 🅳️ ECT Answer: ✅ (c)
Q3. Which drug is FDA-approved specifically for BED? 🅰️ Fluoxetine 🅱️ Topiramate ✅ 🅲️ Lisdexamfetamine 🅳️ Diazepam Answer: ✅ (c)
Q4. A common comorbid condition in BED is: 🅰️ Hypotension 🅱️ Migraine ✅ 🅲️ Obesity and Type 2 Diabetes 🅳️ Cataract Answer: ✅ (c)
Q5. Which is NOT a feature of BED? 🅰️ Eating large quantity of food 🅱️ Feeling guilty after eating ✅ 🅲️ Regular vomiting after eating 🅳️ Eating even when not hungry Answer: ✅ (c)
⚖️🧠 Comparison: Anorexia vs Bulimia vs Binge Eating Disorder (BED)
📘 Essential for Psychiatric Nursing, Mental Health, and Staff Nurse Exams
🧾 Tabular Comparison:
🔹 Feature
🥗 Anorexia Nervosa
🍽️ Bulimia Nervosa
🍔 Binge Eating Disorder (BED)
Definition
Intense fear of weight gain with restriction
Binge eating followed by purging
Binge eating without compensatory behavior
Body Weight
Significantly underweight
Usually normal or slightly overweight
Often overweight or obese
Body Image Disturbance
Severe – distorted perception
Present – preoccupation with weight
Mild to moderate dissatisfaction
Binge Eating
Absent (in restricting type)
Present
Present
Purging/Compensatory Behavior
May occur (in binge/purge type)
Always present (vomiting, laxatives)
Absent
Menstrual Irregularities
Common – amenorrhea
May occur
Less common
Typical Physical Signs
Lanugo, dry skin, bradycardia, low BP
Dental erosion, Russell’s sign, parotid swelling
Obesity-related symptoms
Mood & Behavior
Perfectionism, denial, introverted
Guilt, shame, mood swings
Emotional distress, guilt, low self-worth
Diagnosis Criteria (per DSM-5)
BMI < 18.5 + fear of gaining weight
Binge + compensatory behavior ≥1/week × 3 mo
Binge eating ≥1/week × 3 months
Most Common Gender
Female
Female
Both sexes (common in males too)
Suicide Risk
Very High
High
Moderate
First-line Therapy
CBT + nutritional rehab
CBT + Fluoxetine
CBT-E + Lisdexamfetamine (FDA approved)
Medication Options
SSRIs (if comorbid), Olanzapine
Fluoxetine (FDA approved)
Lisdexamfetamine, SSRIs, Topiramate
📚 Golden One-Liners for Quick Revision:
🟩 Anorexia = fear of fatness + extreme thinness
🟨 Bulimia = binge + purge, weight usually normal
🟧 BED = binge without purge → leads to obesity
🟥 Suicide risk is highest in anorexia
🟦 Fluoxetine: used in bulimia; Lisdexamfetamine: FDA approved for BED
🟪 All require CBT as first-line psychotherapy
✅ MCQs for Practice:
Q1. Which eating disorder is characterized by low body weight and intense fear of gaining weight? ✅ 🅲️ Anorexia Nervosa
Q2. Which sign is specific to bulimia nervosa? ✅ 🅱️ Russell’s sign (knuckle calluses from induced vomiting)
Q3. A patient with repeated binge eating and no purging likely has: ✅ 🅰️ Binge Eating Disorder
Q4. Which eating disorder has the highest suicide risk? ✅ 🅱️ Anorexia Nervosa
Q5. First-line therapy in all three eating disorders includes: ✅ 🅲️ Cognitive Behavioral Therapy (CBT)
ARFID is an eating disorder characterized by persistent failure to meet appropriate nutritional or energy needs due to avoidance or restriction of food intake, without concern about body image or weight.
✅ Formerly known as “Selective Eating Disorder”. ✅ It is now recognized as a distinct diagnosis in DSM-5, separate from anorexia and bulimia.
“ARFID is not fear of fat — it’s fear of food textures, smells, or consequences.”
