Anorexia Nervosa Flashcards

1
Q

Anorexia Nervosa:

A
  • 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
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2
Q

Anorexia Nervosa: Subtypes:

A
  • 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
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3
Q

Anorexia Nervosa: Risks:

A
  • osteoporosis
  • osteopenia
  • infertility (often experience
    menorrhagia)
  • co-morbid mental health disorders
    common
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4
Q

Anorexia Nervosa: Recovery Rates:

A
  • 46% fully recover
  • 33% partial recovery
  • 20% do not recover
  • poor prognosis if duration of
    symptoms before treatment >3 yrs
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5
Q

Bulimia Nervosa:

A
  • 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
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6
Q

Bulimia Nervosa:

Recurrent episodes of binge eating characterised as both:

A
  • 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
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7
Q

Bulimia Subtypes:

A
  • purging
  • non-purging
  • atypical bulimia nervosa
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8
Q

Bulimia Nervosa: Purging Type:

A
  • during the current episode, the
    person has regularly engaged in
    self-induced vomiting or the
    misuse of laxative, diuretics or
    enemas
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9
Q

Bulimia Nervosa: Non-purging Type:

A
  • 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
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10
Q

Bulimia Nervosa: Atypical:

A
  • 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
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11
Q

What is OSFED?

A
  • diagnosis when an individual
    meets most but not all of the
    diagnostic criteria for Anorexia
    Nervosa, Bulimia Nervosa, Binge
    Eating Disorder
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12
Q

Binge Eating Disorder:

A
  • 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
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13
Q

ARFID: Avoidant/Restricative Food Intake Disorder:

A
  • 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
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14
Q

ARFID is not better explained by lack of available food or by an associated culturally sanctioned practice.

True or False?

A

True

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15
Q

Which of the following eating disorders does ARFID occur during?

  • anorexia nervosa
  • bulimia nervosa
  • binge eating
A
  • 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
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16
Q

Disordered Eating vs Eating Disorder:

A

insert slide

17
Q

Prevalence vs Incidence

A

the number of cases present in a specific population

number of new cases in a set of population in a limited period of time

18
Q

What % of people with an eating disorder are underweight?

19
Q

Lifetime Prevalence of eating disorders:

A
  • woman: 5-15%
  • men: 5-8%
20
Q

Which of the following diagnosis has an increasing incidence in people<15?

  • anorexia nervosa
  • bulimia nervosa
  • ARFID
  • OSFED
A

OSFED

Other Specified Feeding and Eating Disorders

21
Q

Causes of Eating Disorders:

A

multifactorial - no single cause

several risk factors both predisposing and precipitating factors

22
Q

Eating Disorders: Predisposing Factors:

A

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

23
Q

Eating Disorders: Protective Factors:

A
  • resilience
  • family
  • social support
24
Q

Eating Disorders: Perpetuating Factors:

A
  • other noticing weight loss in a
    complementary way
  • emotion suppressing nature of
    starvation
  • reduced flexibility of cognitive
    status
25
Eating Disorders: Precipitating:
- dieting - perceived criticism - weight related teasing
26
Anorexia Nervosa: Personality:
27
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
28
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
29
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
30
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
31
What is used to assess a patient with anorexia nervosa?
MEED Risk Assessment Framework
32
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
33
What is the average duration of anorexia nervosa?
8 years