Feeding Eating Disorders B Timothy Walsh MD Professor

Feeding & Eating Disorders B. Timothy Walsh, MD Professor of Psychiatry, Columbia University New York State Psychiatric Institute

Feeding & Eating Disorders • Defining characteristic: – persistent disturbance in eating behavior

Eating Disorders in DSM-IV • Anorexia Nervosa • Bulimia Nervosa

Feeding & Eating Disorders in 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) Anorexia Nervosa Bulimia Nervosa (BN) Binge Eating Disorder (BED) Disordered Eating

Prevalence (AN) Anorexia Nervosa Bulimia Nervosa (BN) Binge Eating Disorder (BED) Disordered Eating

Cos Prevalence Disordered Eating ty Binge Eating Disorder (BED) eri Bulimia Nervosa (BN) Sev t (AN) Anorexia Nervosa

Prevalence of C nsi ty re f Ca ty o Int e ty i ens Disordered Eating eri Binge Eating Disorder (BED) Int Bulimia Nervosa (BN) Sev Cos are t (AN) Anorexia Nervosa

Intensity / Levels of Care • Outpatient (primary care vs specialist care) • Intensive Outpatient Program (IOP) – Generally 3 X 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)