anorexia Flashcards
define
life threatening
intense fear of weight gain, severely distorted body image, restrict cal relative to requirements with significantly low BMI
experience significantly lower taste, appetite, satiety -> perpetuates disorder
restricting type
diet, fasting, excessive exercise causes weight loss
binge eating and purging type
self induced vom or misuse of lax, diuretics, enemas causes weight loss
dx criteria
restrict E intake relative to requirements leading to significantly low body weight in context of age, sex, developmental trajectory, phys health
intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain, even though at a significantly low weight
disturbance in the way ones body weight or shape is experiences, undue influence of body weight or shape on self eval or persistent lack of recognition of the seriousness of the current low body weight
mustve occured in last 3 mo
cm
weight 15 % less than expected for age, height, activity level -> BMI used for severity
amenorrhea, mottled cool extremities, peripheral edema, lack of E, fatigue, muscular weakness, c, hypoT, brady, low temp, impaired renal function, decreased bone density, anemic pancytopenia
abn lab values -> electrolytes only abn if severe purging
lanugo -> downy hair on face and back
epidemiology
adolescents and YA, athletes, LGBTQ+, lots of comorbidities, F, less common than bulimia
etiology - biologic
genetic predisposition, genetic correlations btw AN and MDD, anx, OCD, schiz, glucose and lipid met
neurobiological: tryptophan impacts serotonin synthesis
etiology - psychological and cognitive
ego syntonic -> know actions are harmful but beliefs outweigh
struggle significantly with emotional ID, regulation, processing
low stress tolerance and deficits in behavioral control in response to others stress
etiology - env
internalization of thin body ideal
associated with cultures that value thinness -> social media
rf
F, fam hx ED, hx obese, dieting, over exercising, low self esteem, body dissatisfaction, lack of assertiveness, other ED, hx abuse, comorbidities, distorted body image, media, fashion industry, athlete
warning s
dramatic weight loss, refusal to eat certain foods, restrictions of whole food groups, freq comments of feeling fat despite weight loss, anx about gaining weight, denial of hunger, excuses for not eating, withdrawal from friends, weight loss and good becoming primary concerns
excessive rigid exercise -> rain, fatigue
food rituals -> order, chew excessively
preoccupation with weight, food cal, fat grams, dieting
clinical course
relapse high, suicide, bulimia, poor health outcomes d/t weight, purging, early onset age
recovery is stage not event
complications d/t weight loss starvation - MS
loss of muscle and fat
early onset osteoporosis
complications d/t weight loss starvation - met
hypothy
hypogly
electrolyte abn
complications d/t weight loss starvation - cardiac
brady, hypoT, decreased cardiac muscle, small heart, arrhythmias, chest pain, sudden death
complications d/t weight loss starvation - GI
delayed gastric emptying, bloating, c, abd pain, gas, d, gerd, hemorrhoids
complications d/t weight loss starvation - reproductive
amenorrhea, irregular periods, decreased libido, infertility
complications d/t weight loss starvation - dermatologic
dry and cracking, brittle nails, lanugo, edema, acrocyanosis, thin hair, yellow skin, poor wound healing
complications d/t weight loss starvation - hematologic
leukopenia, anemia, thrombocytopenia, hypercholesterolemia, hypercarotenemia
complications d/t weight loss starvation - neuropsych
abn taste sensation (zinc def), apathetic dep, mild organic mental S, sleep disturbances, fatigue
tm - goals
depend on acuity, health teaching and promo
safe weight = #1 goal
body image disturbance, increase coping, address underlying conflicts (fear, role conflict), assist fam
usually need hospital, intensive therapies, out pt partial hospitalization (day in pt, night out pt)
include fam and support and social in d/c
tm - criteria for hospitalization
usually brief stay
extreme electrolyte imbalance, BW 75% less than ideal
<10% body fat, <50 bpm daytime, SBP <90, temp <96, arrhythmias
tm - once stable
incremental weight gain, goal = 90% ideal BW, precise time, selected menu, observe, regular weighing, constant bathroom monitor, milieu therapy for underlying feelings
refeeding syndrome
body switched to fat source when starving
rapid electrolyte shifts when food reintroduced: hypoMg, K, P
reintroduce slowly to avoid
long term out pt
tm - pharm
fluoxetine for OCD once weight stable
tm - integrative
yoga, massage, acupuncture, bright light
tm - psychological
no specific type for adults
kids: insight oriented, fam based, adolescent focused, CBT
