Reference
Guide | Reference

32  Eating, Appetite, and Body Image

32.1 Summary

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

32.2 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.”

32.3 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.

32.4 Boundary Markers

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

32.5 Variants / Spectrum

  • Restriction-dominant patterns.
  • Binge/purge patterns.
  • Binge without compensatory behavior.
  • Avoidant/restrictive patterns tied to sensory or fear.

32.6 Severity Anchors (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.

32.7 Time-Course Patterns

  • Episodic with stress-linked spikes.
  • Chronic patterns with fluctuating severity.

32.8 Functional Impact

  • Work/school: concentration loss, health impacts.
  • Relationships: secrecy, conflict around meals.
  • Self-care: nutritional compromise or medical risk.

32.9 Common Mimics / Differential

  • Medical causes of weight loss or appetite change.
  • Mood or anxiety-driven appetite shifts.
  • Substance effects.

32.10 Medical / Substance Rule-Outs

  • Endocrine, GI, or metabolic contributors.
  • Medication effects or stimulant use.

32.11 Developmental Expression

  • Childhood: picky eating, sensory avoidance.
  • Adolescence: body image concerns, restriction.
  • Adulthood: chronic patterns or relapse.

32.12 Cultural / Context Notes

  • Body ideals and food norms shape expression.
  • Food insecurity can mimic restriction.

32.13 Measurement Prompts

  • Brief eating behavior screen.
  • Weight/behavior tracking as appropriate.

32.15 Documentation Snippet (1-2 lines)

  • “Reports restrictive eating with weight/shape concerns; Eating/Feeding 3; chronic course.”