Feeding & Eating DisordersFeeding & Eating Disorders

B. Timothy Walsh, MDProfessor of Psychiatry, Columbia University

New York State Psychiatric Institute

Feeding & Eating DisordersFeeding & Eating Disorders

• Defining characteristic:– persistent disturbance in eating behavior

Eating DisordersEating Disordersin DSM-IVin DSM-IV

• Anorexia Nervosa• Bulimia Nervosa

Feeding & Eating DisordersFeeding & Eating Disordersin DSM-5in DSM-5

• Anorexia Nervosa• Bulimia Nervosa• Binge Eating Disorder (BED)• Avoidant/Restrictive Food Intake Disorder (ARFID)• Pica• Rumination Disorder• Not Obesity

Core Features - 1

• Anorexia Nervosa (AN)– Persistent caloric restriction -> low weight; fear of weight

gain

• Bulimia Nervosa (BN)– Binge eating & purging

• Binge Eating Disorder (BED)– Binge eating & no purging

Core Features - 2

• Avoidant/Restrictive Food Intake Disorder (ARFID)– Restrictive food intake, but not AN

• Pica– Ingestion of non-nutritive, non-food substances

• Rumination Disorder– Regurgitation of ingested food

(AN)AnorexiaNervosa

(AN)AnorexiaNervosa

Bulimia Nervosa(BN)

Bulimia Nervosa(BN)

Binge Eating Disorder(BED)

Binge Eating Disorder(BED)

Disordered EatingDisordered Eating

Prevalence

(AN)AnorexiaNervosa

(AN)AnorexiaNervosa

Bulimia Nervosa(BN)

Bulimia Nervosa(BN)

Binge Eating Disorder(BED)

Binge Eating Disorder(BED)

Disordered EatingDisordered Eating

Cost

Severity

Prevalence

(AN)AnorexiaNervosa

(AN)AnorexiaNervosa

Bulimia Nervosa(BN)

Bulimia Nervosa(BN)

Binge Eating Disorder(BED)

Binge Eating Disorder(BED)

Disordered EatingDisordered Eating

Cost

SeverityIn

tens

ity o

f Car

e Intensity of Care

Prevalence

(AN)AnorexiaNervosa

(AN)AnorexiaNervosa

Bulimia Nervosa(BN)

Bulimia Nervosa(BN)

Binge Eating Disorder(BED)

Binge Eating Disorder(BED)

Disordered EatingDisordered Eating

Intensity / Levels of Care

• Outpatient (primary care vs specialist care)• Intensive Outpatient Program (IOP)

– Generally 3X weekly multi-modal treatment

• Partial Hospital Program (PHP)– Daily comprehensive treatment, including meals

• Residential– 24 x 7– All voluntary participation– Lower staffing than inpatient– Structured differently in different parts of US (e.g., supportive housing

+ PHP)

• Inpatient (psychiatry vs medicine or pediatrics)