119. Eating Disorders

Question 1

DSM5 Dx of Anorexia Nervosa

Answer 1

1. Restriction of energy intake relative to requirements, leading to significantly low body weight
2. Weight less than minimally normal/expected
3. Intense fear of gaining weight or becoming fat while underweight
4. Dysmorphia, lack of recognition of seriousness of low body weight
   [BMI is informative but not diagnostic; any drastic weight loss is dangerous]

Question 2

What are the two major types of Anorexia?

Answer 2

1. Restricting Type: controlling how much you eat

2. Binge-Eating/Purging Type: episodes of binging/vomiting-laxative use

Question 3

AN Risk Factors:

Answer 3

Puberty
Perfectionistic Personality
FamHx of Eating Disorder
OCD, Anxiety
Impaired family interactions
Stressful Life events

Question 4

Treatment of AN

Answer 4

Weight Restoration
Modify Distorted Eating behavior and address psych/family issues (psychotherapy)
Nutritionists, Monitor Physical Activity
CBT, Family-based Therapy
Meds not effective - FOOD is most important

Question 5

DSM 5 Dx of Bulimia Nervosa

Answer 5

1. Recurrent episodes of binge eating (discrete time of lack of control)
2. Inappropriate compensatory behavior to prevent weight gain (vomit, exercise, laxative)
3. Binge eating 1x/wk for 3mo

Question 6

BN Risk Factors, Favorable prognostic factors

What is Russel’s Sign?

Answer 6

Dieting
Puberty
Transitions
Various Jobs where weight is important (athletes, actors, models)
Anorexia, Impulsivity, Anxiety

PF: Younger age of onset, higher SES

RS: scrapes on back of hand from inducing vomiting

Question 7

Tx of BN

Answer 7

1. THERAPY - CBT/DBT
2. SSRI - Fluoxetine - extends time to relapse

Don’t give bupropion - seizure risk

Question 8

What is the dx of a binge eating disorder (BED)?

Answer 8

1. Recurrent episodes of binge eating with lack of control over discrete time
2. Assoc with 3+ of: eating more rapidly, until uncomfortably full, when not feeling hungry, eating alone, feeling disgusted

Question 9

Etiology for Eating disorders (biologic causes)

Answer 9

1. Central NT dysregulation affecting 5HT, DA, NE
2. Vomiting = increase DA = reinforces/rewards behavior

Genetics: EDs are FAMILIAL! some genetic component exists

Question 10

What is the course/mortality of AN and BN?

Answer 10

AN: HIGHEST mortality rate of any psych disorder!! long term distorted body image, <25% good psychological outcome

BN: favorable outcome: 1/3 doing well, 1/3 still affected, 1/3 doing poorly after 5 years