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Year 2 - BRS > 4.10 - Eating disorders > Flashcards

4.10 - Eating disorders Flashcards

1
Q

What are eating disorders? (3)

A
  • 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
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2
Q

What are examples of disturbances of eating behaviour? (2)

A
  • binge eating
  • purging (quantity, range)
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3
Q

What are examples of behaviours intended to control weight? (4)

A
  • restricted eating (fasting)
  • self-induced vomiting
  • excessive exercise
  • laxative, diuretic and other energy burning or appetite suppressing medications (e.g. caffeine, smoking)
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4
Q

How can eating disorders impair physical health? (5)

A
  • impacts growth and development
  • stop periods
  • effects on the brain
  • results in osteoporosis
  • high mortality
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5
Q

How can eating disorders impair psychosocial function? (2)

A
  • functional impairment:
    • impacts work
    • relationships (family, peers, intimate)
    • daily living
  • distress
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6
Q

What are some DSM-V and ICD-11 feeding and eating disorders? (7)

A
  • anorexia nervosa
  • bulimia nervosa
  • binge eating disorder
  • other specified feeding and eating disorders (OSFED)
  • avoidant/restrictive food intake disorder (ARFID)
  • rumination disorder/syndrome
  • pica
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7
Q

What four feeding and eating disorders are associated with weight concerns?

A
  • anorexia nervosa
  • bulimia nervosa
  • binge eating disorder
  • other specified feeding and eating disorders (OSFED)
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8
Q

What are the diagnostic criteria (DSM-V) for anorexia nervosa? (3)

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
  • intense fear of gaining weight or becoming fat, or
    persistent behaviour that interferes with weight gain
  • disturbance in experience of weight/shape, undue influence of weight/shape on self-evaluation, or persistent lack of recognition of seriousness of low body weight
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9
Q

What feature of anorexia nervosa is not present in the DSM-V?

A

Amenorrhoea not in DSM-V

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10
Q

What are the two subtypes of anorexia nervosa?

A
  • restricting
  • binge-eating/purge
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11
Q

What is bulimia nervosa? (4)

A
  • over-eating episodes:
    • large amount of food in discrete time period
    • sense of lack of control
  • inappropriate compensatory mechanisms (purging etc)
  • body image disturbance
  • occur at least 1x week for 3x weeks
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12
Q

What is binge eating disorder? (3)

A
  • episodes of over-eating
  • no or minimal compensation
  • hence, frequently overweight
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13
Q

Compare anorexia nervosa vs bulimia nervosa vs binge eating disorder (6)

A
  • weight: low vs normal/high vs normal/high
  • binge eating: (Y) Y Y
  • dietary restriction: Y Y N
  • self induced vomiting: (Y) Y N
  • excessive exercise: (Y) Y N
  • guilt and shame: Y Y (Y)
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14
Q

What is it when someone has anorexia nervosa but is not underweight?

A

Atypical AN in DSM-V = AN in ICD-11

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15
Q

What is purging disorder?

A
  • 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
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16
Q

What conditions are OSFED (other specific feeding and eating disorders)? (4)

A
  • atypical anorexia nervosa
  • purging disorder
  • atypical bulimia nervosa
  • night eating syndrome
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17
Q

What does ARFID (avoidant/restrictive food intake disorder) replace and extend?

A

Replaces and extends Feeding Disorders of Infancy and Early Childhood (FdoIEC)

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18
Q

What is ARFID (avoidant/restrictive food intake disorder)

A
  • feeding/eating disturbance:
    • significant weight loss
    • significant nutritional deficiency
    • dependence on enteral feeding/nutritional supplements
    • marked interference with psychosocial functioning
  • no weight/shape concerns
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19
Q

What are the three main subtypes of ARFID?

A
  • individuals who do not eat enough/show little interest in feeding
  • individuals who only accept a limited diet in relation to sensory features
  • individuals whose food refusal is related to aversive experience
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20
Q

Compare anorexia nervosa vs bulimia nervosa vs binge eating disorder vs purging disorder vs ARFID (6)

A
  • weight: low vs normal/high vs normal/high vs normal/high vs low/normal (occ. high)
  • binge eating: (Y) Y Y N N
  • dietary restriction: Y Y N Y Y
  • self induced vomiting: (Y) Y N Y N
  • excessive exercise: (Y) Y N Y N
  • guilt and shame: Y Y (Y) Y N
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21
Q

What are some key points about the epidemiology of eating disorders?

A
  • ED relatively common in childhood and adolescence
    • around 40% of adolescent girls show ED behaviours by age 16, 11% diagnosable
  • incidence of AN and BN are stable
  • incidence of OSFED and BED may be increasing
  • AN is still most common disorder in ED clinics
  • not much research on ARFID
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22
Q

What does prevalence mean?

