Fundamentals of Diagnosing and Treating Eating Disorders

Fundamentals of Diagnosing and Treating Eating Disorders

Janna Gordon-Elliott Fundamentals of Diagnosing and Treating Eating Disorders A Clinical Casebook 123

Janna Gordon-Elliott New York, NY USA ISBN 978-3-319-46063-5 ISBN 978-3-319-46065-9 (ebook) DOI 10.1007/978-3-319-46065-9 Library of Congress Control Number: 2016950904 Springer International Publishing Switzerland 2017 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer International Publishing AG The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland

Preface Epitomized by the prototypical disorders of anorexia nervosa and bulimia nervosa, feeding and eating disorders span a wide range of disturbance related to eating, weight regulation, and body image, and impact individuals across gender, sexual orientation, racial/ethnic, and socioeconomic lines. It has been estimated that up to 20 million women and 10 million men in the USA may be affected by a clinically significant eating disorder at some point in their lives, and many more will have sub-syndromal disturbances in eating, body image, and weight concerns [1]. The impact of feeding and eating disorders is substantial, with significant medical, psychological, and functional consequences. Anorexia nervosa, for example, appears to carry the highest mortality rate of all psychiatric disorders, and the long-term physical, emotional, and social sequelae add to further burden for the individual and society. The high prevalence and pernicious impact of full-syndrome feeding and eating disorders as well as subclinical troubles in eating and body image should prompt careful attention to the possible presence of eating-disordered symptoms in all patients in clinical practice, whether or not issues of eating or weight are part of the chief complaint. Moreover, feeding and eating disorders may coexist with other mental and medical conditions or may manifest v

vi Preface in atypical ways. Mental health clinicians and practitioners across clinical specialties and disciplines will benefit from additional knowledge and skills related to the recognition and initial management of feeding and eating disorders. With enhanced detection, assessment, and appropriate referral, more individuals struggling with problematic eating patterns or ideas about body or weight may have the benefit of treatment. Many changes were made in the categorization and diagnosis of eating disorders with the transition of the Diagnostic and Statistical Manual (DSM) from DSM-IV-TR to DSM-5, including combining diagnoses from different chapters and revising the diagnostic criteria of others. In this book, illustrative cases are utilized to demonstrate the eight feeding and eating disorders, in addition to a range of presentations that are not clearly as typical but which still may be common in clinical practice. Changes in DSM-5 affecting the feeding and eating disorders are reviewed. Strategies and clinical pearls related to the recognition, assessment, and management of eating disorder pathology in patients in clinical practice are discussed through the viewpoint of vivid case presentations. Clinical material is drawn from the author s clinical work with patients over years and in different treatment settings, as well as idealized and prototypical diagnostic presentations. All cases presented have been developed by the author combining characteristics of real individuals as well as fictitious elements. No case presented represents a specific individual. First names were created and assigned alphabetically and have no connection to actual patients. New York, USA Janna Gordon-Elliott References 1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing. 2. Wade TD, Keski-Rahkonen A, & Hudson J. (2011). Epidemiology of eating disorders. In M. Tsuang and M. Tohen (Eds.), Textbook in Psychiatric Epidemiology (3rd ed.) (pp. 343 360). New York: Wiley.

Contents Part I Patients who Eat Too Little 1 Arlene, an Anxious Young Woman.... 3 1.1 Case Presentation.... 3 1.2 Diagnosis/Assessment... 5 1.3 Differential Diagnosis... 9 1.4 Outcome... 11 Suggested Readings... 12 2 Becky s Body Worries... 13 2.1 Case Presentation.... 13 2.2 Diagnosis/Assessment... 14 2.3 Differential Diagnosis... 18 2.4 Outcome... 19 References... 20 Suggested Readings... 20 3 Cassandra, the College Student... 21 3.1 Case Presentation.... 21 3.2 Diagnosis/Assessment... 23 3.3 Differential Diagnosis... 27 3.4 Outcome... 29 References... 30 Suggested Readings... 30 vii

