99b - Eating Disorders Flashcards
How can anorexia: binge/purge subtype be differentiated from bulimia nervosa?
- Anorexia
- Characterized by intense fear of gaining weight, history of significant weight loss, and restriction of energy intake (extreme diets)
- Binging then subsequent purge are to minimize calorie intake
- More likely to have v low BMI
- Bulemia nervosa
- Characterized by loss of control during binges, purge to regain control
- Weight may fluctuate
- May also have fear of gaining weight, body dysmorphia
What are the two types of anorexia nervosa?
- Restricting Type – controlling how much you eat w/o the binge-eating and purging
- Binge Eating/Purging (Bulimic) Type
List some of the clinical findings of anorexia nervosa
Clinical findings
- Baby hairs on body
- Hair loss on head
- Electrolyte abnormalities
- Dehydration,
- Hypotension
- Edema
- Constipation
- Osteoporosis
Describe the clinical management of anorexia nervosa
Goal = weight restoration (EAT)
- Phosphorous: may need to replete
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Psychotherapy = mainstay of treatment
- CBT for adult patient
- Family-based for younger patient
- Nutritionist
- Hospitalization if necessary
Medications are not effective: food is the medication!
But medication may be helpful to manage anxiety, comorbidities
Which psychological disorder has the highest mortality rate?
eating disorders (anorexia)
Anorexia restrictive type is associated with cluster personality disorders
Anorexia binge/puge type is associated with cluster personality disorders
Anorexia restrictive type is associated with cluster c personality disorders (anxious, fearful)
Anorexia binge/puge type is associated with cluster b personality disorders (dramatic, emotional, erractic)
Which SSRI can be used to manage bulemia?
Fluoxetine (Prozac) (an SSRI)
But psychotherapy (CBT or DBT) is the mainstay of treatment
Bupropion is contraindicated given its seizure risk.
A patient has intense fear of gaining weight, body dysmorphia, and restricted food intake
Which eating disorder is most likely?
Anorexia nervosa
The severity of bulimia is based on what behavior?
Severity is based on the number of inappropriate compensatory behaviors (not number of binges, number of purges)
- Mild = 1-3/week
- Moderate = 4-7/week
- Severe = 8-13/week
- Extreme = 14+/week
What is Russel’s sign?
What is it indicative of?
Lacerations/abrasions on the backs of hands/fingers
Due to frequent contact with teeth
Indicative of bulimia nervosa
The prognosis of anorexia is [better/worse] than for bulimia
The prognosis of anorexia is worse than for bulimia
How is bulemia nervosa managed clinically?
- Cognitive behavioral therapy
- Esp. dialectial behaviorla therapy
- Medication
- Fluoxetine (SSRI) - better for adult patients than adolescents
What factors predict good prognosis for anorexia nervosa?
- Younger age of onset
- Restrictive type (vs binge/purge)
- Shorter chronicity of illness
- Higher weight at treatment
- Good social functioning, support
How is the severity of anorexia nervosa assessed?
- severity of anorexia is based on BMI ® mild > 17 kg/m2, moderate <17, severe < 16, extreme < 15
- BMI is one piece of the diagnosis, but not the only piece; you don’t have to be stick thin to have the diagnosis
- drastic weight loss is dangerous even if they are a normal weight
- BMI is one piece of the diagnosis, but not the only piece; you don’t have to be stick thin to have the diagnosis
What is binge-eating disorder?
-
Binge-Eating Disorder (BED) = eating large volumes of food w/o any compensatory behaviors
- a lot of patients become obese
- should be treated w/ cognitive behavioral therapy