A

Existing cases at a time point, or over a time period

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23
Q

What is the prevalence of adolescent anorexia nervosa?

A

0.3-2%, higher prevalence using DSM-V criteria (no amenorrhoea)

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24
Q

What is the prevalence of adolescent and adult bulimia nervosa, and the F:M ratio?

A
  • adolescence 1-2%
  • adult 2-3%
  • F:M 9:1
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25
Q

What is the prevalence of OSFED in females and males?

A
  • F 2.3%
  • M 0.3%
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26
Q

What is the prevalence of ARFID in primary schools and tertiary referral centres?

A
  • 3.2% primary school
  • 14% tertiary centres
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27
Q

How are the trends for obesity and eating disorders linked?

A

Rise in obesity and a parallel rise in eating disorders (–> linked)

28
Q

What are some important facts about eating disorders?

A
  • classified as serious mental illnesses (like psychoses)
  • commoner than psychoses
  • affect people of all ages, genders and ethnicities
29
Q

What is the standard mortality ratio (SMR) for different types of eating disorder like? (4)

A
  • AN 5.35-5.86 (up to 13 if hospitalised)
  • BN 1.49-1.93
  • binge eating disorder 1.5
  • purging disorder 3.9
  • (T1DM 3-5, asthma 1.47-1.9)
30
Q

What is ‘Medical Emergencies in Eating Disorders: Guidance on Recognition and Management’? (11)

A
  • published in 2022
  • updated ‘MARSIPAN’ guidance
  • used NICE methodology
  • rigorous literature review
  • all eating disorders - name change
  • all ages
  • multidisciplinary authorship
  • involved people with lived experience
  • independent stakeholder review
  • consensus building
  • endorsed by Academy of Medical Royal Colleges
31
Q

What are some key messages from Medical Emergencies in Eating Disorders: Guidance on Recognition and Management - medical teams? (5)

A
  • medical teams need to actively treat the patient:
  • safely re-feed
  • manage fluid and electrolyte problems (often from purging)
  • arrange discharge
  • manage behaviours
32
Q

What are some key messages from Medical Emergencies in Eating Disorders: Guidance on Recognition and Management - mental health teams? (4)

A
  • assess and treat patients under compulsion
  • address family concerns
  • advise on appropriate onward care
  • advise on patients with complex comorbidity
33
Q

What are two practical tools that the Medical Emergencies in Eating Disorders: Guidance on Recognition and Management contains?

A
  • all age risk assessment framework with gradings
  • action checklist for emergencies
34
Q

What are the key points from the Medical Emergencies in Eating Disorders: Guidance on Recognition and Management? (5)

A
  • eating disorders are not visible - you need to ask
  • normal blood tests do not mean things are OK
  • cardiovascular parameters are the best pointers to risk
  • intake and rate of weight loss is more important than weight
  • red for risk means ask someone who knows
35
Q

What are the family risk factors for eating disorders? (3)

A
  • history of diet/eating disorders
  • history of depression/anxiety/alcohol dependence
  • history of obesity
36
Q

What are the individual risk factors for eating disorders? (10)

A
  • female gender
  • genetics
  • premature birth
  • low self esteem
  • perfectionism
  • previous depression/anxiety
  • previous obesity
  • early puberty
  • diabetes
  • Crohn’s disease
37
Q

What are possible triggers and maintaining factors for eating disorders? (6)

A
  • puberty
  • socio-cultural pressures e.g. thin ideal portrayed in the media and social media
  • family factors
  • pressure to achieve
  • behaviour of peers
  • comments about weight
38
Q

How much more likely were first degree relatives of individuals with AN to develop AN?

A

11x more likely

39
Q

What is the genetic heritability for AN, BN and BED?

A
  • AN 58-74%
  • BN 54-83%
  • BED 41-57%
40
Q

What does LD score regression (LDSR) show in relation to AN?

A

Genetic correlations between AN and diverse phenotypes

+ve correlations: neuroticism, schizophrenia, education
-ve correlations: high BMI, overweight, fasting insulin/glucose

41
Q

Why does research/LDSR on eating disorders matter? (4)

A
  • reduces stigma and blame
  • might help identify important gene environment interactions
  • might inform treatment decisions
  • might help us develop interventions
42
Q

How do eating disorders relate to childhood eating behaviour and appetite?

