1: Eating Disorders Flashcards
epidemiology of eating disorders
- anorexia: 1% of women
- bulimia: 1-3% of women
- binge-eating: 2% of women, 1% of men
female to male ratio 10:1 for anorexics
factors in the multifactorial pathogenesis
- genetic: higher in monozygotic twins
- psych: means of coping
- biological: chemical changes occur w/ starvation
- family: higher incidence in 1st degree relatives
- env’t: higher in cultures that value thinness
- social: teasing
7 risk factors for developing an eating disorders
- female gender
- early pubertal development
- perfectionist
- low self-esteem
- sense of personal ineffectiveness
- difficulties w/ communication, conflict resolution, and separation from family
- drive to excel in sports
diagnostic criteria for anorexia
- restriction of energy intake -> significantly low body weight
- intense fear of gaining weight/becoming fat
- disturbance in the way in which one’s body weight or shape is experiences/lack of recognition of the seriousness of the problem
weight usually below 85% of normal for age/gender
restricting subtype of anorexia
weight loss achieved by dieting, fasting, and/or excessive exercise
binge eating/purging subtype of anorexia
weight loss achieved by self-induced vomiting, misuse of laxatives/diuretics/enemas, diet pills, stimulants
anorexia levels of severity: mild, moderate, severe, extreme
mild: BMI 17-18.5kg/m2
moderate: BMI 16-16.99 kg/m2
severe: BMI 15-15.99 kg/m2
extreme: BMI
diagnostic criteria for bulimia
- recurrent episodes of binge eating (eating in a discrete period a larger than normal amt or sense of lack of control over eating during episode)
- recurrent inappropriate compensatory behaviors to prevent weight gain at least 1/week for 3 mo.
- self eval is unduly influenced by body shape/weight
- disturbance doesn’t occur during anorexic episodes
bulimia levels of severity: mild, moderate, severe, extreme
mild: 1-3 episodes/week
moderate: 4-7 episodes/week
severe: 8-13 episodes/week
extreme: 14 or more episodes/week
diagnostic criteria for binge-eating disorder
- recurrent episodes of binge eating
- episodes associated with 3 or more of the following:
- eating too rapidly
- eating until feeling uncomfortably full
- eating large amts of food when not feeling hungry
- eating alone b/c of embarrassment
- feeling disgusted w/ oneself, depressed, or guilty after
- marked distress regarding binge eating
- at least 1/week for 3 mo
- not associated with inappropriate compensatory behavior
binge-eating levels of severity: mild, moderate, severe, extreme
mild: 1-3 episodes/week
moderate: 4-7 episodes/week
severe: 8-13 episodes/week
extreme: 14 or more episodes/week
presenting symptoms of eating disorders
- amenorrhea or menstrual irregularities
- abdominal pain and bloating
- cold intolerance
- constipation
- dizziness
- dry skin
- fatigue
- GERD (from vomiting)
- palpitations
- syncope
physical findings in anorexia
- acrocyanosis (blue fingers/toes)
- bradycardia
- emaciation
- hypotension (especially orthostatic hypotension)
- lanugo (fine hair)
- cold extremities
- hypothermia
- atrophic breasts
- edema of extremities
- flat affect
- alopecia (lose hair)
- salivary gland enlargement (from starvation)
physical findings in bulimia
- salivary gland enlargement (from vomiting), inflammation of parotid duct
- calluses on knuckles (Russell’s sign)
- mouth sores
- dental enamel erosions
- hypotension (especially orthostatic)
- edema of extremities (more due to compensatory methods, like diuretics)
- Mallory-Weiss tear (vomit forcefully and tear esophageal mucosa - usually present w/ bloody vomit)
lab abnormalities in anorexia
- mild normochromic, normocytic anemia with moderate leukopenia
- low blood sugar
- elevated serum cholesterol
- hyponatremia may be present from water loading
- elevated liver enzymes from refeeding or apoptosis from starvation