🧭 DSM-5 Diagnostic Criteria:
A. Eating or feeding disturbance (e.g., lack of interest, sensory sensitivity, fear of choking/vomiting), resulting in one or more of the following:
Significant weight loss (or failure to gain weight in children)
Nutritional deficiency
Dependence on enteral feeding or oral supplements
Marked interference with psychosocial functioning
B. Not due to lack of available food or culturally sanctioned practices
C. Not associated with body image disturbance (unlike anorexia)
D. Not better explained by another medical or psychiatric condition
🟥 Weight loss + food phobia ≠ anorexia = could be ARFID
✅ Top 5 MCQs for Practice:
Q1. ARFID is characterized by: 🅰️ Fear of becoming fat ✅ 🅱️ Avoidance of eating due to sensory or fear reasons 🅲️ Repeated purging 🅳️ Body image obsession Answer: ✅ (b)
Q2. Which of the following is NOT typical of ARFID? 🅰️ Nutritional deficiency 🅱️ Growth failure ✅ 🅲️ Fear of weight gain 🅳️ Food selectivity Answer: ✅ (c)
Q3. ARFID is most commonly associated with which comorbidity? 🅰️ Hypertension 🅱️ Epilepsy ✅ 🅲️ Autism Spectrum Disorder 🅳️ Diabetes Answer: ✅ (c)
Q5. A common pharmacological agent used to stimulate appetite in ARFID (children): 🅰️ Haloperidol ✅ 🅱️ Cyproheptadine 🅲️ Risperidone 🅳️ Zolpidem Answer: ✅ (b)
🍱🧠 Other Specified Feeding or Eating Disorders (OSFED)
OSFED is a diagnostic category in DSM-5 for eating disorders that do not meet the full criteria for anorexia nervosa, bulimia nervosa, or binge eating disorder but still cause clinically significant distress and impairment.
✅ OSFED was previously known as EDNOS (Eating Disorder Not Otherwise Specified) in DSM-IV.
“OSFED is real, serious, and often overlooked.”
🧠 DSM-5 Criteria Highlights:
A person does not fully meet criteria for other specific eating disorders
Still has disturbed eating patterns and body image concerns
Causes psychological distress or functional impairment
🧭 Common Subtypes of OSFED:
🟩 1. Atypical Anorexia Nervosa
All criteria for anorexia nervosa are met, EXCEPT the person is not underweight
Weight may remain within or above normal range
Significant weight loss, fear of weight gain, restrictive behavior present
🟨 2. Bulimia Nervosa (Low Frequency or Limited Duration)
All criteria for bulimia nervosa are met
But binge/purge occurs less than once a week or for < 3 months
🟧 3. Binge Eating Disorder (Low Frequency or Limited Duration)
All criteria for BED are met
Binge episodes are less frequent or less than 3 months duration
🟦 4. Purging Disorder
Regular purging behaviors (vomiting, laxatives)
No binge eating episodes
Body image concerns present
🟥 5. Night Eating Syndrome
Recurrent nighttime eating episodes
Reduced morning appetite
Distress, insomnia, and guilt associated
🧪 Clinical Features of OSFED:
Intense preoccupation with body weight, shape
Restriction of food or abnormal eating behaviors
Mood swings, guilt, shame
Nutritional deficiencies, menstrual issues
Self-esteem linked to body image
🧠 Risk Factors:
History of dieting or body dissatisfaction
Family history of eating disorders
Perfectionism, low self-worth
Comorbid anxiety, depression, trauma
💊 Management of OSFED:
🟩 1. Psychotherapy (Mainstay):
Cognitive Behavioral Therapy (CBT-E)
Family-based therapy (esp. for adolescents)
Mindfulness-based interventions
🟨 2. Medications (as per symptoms):
SSRIs (Fluoxetine) – for purging type, mood disorders
Topiramate, Lisdexamfetamine – in selected binge episodes
Supplements for nutritional deficits
🟧 3. Nutritional Support:
Structured eating plans
Addressing fears related to food
Regular meal routines
🟥 4. Psychoeducation:
Educate about health risks of disordered eating
Promote positive body image
Address social stigma and internalized shame
👩⚕️ Nursing Responsibilities:
Monitor weight, vitals, labs regularly
Assess for compensatory behaviors and suicidal ideation
Create a safe, supportive environment
Educate on healthy eating and self-acceptance
Involve family or caregiver support
Prevent relapse and encourage follow-up