A
  • 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
43
Q

What are psychological risk factors for eating disorders? (5)

A
  • temperament/personality
  • neurocognition
  • self-esteem
  • psychopathology
  • behaviour
  • (life events)
  • (trauma)
44
Q

What are sociocultural risk factors for eating disorders? (3)

A
  • family
  • school/peers
  • wider social influences
  • (life events)
  • (trauma)
45
Q

What psychological factors are linked to eating disorders? (4)

A
  • perfectionism (especially 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
46
Q

What trauma/life events are linked to eating disorders? (2)

A
  • sexual abuse (binge-purge type disorders)
  • life events (non-specific)
47
Q

How are family influences linked to eating disorders? (3)

A
  • 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
48
Q

What sociocultural factors are linked to eating disorders? (3)

A
  • 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
49
Q

What are important predisposing, triggers/precipitating and perpetuating/maintaining factors for eating disorders?

A

Bullying and isolation

50
Q

What is the aetiology of anorexia nervosa?

A
  • prenatal - genetic and other prenatal factors (e.g. influence of hormones)
  • childhood - traits and cognitive style (obsessionality, perfectionism, deficits in social cognition)
  • puberty (brain development, hormones, stressful life events, cultural values)
  • diet –> weight loss –> starvation-induced changes –> increased anxiety, depression and obsessionality (cycle)
  • adulthood - chronic illness / recovery
51
Q

What is the revised model for the onset of eating disorders?

A
  • elevated BMI
  • pressure to be thin
  • thin-ideal internalisation
  • body dissatisfaction –> negative affect
  • dieting –> negative affect
  • eating pathology
52
Q

What is core to the CBT model for maintenance of bulimia nervosa?

A

Core low self-esteem (leads to binge eating and compensatory vomiting/laxative misuse <–> mood intolerance)

53
Q

What is the triad of evidence-based practice?

A
  • best scientific evidence - results of experiments and quantitative studies
  • clinical experience - expert panels, practice groups, consensus statements
  • patient references - satisfaction, QoL, treatment burden, qualitative studies
54
Q

What is best scientific evidence in eating disorders?

A
  • 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 randomised controlled treatment trials for EDs, there are few replication studies
  • many RCTs show no differences / differences that diminish over time, between treatment arms
  • clinical guidelines (e.g. NICE) mostly based on consensus views rather than strong research
55
Q

How many published guidelines are there for the treatment of EDs and compare them?

A
  • nine published guidelines for treatment of ED
  • international comparison
  • similarities on evidence for psychological therapies
  • differences in recommendations for other aspects of care
56
Q

What is covered in the scope of the NICE guidelines (2017) to treat eating disorders?

A

Children, young people and adults with an eating disorder (AN, BN, BED, atypical ED), or a suspected eating disorder

57
Q

What is not covered in the scope of the NICE guidelines (2017) to treat eating disorders? (3)

A
  • 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 (e.g. depression)
  • people with feeding disorders e.g. pica or ARFID (e.g. food avoidance or picky/selective eating)
  • people with obesity without an eating disorder
58
Q

What psychological interventions are used to treat EDs in children and young people? (3)

A
  • ED focussed family therapy
  • CBT
  • adolescent focussed therapy (AN only)
59
Q

What psychological interventions are used to treat EDs in adults? (3)

A
  • MANTRA (AN only)
  • SSCM (AN only) - supportive clinical management
  • CBT
60
Q

What are some common psychological interventions to treat EDs in all people? (2)

A
  • psychoeducation on effects of starvation on body and mind, regulating body weight, dieting
  • adverse effects of attempting to control weight with self-induced vomiting, laxatives or other compensatory mechanisms
61
Q

What is the ultimate goal of psychological interventions to treat EDs?

A

Increasing person’s confidence in making positive decisions when coping with stress that do not include food or eating

62
Q

What should you note about medication for EDs? (2)

A
  • never use on its own
  • tends to be used to manage comorbidities or support symptoms control in short term
63
Q

What are the two most commonly used classes of medications for EDs?

A
  • SSRIs for anxiety or depression
  • olanzapine or aripiprazole to reduce emotional dysregulation during refeeding
64
Q

What is the triangle of care?

A
  • service user
  • carer
  • professional
65
Q

What are some long-term complications of eating disorders? (6)

A
  • death
  • growth stunting (if pre-pubertal onset)
  • osteoporosis
  • pregnancy complications
  • dental erosion
  • mental health comorbidities including substance misuse
66
Q

What are the outcomes of EDs? (3)

A
  • most young people go into remission (80%)
  • some relapse into adulthood
  • later onset and certain personality traits increase likelihood of persistence
67
Q

What is most important in managing EDs?

A

Early intervention (to prevent future deaths)

Year 2 - BRS (84 decks)

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