Guide
Guide | Reference

22  Eating, Appetite, and Body Image

22.1 Summary

  • Changes in appetite, eating behavior, or body image that drive distress, restriction, or loss of control.

22.2 Patient-Language Phrases

  • “I’m scared of gaining weight.”
  • “I feel out of control when I eat.”
  • “Food textures make it hard to eat.”
  • “I avoid meals even when I’m hungry.”

22.3 Core Features

  • Restriction or avoidance of food.
  • Binge episodes or loss of control.
  • Compensatory behaviors or excessive exercise.
  • Distorted body image or weight/shape concerns.

22.4 Boundary Markers

  • What it is: persistent eating-related distress or dysregulation with functional impact.
  • What it is not: short-term diet changes without impairment.

22.5 Quick Structure

  • Variants / Spectrum
    • Restriction-dominant patterns.
    • Binge/purge patterns.
    • Binge without compensatory behavior.
    • Avoidant/restrictive patterns tied to sensory or fear.
  • Severity (0-4)
    • 0: No significant eating dysregulation.
    • 1: Mild, intermittent, manageable.
    • 2: Moderate, recurring, impacts function.
    • 3: Severe, persistent, with medical or functional risk.
    • 4: Extreme, disabling or unsafe.
  • Time-course
    • Episodic with stress-linked spikes.
    • Chronic patterns with fluctuating severity.
  • Functional impact
    • Work/school: concentration loss, health impacts.
    • Relationships: secrecy, conflict around meals.
    • Self-care: nutritional compromise or medical risk.
  • Developmental expression
    • Childhood: picky eating, sensory avoidance.
    • Adolescence: body image concerns, restriction.
    • Adulthood: chronic patterns or relapse.
  • Cultural/context notes
    • Body ideals and food norms shape expression.
    • Food insecurity can mimic restriction.