viii Contents 4 Danny, the Picky Eater... 33 4.1 Case Presentation.... 33 4.2 Diagnosis/Assessment... 34 4.3 Differential Diagnosis... 37 4.4 Outcome... 40 References... 41 Suggested Readings... 41 5 Eric, the Hopeful Olympian.... 43 5.1 Case Presentation.... 43 5.2 Diagnosis/Assessment... 44 5.3 Differential Diagnosis... 48 5.4 Outcome... 49 Reference... 50 Suggested Readings... 50 6 Francine s Insulin Issues... 51 6.1 Case Presentation.... 51 6.2 Diagnosis/Assessment... 52 6.2.1 Eating Disorders and Chronic Medical Illness... 55 6.2.2 Assessment... 56 6.2.3 Eating Disorders and Online Media... 57 6.3 Differential Diagnosis... 58 6.4 Outcome... 58 References... 60 Suggested Reading... 60 Part II Patients who Eat Too Much 7 Ginny, the Secret Eater... 63 7.1 Case Presentation.... 63 7.2 Diagnosis/Assessment... 64 7.2.1 Clinical Features.... 66 7.2.2 Comorbidity... 67 7.2.3 Assessment... 67 7.2.4 Treatment... 69 7.3 Differential Diagnosis... 70 7.4 Outcome... 73 References... 74 Suggested Readings... 74

Contents ix 8 Hannah s Troubles... 75 8.1 Case Presentation.... 75 8.2 Diagnosis/Assessment... 76 8.3 Differential Diagnosis... 76 8.4 Outcome... 80 References... 81 Suggested Readings... 81 9 Ian, the Guilty Eater... 83 9.1 Case Presentation.... 83 9.2 Diagnosis/Assessment... 84 9.3 Differential Diagnosis... 91 9.4 Outcome... 92 Suggested Readings... 93 10 James, the Inconsistent Eater... 95 10.1 Case Presentation.... 95 10.2 Diagnosis/Assessment... 96 10.3 Differential Diagnosis... 96 10.4 Outcome... 100 References... 101 Suggested Reading... 101 11 Kendra s Social Anxiety.... 103 11.1 Case Presentation.... 103 11.2 Diagnosis/Assessment... 104 11.2.1 Management... 106 11.3 Differential Diagnosis... 108 11.4 Outcome... 108 Reference... 109 Suggested Readings... 109 12 Lisa, Overweight but Undernourished... 111 12.1 Case Presentation.... 111 12.2 Diagnosis/Assessment... 112 12.2.1 Management... 116 12.3 Differential Diagnosis... 119 12.4 Outcome... 119 References... 120 Suggested Readings... 120

x Contents Part III Patients who Eat in Odd Ways 13 Mimi, the Quiet Little Girl... 123 13.1 Case Presentation.... 123 13.2 Diagnosis/Assessment... 124 13.2.1 Management... 127 13.3 Differential Diagnosis... 128 13.4 Outcome... 128 Suggested Readings... 129 14 Nilda s Food Allergies... 131 14.1 Case Presentation.... 131 14.2 Diagnosis/Assessment... 132 14.2.1 Management... 137 14.3 Differential Diagnosis... 138 14.4 Outcome... 139 Suggested Readings... 140 15 Olive, the Healthy Eater... 141 15.1 Case Presentation.... 141 15.2 Diagnosis/Assessment... 142 15.2.1 Eating Disorders in Older Adults... 147 15.2.2 Treatment... 149 15.3 Differential Diagnosis... 149 15.4 Outcome... 150 Suggested Readings... 150 16 Peter, Healthy Weight but Unhealthy... 151 16.1 Case Presentation.... 151 16.2 Diagnosis/Assessment... 152 16.3 Differential Diagnosis... 155 16.4 Outcome... 155 Suggested Readings... 156 Index... 157