777 final eating disorder Flashcards
DSM 5 Diagnoses
Pica (307.52)
Rumination Disorder (307.53)
Avoidant/Restrictive Food Intake Disorder (307.59)
Anorexia Nervosa (307.1)
Bulimia Nervosa (307.51)
Binge-Eating Disorder (307.51)
Other Specified Feeding or Eating Disorder (307.59)
Unspecified Feeding or Eating Disorder (307.50)
Anorexia Nervosa DSM 5 Criteria
A. Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than the minimally normal or, for children and adolescents, less than that minimally expected.
B. Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Anorexia Nervosa DSM 5 Criteria (continued)
Coding note: The ICD 9-CM code for anorexia nervosa is 307.1, which is assigned regardless of the subtype. The ICD-10-CM code depends on the subtype.
Specify whether:
Restricting type: During the last 3 months, the individual has not engaged in recurrent episodes of binge eating or purging behavior (i.e.. Self-induced vomiting or the misuse of laxatives, diuretics or enemas). This subtype describes presentations in which weight loss is accomplished primarily through dieting, fasting, and/or excessive exercise.
Binge-eating/purging type: During the last 3 months, the individual has engaged in recurrent episodes of binge eating, or purging behaviors (i.e., slef-induced vomiting or the misuse of laxatives, diuretics, or enemas)
Anorexia Nervosa DSM 5 Criteria (continued)
Specify if: In partial remission In full remission Specify current severity: The minimum level of severity is based, for adults on current body mass index (BMI) or, for children and adolescents, in BMI percentile. The ranges below are derived from the WHO categories for thinness in adults; for children and adolescents, corresponding BMI percentiles should be used. The level of severity may be increased to reflect clinical symptoms, the degree of functional disability, and the need for supervision. Mild: BMI > 17 kg/m2 Moderate: BMI 16-16.99 kg/m2 Severe: BMI 15-15.99 kg/m2 Extreme: BMI < 15 kg/m2
Epidemiology
12 month prevalence is 0.4% - 1% in adolescent girls 5% of young women with some symptoms Less common in males Gay males (norms for slimness) 10:1 ratio female to male Age of onset mid-teens - early 20’s Most common age of onset 14-18 Most frequent in developed countries Increased frequency in modeling, ballet, wrestling elite athletes
Onset associated with stressful life event
Genetic
Higher concordance rate in monozygotic twins
Sisters of patients more likely to be afflicted
Major mood disorders more common in family members
Biological Factors
Social Factors
Psychological and psychodynamic factors
Biologic Factors Influencing Anorexia Nervosa
Endongenous opioids may contribute to denial of hunger Starvation Hypercortisolemia Nonsupression by dexamethasone Suppression of thyroid function Ammenorhea hypoleptinemia CT reveals enlarged CSF spaces Studies have shown dysfunction in serotonin, dopamine, norepinephrine
Social Factors
Sociocultural influences
Family issues
Vocational/avocational influences: ballet, wrestling, gymnastics, athletes, models
Internet influences (ana website)
Psychological and Psychodynamic Factors
Reaction to independence Weight concerns Increased social and sexual functioning Lack of autonomy and self-hood Experience their body under parents’ control Unable to separate psychologically from mother Negative emotionality/affect Perfectionism Alexithymia
Psychodynamic Formulations
Multiply determined symptom
Desperate attempt to be special and unique
An attack on the false sense of self fostered by parental expectations
Assertion of a nascent true self
Attack on a hostile maternal interject
A defense against greed and desire
Effort to make others feel greedy and helpless
Defensive attempt to prevent projections from the parents from entering the patient
Escalating cry for help to shake the parents out of their self-absorption
Dissociative defense into separate self states as a way of regulating intense affect
Behaviors
Intense fear of gaining weight Secretive Refuse to eat with families or in public Often preoccupied with food Diet with restricted fat and carbohydrates Laxative and diuretic abuse Over exercising/physical hyperactivity Rigid and perfectionistic Compulsive stealing Poor sexual adjustment
Signs and Symptoms
BMI 17 or below Hypothermia Hypotension Lanugo ECG changes: T wave flattening or inversion, ST segment depression, lengthening of QT interval Dependent edema Bradycardia Amenorrhea
Differential Diagnoses
Medical conditions MDD Schizophrenia Substance use disorders Social anxiety disorder OCD Body dysmorphic disorder Bulimia nervosa Avoidant/restrictive food intake disorder
Comorbidities
MDD Bipolar disorder Substance use disorder OCD Social anxiety disorder Specific phobia BPD Obsessive compulsive personality disorder
Subtypes
Restricting type 50% of cases 300-500 calories/day Over exercising Binge-eating purging type
Assessment (continued)
BMI VS Labs: CBC, lipids, LFT’s ECG Bone density Delayed or absent menses Hypertrophy of salivary glands Dental enamel erosion/caries Scars or calluses on dorsal surface of fingers Suicide assessment
SCOFF Assessment Tool
Do you make yourselfSick because you feel uncomfortably full?
Do you worry you have lostControl over how much you eat?
Have you recently lost more thanOne stone in a 3 month period?
Do you believe yourself to beFat when others say you are too thin?
Would you say thatFood dominates your life?
*One point for every “yes”; a score of ≥2 indicates a likely case of anorexia nervosa or bulimia
