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
2
Q
What are examples of disturbances of eating behaviour? (2)
A
- binge eating
- purging (quantity, range)
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)
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
5
Q
How can eating disorders impair psychosocial function? (2)
A
- functional impairment:
- impacts work
- relationships (family, peers, intimate)
- daily living
- distress
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
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)
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
9
Q
What feature of anorexia nervosa is not present in the DSM-V?
A
Amenorrhoea not in DSM-V
10
Q
What are the two subtypes of anorexia nervosa?
A
- restricting
- binge-eating/purge
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
12
Q
What is binge eating disorder? (3)
A
- episodes of over-eating
- no or minimal compensation
- hence, frequently overweight
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)
14
Q
What is it when someone has anorexia nervosa but is not underweight?
A
Atypical AN in DSM-V = AN in ICD-11
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
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
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)
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
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
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
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
22
Q
What does prevalence mean?
A
Existing cases at a time point, or over a time period
23
Q
What is the prevalence of adolescent anorexia nervosa?
A
0.3-2%, higher prevalence using DSM-V criteria (no amenorrhoea)
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
25
What is the prevalence of OSFED in females and males?
- F 2.3%
- M 0.3%
26
What is the prevalence of ARFID in primary schools and tertiary referral centres?
- 3.2% primary school
- 14% tertiary centres
27
How are the trends for obesity and eating disorders linked?
Rise in obesity and a parallel rise in eating disorders (--> linked)
28
What are some important facts about eating disorders?
- classified as serious mental illnesses (like psychoses)
- commoner than psychoses
- affect people of all ages, genders and ethnicities
29
What is the standard mortality ratio (SMR) for different types of eating disorder like? (4)
- 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
What is 'Medical Emergencies in Eating Disorders: Guidance on Recognition and Management'? (11)
- 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
What are some key messages from Medical Emergencies in Eating Disorders: Guidance on Recognition and Management - medical teams? (5)
- medical teams need to actively treat the patient:
- safely re-feed
- manage fluid and electrolyte problems (often from purging)
- arrange discharge
- manage behaviours
32
What are some key messages from Medical Emergencies in Eating Disorders: Guidance on Recognition and Management - mental health teams? (4)
- assess and treat patients under compulsion
- address family concerns
- advise on appropriate onward care
- advise on patients with complex comorbidity
33
What are two practical tools that the Medical Emergencies in Eating Disorders: Guidance on Recognition and Management contains?
- all age risk assessment framework with gradings
- action checklist for emergencies
34
What are the key points from the Medical Emergencies in Eating Disorders: Guidance on Recognition and Management? (5)
- 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
What are the family risk factors for eating disorders? (3)
- history of diet/eating disorders
- history of depression/anxiety/alcohol dependence
- history of obesity
36
What are the individual risk factors for eating disorders? (10)
- female gender
- genetics
- premature birth
- low self esteem
- perfectionism
- previous depression/anxiety
- previous obesity
- early puberty
- diabetes
- Crohn's disease
37
What are possible triggers and maintaining factors for eating disorders? (6)
- 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
How much more likely were first degree relatives of individuals with AN to develop AN?
11x more likely
39
What is the genetic heritability for AN, BN and BED?
- AN 58-74%
- BN 54-83%
- BED 41-57%
40
What does LD score regression (LDSR) show in relation to AN?
Genetic correlations between AN and diverse phenotypes
## Footnote
+ve correlations: neuroticism, schizophrenia, education
-ve correlations: high BMI, overweight, fasting insulin/glucose
41
Why does research/LDSR on eating disorders matter? (4)
- reduces stigma and blame
- might help identify important gene environment interactions
- might inform treatment decisions
- might help us develop interventions
42
How do eating disorders relate to childhood eating behaviour and appetite?
- 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
What are psychological risk factors for eating disorders? (5)
- temperament/personality
- neurocognition
- self-esteem
- psychopathology
- behaviour
- (life events)
- (trauma)
44
What are sociocultural risk factors for eating disorders? (3)
- family
- school/peers
- wider social influences
- (life events)
- (trauma)
45
What psychological factors are linked to eating disorders? (4)
- 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
What trauma/life events are linked to eating disorders? (2)
- sexual abuse (binge-purge type disorders)
- life events (non-specific)
47
How are family influences linked to eating disorders? (3)
- 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
What sociocultural factors are linked to eating disorders? (3)
- 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
What are important predisposing, triggers/precipitating and perpetuating/maintaining factors for eating disorders?
Bullying and isolation
50
What is the aetiology of anorexia nervosa?
- 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
What is the revised model for the onset of eating disorders?
- elevated BMI
- pressure to be thin
- thin-ideal internalisation
- body dissatisfaction --> negative affect
- dieting --> negative affect
- eating pathology
52
What is core to the CBT model for maintenance of bulimia nervosa?
Core low self-esteem (leads to binge eating and compensatory vomiting/laxative misuse <--> mood intolerance)
53
What is the triad of evidence-based practice?
- 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
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 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
How many published guidelines are there for the treatment of EDs and compare them?
- nine published guidelines for treatment of ED
- international comparison
- similarities on evidence for psychological therapies
- differences in recommendations for other aspects of care
56
What is covered in the scope of the NICE guidelines (2017) to treat eating disorders?
Children, young people and adults with an eating disorder (AN, BN, BED, atypical ED), or a suspected eating disorder
57
What is not covered in the scope of the NICE guidelines (2017) to treat eating disorders? (3)
- 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
What psychological interventions are used to treat EDs in children and young people? (3)
- ED focussed family therapy
- CBT
- adolescent focussed therapy (AN only)
59
What psychological interventions are used to treat EDs in adults? (3)
- MANTRA (AN only)
- SSCM (AN only) - supportive clinical management
- CBT
60
What are some common psychological interventions to treat EDs in all people? (2)
- 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
What is the ultimate goal of psychological interventions to treat EDs?
Increasing person's confidence in making positive decisions when coping with stress that do not include food or eating
62
What should you note about medication for EDs? (2)
- never use on its own
- tends to be used to manage comorbidities or support symptoms control in short term
63
What are the two most commonly used classes of medications for EDs?
- SSRIs for anxiety or depression
- olanzapine or aripiprazole to reduce emotional dysregulation during refeeding
64
What is the triangle of care?
- service user
- carer
- professional
65
What are some long-term complications of eating disorders? (6)
- death
- growth stunting (if pre-pubertal onset)
- osteoporosis
- pregnancy complications
- dental erosion
- mental health comorbidities including substance misuse
66
What are the outcomes of EDs? (3)
- most young people go into remission (80%)
- some relapse into adulthood
- later onset and certain personality traits increase likelihood of persistence
67
What is most important in managing EDs?
Early intervention (to prevent future deaths)