📚 Golden One-Liners for Revision:
🟩 OSFED = significant eating disturbance without meeting full DSM-5 criteria
🟨 Atypical anorexia = weight not low but symptoms present
🟧 Purging disorder = vomiting/laxatives without binging
🟦 CBT-E = gold standard therapy
🟥 Night eating syndrome is an OSFED subtype
✅ Top 5 MCQs for Practice:
Q1. OSFED stands for: ✅ 🅱️ Other Specified Feeding or Eating Disorder
Q2. In atypical anorexia nervosa, the patient is: 🅰️ Obese ✅ 🅱️ Normal weight but with anorexic behavior 🅲️ Binging frequently 🅳️ Without food phobia Answer: ✅ (b)
Q3. Purging disorder involves: 🅰️ Only binge eating ✅ 🅱️ Purging without binge eating 🅲️ Insomnia 🅳️ Excessive exercise only Answer: ✅ (b)
Q4. Best psychotherapy for OSFED is: 🅰️ Group therapy 🅱️ Psychoanalysis ✅ 🅲️ CBT-E 🅳️ ECT Answer: ✅ (c)
Q5. Night eating syndrome includes all EXCEPT: 🅰️ Evening hyperphagia ✅ 🅱️ Early morning hunger 🅲️ Insomnia 🅳️ Shame about night eating Answer: ✅ (b)
🍂🧠 PICA and Rumination Disorder
📘 Essential for Pediatric Nursing, Psychiatric Nursing, and Community Health Exams
🔰 Overview:
Both PICA and Rumination Disorder are classified under Feeding and Eating Disorders in DSM-5. They are more common in infants, children, and individuals with developmental disabilities, but may also occur in adults.
🟩🍂 PICA
🔰 Definition:
PICA is the persistent eating of non-nutritive, non-food substances for at least 1 month, that is inappropriate for the individual’s developmental level and not culturally supported or socially normative.
Rumination Disorder is the repeated regurgitation of food, which is re-chewed, re-swallowed, or spit out, occurring for at least 1 month, not due to a medical condition (like reflux).
🔄 Clinical Features:
Occurs within 30 minutes of eating
Food is regurgitated effortlessly, without nausea or gagging
Individual may appear content or calm during the process
May lead to weight loss or malnutrition in children
Often no distress associated by the patient
⚠️ Complications:
Esophagitis
Dental erosion
Malnutrition and dehydration
Social withdrawal or embarrassment
Misdiagnosis as vomiting or reflux
🧠 Risk Factors:
Lack of stimulation or neglect (especially infants)
Intellectual disability
Anxiety or psychosocial stress
Institutionalization
🩺 Management of Rumination Disorder:
Behavioral therapy (habit reversal, distraction after meals)
Parental education and positive reinforcement
Postural training after meals (upright position)
Treat comorbid anxiety or depression
Nutritional support and weight monitoring
👩⚕️ Nursing Responsibilities for Both Disorders:
Assess eating patterns and history of substance ingestion/regurgitation
Monitor growth parameters, weight trends, and nutritional status
Educate caregivers and promote safe feeding environments
Prevent access to non-edible items (in PICA)
Observe for medical complications (e.g., anemia, infection)
Collaborate with psychologists, dietitians, pediatricians
📚 Golden One-Liners for Revision:
🟩 PICA = Eating non-food items > 1 month
🟨 Rumination Disorder = Repeated regurgitation without nausea
🟥 Both are more common in children and individuals with developmental delays
🟦 Lead poisoning & GI obstruction = major PICA risks
🟧 Rumination usually occurs soon after eating and is not vomiting
✅ Top 5 MCQs for Practice:
Q1. Which substance is commonly ingested in PICA? 🅰️ Fruits 🅱️ Cooked meat ✅ 🅲️ Clay or dirt 🅳️ Milk Answer: ✅ (c)
Q2. Rumination Disorder is best defined as: 🅰️ Repeated vomiting with nausea ✅ 🅱️ Re-chewing and re-swallowing regurgitated food 🅲️ Avoidance of food texture 🅳️ Eating at night Answer: ✅ (b)
Q3. Which condition is NOT a complication of PICA? 🅰️ Lead poisoning 🅱️ Parasitic infection 🅲️ Anemia ✅ 🅳️ Hyperthyroidism Answer: ✅ (d)
Q4. A key behavioral feature of rumination is: ✅ 🅱️ Calm appearance while regurgitating food
Q5. First step in management of PICA is: 🅰️ Surgery ✅ 🅱️ Correct iron/zinc deficiency 🅲️ Remove stomach 🅳️ Administer antidepressants Answer: ✅ (b)
⚖️🍽️ Comparison of Feeding and Eating Disorders (DSM-5)