1B eating disorders Flashcards
What are eating disorders?
- Mental disorders
- ‘A persistent disturbance of eating behaviour or behaviour intended to control weight, which significantly impairs physical health or psychosocial functioning’
- Driven by fear of fatness or extreme distress about eating
What are disturbances of eating behaviour?
- Binge eating
- Restricted eating
- Quantity
- Range
What behaviour intends to control weight?
- Restricted eating (fasting)
- Self induced vomiting
- Excessive exercise
- Laxative, diuretic and other energy burning or appetite suppressing medications (e.g. caffeine, smoking)
How do eating disorders impair physical health?
- Impacts growth and development
- Stop periods
- Effects on the brain
- Results in osteoporosis
- High mortality
How do eating disorders impair psychosocial function?
- Functional impairment
- Impacts work
- Relationships (family, peers, intimate)
- Daily living
- Distress
List some DSM5 and ICD11 feeding and eating disorders
- Anorexia Nervosa
- Bulimia Nervosa
- Binge Eating Disorder
- Other Specified Feeding and Eating Disorders (OSFED)
- Avoidant/Restrictive Food Intake Disorder (ARFID)
- Rumination Disorder/Syndrome
- Pica
What is anorexia nervosa?
A. Restriction of energy intake relative to requirements leading to significantly low body weight in the context of age, sex, developmental trajectory and physical health.
B. Intense fear of gaining weight or becoming fat, or persistent behaviour that interferes with weight gain.
C. Disturbance in experience of weight/shape, undue influence of wt/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight
What subtype is anorexia nervosa?
Restricting vs. Binge-eating/Purge
What is bulimia nervosa?
- Over eating episodes
large amount of food in discrete time period
sense of lack of control - Inappropriate compensatory mechanisms
- Body image disturbance
How often does bulimia nervosa occur?
At least 1x week for 3x weeks
What is binge eating disorder?
- Episodes of over eating
- No or minimal compensation
- Hence, frequently overweight
What is purging disorder?
- Defined by recurrent purging behaviour to influence weight or shape (e.g., self-induced vomiting, misuse of laxatives, diuretics, or other medications including insulin) in the absence of binge eating.
- Weight is in the normal range
- OSFED are atypical AN, purging disorder, atypical BN and night eating syndrome
What is ARFID?
- Replaces and extends Feeding Disorders of Infancy and Early Childhood (FdoIEC)
- Feeding/Eating disturbance
- significant weight loss
- significant nutritional deficiency
- dependance on enteral feeding/nutritional supplements
- marked interference with psychosocial functioning
- No weight/shape concerns
What are the three main subtypes of ARFID?
- individuals who do not eat enough/show little interest in feeding;
- individuals who only accept a limited diet in relation to sensory features;
- and individuals whose food refusal is related to aversive experience
How common are ED?
Relatively common in childhood and adolescence:
Around 40% of adolescent girls show ED behaviours by age 16, 11% diagnosable
What are the key messages from the NICE published guidelines on medical emergencies in eating disorders?
- Medical teams need to actively treat the patient. Responsibilities include:
- safely re-feeding the patient, neither under nor over feeding
- managing fluid and electrolyte problems, often caused by purging behaviours
- arranging discharge to an appropriate setting, in agreement with the mental health team, commissioners, the patient and their family as soon as safe and indicated
- managing the behaviours common in patients with eating disorders, in collaboration with the mental health team
- The mental health team need to additionally:
- occasionally assess and treat patients under compulsion using relevant mental health legislation
- address family concerns and involve both patients and their families in discussions about treatment
- advise on appropriate onward care following medical stabilisation
- advise on patients with complex comorbidity, such as personality disorder or autism
What are some key points of the management of eating disorders?
What factors contribute towards eating disorders?
What is the occurrence of eating disorders running in the family?
First degree relatives of individuals with AN were 11 times more likely to develop AN
- AN: ~58%-74%
- BN: between 54%-83%
- BED: between 41%-57%
Why does the genetic component of EDs matter?
- Reduces stigma and blame
- Might help identify important gene environment interactions
- Might inform treatment decisions
- Might help us develop interventions
Explain childhood eating behaviour and appetite on ED
- Children with AN more likely to have had early feeding and GI problems, picky eating and mealtime conflict
- Children with BN were less picky and ate faster and more likely to overeat
What are the psychosocial risk factors of ED?
Psychological
- Temperament/personality
- Neurocognition
- Self-esteem
- Psychopathology
- Behaviour
Sociocultural
- Family
- School/peers
- Wider social influences
Psychosocial
- Life events
- Trauma
How do psychological factors increase risk of ED?
- Perfectionism (esp fasting and purging)
- High self-esteem: protective for AN
- Low self-esteem: risk factor for bulimic and compulsive eating
- Anxiety disorders (i.e. OCD) increases risk of AN
- Externalising disorders (i.e. ADHD), hx of depression increases risk of BN
How do trauma/life events increase risk of ED?
- Sexual abuse (binge-purge type disorders)
- Life events (non-specific)
How do family influences increase risk of ED?
- No evidence for family interaction or ‘type’
- Some evidence that maternal emotional wellbeing and protective parenting style important
- Maternal dieting and paternal comments about weight influence girls but not boys
What sociocultural factors increase risk of ED?
- Some evidence of increase in developing countries of incidence/prevalence (mass media exposure)
- Bullying, teasing by peers, social pressure to be thin
- Exposure to social network media
Explain the aetiology of AN
Explain the aetiology of bulimic symptomatology
What is the triad of evidence-based practice?
- Best scientific evidence
- Clinical experience
- Patient preferences
What is Best scientific evidence in eating disorders?
Evidence for effectiveness of existing treatments is weak across the age range
e.g. Few large scale randomised controlled drug trials for AN
- Where we do now have randomized controlled treatment trials for eating disorders, there are few replication studies
- Many RCTs show no differences, or differences that diminish over time, between treatment arms
- Clinical guidelines (e.g. NICE) mostly based on consensus views rather than strong research
What are the NICE published guidelines for treatment of ED?
Who do the NICE guidelines cover?
Children, young people and adults with an eating disorder (anorexia nervosa, bulimia nervosa, binge eating disorder or atypical eating disorder), or a suspected eating disorder
Who do the NICE guidelines not cover?
- People with disordered eating because of a physical health problem or another primary mental health problem of which a disorder of eating is a symptom (for example, depression).
- People with feeding disorders, such as pica or Avoidant Restrictive Food Intake Disorders (for example, food avoidance emotional disorder or picky/selective eating).
- People with obesity without an eating disorder.
What are psychological interventions for children and young people with ED?
- ED focussed Family Therapy
- CBT
- Adolescent focussed therapy (AN only)
What are psychological interventions for adults with ED?
- MANTRA (AN only)
- SSCM (AN only)
- CBT
What are common psychological interventions for both children, young people and adults?
- psychoeducation on effects of starvation on the body and mind, regulating body weight, dieting; the adverse effects of attempting to control weight with self-induced vomiting, laxatives or other compensatory behaviours
- Ultimate goal of increasing persons confidence in making positive decisions when coping with stress that do not include food or eating
What medication management is given for ED?
What are some long term complications of ED?
- Death
- Growth stunting (if pre-pubertal onset)
- Osteoporosis
- Pregnancy complications
- Dental erosion
- Mental health comorbidities including substance misuse
