Anorexia + Bulimia

Question 1

What is Anorexia Nervosa?

Answer 1

• Eating disorder characterised by the restriction of calorie intake leading to low body weight, an intense fear of gaining weight and a body image disturbance.
• MORE COMMON IN GIRLS
• ONSET of 16-17yrs in girls

Question 2

Risk factors of Anorexia Nervosa?

Answer 2

1) Genetic
2) Perfectionist character traits
3) Family - refusing food as way of being head in families
4) Low self-esteem
5) Adverse life events (abuse/deaths in family)
6) Depression/anxiety

Question 3

Clinical presentation of Anorexia Nervosa?

Answer 3

1) Fatigue
2) Cold intolerance
3) Altered sleep
4) Reduced cognition
5) Costipation + amenorrhoea
6) Dry skin, brittle hair, Lanugo hair
7) Hypotension and bradycardia
8) Weak proximal muscles - squat test + low metabolic rate
9) Dental caries

Ddx: Depression, Bulimia nervosa, Coeliac/Crohn’s

Question 4

Diagnosis of Anorexia Nervosa?

Answer 4

• TRIAD:
  1) Weight <85% of expected BMI or <17.5kg/m^2
  2) Intense fear of gaining weight/body image distortion - overvalued idea
  3) Endocrine effects - Amennorhoea/delayed puberty

Question 5

What screening tool can be used for Anorexia Nervosa?

Answer 5

SCOFF screening tool:

1) Make yourself sick when too full?
2) Lost control over eating?
3) Lost over one stone in 3 months?
4) Believe your fat when others say you’re thin?
5) Does food dominate your life?

> 2 indicated anorexia or bulimia nervosa.
- Serum T3 may be low - false suspicion of hypothyroidism.

Question 6

Treatment of Anorexia Nervosa?

Answer 6

1) RESTORE NUTRITIONAL BALANCE - weight gain to final BMI 20-25
(Risk of referring syndrome -reduced phosphate due to rapid initiation of food after <10 days undernutrition, consult dietician to develop slow referring + MONITOR PHOSPHATE LEVELS).
2) Psych, Paeds and Dietician involvement
- Family/carers - family therapy if appropriate
- Individual psych treatment to change cognitions that drive anorexia, and strategies to avoid relapse.
- Majority outpatients
3) SEVERE ANOREXIA - Typically stay in hospital for 5 months, high risk of relapse is within 2-3yrs following treatment (declines after)2.

Question 7

What is Bulimia Nervosa?

Answer 7

Eating disorder characterised by recurrent episodes of binge eating followed by behaviours aimed at compensating for the binge e.g. vomiting, laxative use and starvation.
- More common in girls and age of onset around 18yrs.

Question 8

RF for Bulimia Nervosa?

Answer 8

1) Young asian women
2) Past history of anorexia nervosa
3) Personal/FH of obesity
4) Similar to anorexia nervosa

Question 9

Clinical presentation of Bulimia Nervosa?

Answer 9

1) Fatigue + lethargy
2) Bloating, constipating and abdominal pain
3) Irregular menstruation
4) Enlarged parotid glands
5) Vomiting: Oesophagitis, gastric dilation (risk of rupture), RUSSELL’s sign - calluses on the back of hands (from tooth marks during induction of vomiting)

Ddx: Upper GI disorders, anorexia nervosa

Question 10

Diagnosis of Bulimia Nervosa?

Answer 10

1) Recurrent binge-eating episodes
2) Preoccupation with body weight and image
3) Regular compensatory mechanisms for binge eating - laxatives, vomiting, over-exercise and starvation
4) SCOFF QUESTIONNAIRE

Question 11

Treatment of Bulimia Nervosa?

Answer 11

• Mild - support, self-help blood, food diary
• Moderate to severe - referral to inpatient unit and psychiatric assessment
• Antidepressants (fluoxetine to reduce binges and purging)
• CBT can help