Anorexia Nervosa Flashcards
Anorexia Nervosa:
- restriction of energy intake relative
to requirements, leading to a
significant low body weight in the
context of age, sex, developmental
trajectory and physical health (less
than minimally normal) - below BMI 17.5; less than 85% of
an ideal body weight - intense fear of gaining weight or
persistent behaviour that
interferes with weight gain - disturbed by ones body weight or
shape, self-worth influenced by
body weight or shape or persistent
lack of recognition of seriousness
of low bodyweight
Anorexia Nervosa: Subtypes:
- anorexia nervosa restrictive type
- anorexia nervosa binge-purge type
- atypical anorexia nervosa = all
criteria are met, except despite
significant weight loss, the
individual’s weight is within or
above the normal range
Anorexia Nervosa: Risks:
- osteoporosis
- osteopenia
- infertility (often experience
menorrhagia) - co-morbid mental health disorders
common
Anorexia Nervosa: Recovery Rates:
- 46% fully recover
- 33% partial recovery
- 20% do not recover
- poor prognosis if duration of
symptoms before treatment >3 yrs
Bulimia Nervosa:
- recurrent episodes of binge eating
- recurrent inappropriate
compensatory behaviours in order
to prevent weight gain (self-
induced vomiting, misuse of
laxatives, diuretics, fasting,
excessive exercise) - binge eating and inappropriate
compensatory behaviours occur at
least once a week for 3 months - disturbance does not occur
exclusively during episodes of
anorexia nervosa
Bulimia Nervosa:
Recurrent episodes of binge eating characterised as both:
- eating within a discrete period of
time an amount of food that is
definitively larger than what most
individuals would eat in a similar
period of time under similar
circumstances - a feeling that one can not stop
eating or control what or how
much one is eating
Bulimia Subtypes:
- purging
- non-purging
- atypical bulimia nervosa
Bulimia Nervosa: Purging Type:
- during the current episode, the
person has regularly engaged in
self-induced vomiting or the
misuse of laxative, diuretics or
enemas
Bulimia Nervosa: Non-purging Type:
- during the current episode, the
person has used inappropriate
compensatory behaviours such as
fasting or excessive exercise but
has not regularly engaged in self-
induced vomiting or the misuse of
laxative, diuretics or enemas
Bulimia Nervosa: Atypical:
- binge eating of low frequency or
limited duration - all criteria are met except that
binge eating and inappropriate
compensatory behaviours occur at
a lower frequency and or for less
than 3 months
What is OSFED?
- diagnosis when an individual
meets most but not all of the
diagnostic criteria for Anorexia
Nervosa, Bulimia Nervosa, Binge
Eating Disorder
Binge Eating Disorder:
- recurrent episodes of binge eating:
- eating,, in a discrete period of
time an amount of food that is
definitely larger than most
people would eat in a similar
period of time- sense of lack of control over eating during the episode
- no compensatory behaviour
- associated with three or more of
the following:- eating more rapidly than normal
- eating until uncomfortably full
- eating large amounts of food
when not feeling physically
hungry - eating alone because of being
embarrassed by how much one
is eating - feelings of disgust, depression,
guilty after overeating
- 1 day a week for 3 months
- no regular use of inappropriate
compensatory behaviour - marked distress associated with
binge eating
ARFID: Avoidant/Restricative Food Intake Disorder:
- eating or feeding disturbance as
manifested by persistent failure to
meet appropriate nutritional
and/or energy needs associated
with one or more of the following - significant weight loss or failure to
achieve expected weight in
children - significant nutritional deficiency
- dependence on enteral feeding or
oral nutritional supplements - marked interference with
psychosocial functioning
ARFID is not better explained by lack of available food or by an associated culturally sanctioned practice.
True or False?
True
Which of the following eating disorders does ARFID occur during?
- anorexia nervosa
- bulimia nervosa
- binge eating
- does not occur exclusively during
either condition - no evidence of a disturbance in
the way in which one’s body
weight or shape is experienced
Disordered Eating vs Eating Disorder:
insert slide
Prevalence vs Incidence
the number of cases present in a specific population
number of new cases in a set of population in a limited period of time
What % of people with an eating disorder are underweight?
15%
Lifetime Prevalence of eating disorders:
- woman: 5-15%
- men: 5-8%
Which of the following diagnosis has an increasing incidence in people<15?
- anorexia nervosa
- bulimia nervosa
- ARFID
- OSFED
OSFED
Other Specified Feeding and Eating Disorders
Causes of Eating Disorders:
multifactorial - no single cause
several risk factors both predisposing and precipitating factors
Eating Disorders: Predisposing Factors:
Biological:
- twin based heritability
- Bulimia nervosa 50-80%
- Binge eating 40-57%
- female, young
Psychological:
- anorexia nervosa: perfectionistic
personality trait, anxiety disorder,
social impairment
- bulimia nervosa: impulsivity,
depression
- low self-esteem
Social:
- trauma (binge-purge)
- maternal dieting
- paternal comments
- environment where low weight is
valued
- social media exposure
- bullying
Eating Disorders: Protective Factors:
- resilience
- family
- social support
Eating Disorders: Perpetuating Factors:
- other noticing weight loss in a
complementary way - emotion suppressing nature of
starvation - reduced flexibility of cognitive
status
Eating Disorders: Precipitating:
- dieting
- perceived criticism
- weight related teasing
Anorexia Nervosa: Personality:
Changes and Effects of Starvation:
- emotional
- social
- cognitive
- physical
- deterioration of mood, anxiety
increase, outbursts of anger, guilt
around eating - withdrawn, isolated, social
inadequacy - more thoughts of food, impaired
concentration, judgement and
decision making - stomach aches, dizziness,
decreased tolerance of cold
temperature, reduced strength,
hair loss
Eating Disorders: Medical Complications:
- cardiac abnormalities: less muscle
mass (heart), electrolyte
abnormalities - oesophagus damaged by vomiting
- teeth damaged by vomiting
- risk of osteoporosis
- russell’s sign of self-vomiting, with
scratches noted on the back of the
hand to induce gag reflex - low blood pressure
Refeeding Syndrome:
- process of re-introducing food
after malnourishment or
starvation - potentially fatal shift in fluids and
electrolytes that may occur in
malnourished patients on
refeeding following a period of
starvation - when food intake starts again,
carb metabolism occurs and
insulin secretion increases - this stimulates cellular uptake of
phosphate, which can lead to
profound hypophosphataemia - usually occurs within the first 5
days of re-introducing of nutrition,
but may happen up to 2 weeks
after
Who is at risk of refeeding syndrome?
- increases with a fall in BMI
- severity of the rate and degree
weight loss in the last 6 months
should be considered; if greater
than 10% lost, this is considered
clinically significant - if child’s intake is minimal for 5
days consider risk, extremely high
after 10 days of little or no intake - phsyical co-morbidities
- presence of oedema is an
associated sign - should be considered in patients
with rapid gains in weight outside
of the amount that would normally
be predicted
What is used to assess a patient with anorexia nervosa?
MEED Risk Assessment Framework
Anorexia Nervosa: Physical Health Monitoring:
- BMI
- blood pressure and pulse (sitting
and standing) - temperature
- FBC
- LFTs
- U&Es
- Calcium, phosphate, magnesium
- random glucose
- ECG: if weight is low or continuing
weight loss - presence of self harm/high mental
health risk
What is the average duration of anorexia nervosa?
8 years
