7. Eating Disorders

Question 1

What is the SCOFF questionnaire and what are the 5 main questions?

Answer 1

Aids early detection of eating disorders (anorexia or bulimia)
* Do you make yourself sick because you feel uncomfortably full?
* Do you worry you have lost control over how much you eat
* Have you recently lost more than one stone in a three month period
* Do you believe yourself to be** fat** when others say you are too thin
* Would you say that Food dominates your life?

One point for every YES
Score >=2 suggests likely anorexia or bulimia nervosa

Question 2

What is bulimia?

Answer 2

• recurrent (at least once per week for 3 months) episodes of binge eating
• followed by compensatory behaviour such as self-induced vomiting, laxative abuse or excessive exercise

Question 3

What is binge eating disorder?

Answer 3

• recurrent episodes of binge eating
• absence of compensatory behaviours
• feelings of lack of control.

Question 4

What is anorexia?

Answer 4

• restriction of food intake
• or persistent behaviour which interferes with weight gain
• and leads to low body weight
• body image disturbance and an intense fear of gaining weight

Anorexia nervosa has the highest rate of mortality of all mental health disorders.

Question 5

what are the values for low weight in anorexia nervosa?

Answer 5

BMI <18.5
BMI for age <5th percentile on growth chart in children

Question 6

How should suspected eating disorder be managed in Primary Care?

Answer 6

• Immediately refer to age appropriate eating disorder service.
• Whilst awaiting assessment - regular review of physical and mental health - monitor for red flags for urgent admission.

Question 7

When should emergency admission occur for eating disorder?

Answer 7

*Rapid weight lotss (1kg/week for 2 weeks)
* Adult BMI <18, child <70%
* Bradycardia <40
* Tachycardia on standing
* Prolonged QT on ECG
* Hypotension, or postural hypotension
* Hypothermia
* Reduced muscle power on sit up-squat-stand SUSS test
* Concurrent infection
* Low WCC, HB <100
* Electrolyte imbalance, hypoglycaemia
* Risk of refeeding syndrome - fasting >5 days, BMI <16, dehydration, diet pills/diuretics
* Risk of suicide/self harm

Question 9

What specialist treatments are given for anorexia in adults?

Answer 9

• individual eating disorder focussed CBT (CBT-ED)
• MANTRA (maudsley anorexia nervosa treatment for adults)
• Specialist supportive clinical management (SSCM)
• If above 3 options not effective - ED focussed psychodynamic therapy

Question 10

What specialist treatments are given for anorexia in children?

Answer 10

• Anorexia-nervosa-focused family therapy for children and young people
• Individual CBT-ED or adolescent focused psychotherapy for anorexia nervosa (if family therapy ineffective)

Question 11

What are the specialist treatment options for bulimia in adults?

Answer 11

• Bulimia focussed guided self help
• if self help ineffective- CBT-ED

Question 12

What are the specialist treatment options for bulimia in children?

Answer 12

• Bulimia-nervosa-focused family therapy
• if family therapy ineffective
• individual CBT-ED