CM: Eating Disorders

Question 1

What are the clinical symptoms related to eating disorders?

Answer 1

restricting
purging
binging

Question 2

What are the psychological symptoms associated w eating disorders?

Answer 2

psyche: thoughts and feelings
thoughts = low self esteem, thoughts about body shape, weight, perfectionism, food
feelings: anxiety (pre-existing disorders), depression

Question 3

What is an eating disorder?

Answer 3

eating separated from nutritional needs, social interaction, free choices

Question 4

When and how are electrolytes altered in eating disorders?

Answer 4

only in bulimia (purging) - hypochloremic metabolic acidosis, low K, Cl, Mg

Question 5

What is the percentage of body fat required for menstruation?

Answer 5

20-25%

Question 6

What is refeeding syndrome?

Answer 6

body has reserves of electrolytes in bone, muscle, etc
after starving 5 days or more metabolism changes - when food resumed, demand for these electrolytes may exceed availability in reserves –> acute depletion

Question 7

What is the diagnostic criteria for anorexia nervosa?

Answer 7

restriction of energy intake leading to low body weight
intense fear of gaining weight or becoming fat even though underweight
disturbance about body, undue influence of weight on self-eval, denial of seriousness of low body weight

Question 8

What are the subtypes of anorexia nervosa?

Answer 8

based on behavior over last 3 months
restricting type - no binging/purging
binge-eating/purging type

Question 9

What is the epidemiology of anorexia?

Answer 9

onset 14-18 YO, more common in women
common comorbids = anxiety (social phobias inc childhood separation anxiety, OCD), depression
multifactorial etiology

Question 10

What are the clinical features of anorexia?

Answer 10

NO loss of appetite until late in disorder
peculiar behaviors with food/hiding food
rigid and perfectionistic
denial despite emaciation
somatic complaints
poor sexual adjustment

Question 11

What are the physical findings associated with anorexia?

Answer 11

cachexia, slowing of cardiac fxning and arrhythmias, GI symptoms, skin symptoms, leukopenia, osteoporosis

Question 12

What are the lab findings associated with anorexia?

Answer 12

hypokalemia –> ST and T wave changes, hypochloremic acidosis, hypomagnesemia
salivary gland enlargement, pancreatic inflammation (increased amylase), seizures and neuropathies
gastric and dental erosions

Question 13

What is general treatment for anorexia?

Answer 13

hospitalization for nutrition
psychotherapy: cognitive-behavioral therapy, family therapy (best outcomes)
No FDA approved meds

Question 14

What is the diagnostic criteria for bulimia?

Answer 14

recurrent binge eating and compensatory behaviors to prevent weight gain (vomiting, laxatives, fasting, exercise)
behaviors occur at least 1 times/week for 3 months (2 in DSM-IV)
does not occur during episodes of anorexia

Question 15

What are the subtypes of bulimia?

Answer 15

mostly purging type

only 5% nonpurging type (fast or exercise instead)

Question 16

What is the epidemiology of bulimia?

Answer 16

onset later in adolescence than anorexia
pts usually normal weight or overweight (if underweight = anorexia)
etiology is multifactorial

Question 17

What is the prognosis of bulimia compared to anorexia?

Answer 17

thought to be better
less likely to obtain treatment in milder cases
mood disorders commonly comorbid
generally more waxing and waning

Question 18

What is the general treatment of bulimia?

Answer 18

hospitalization less often than anorexia
cognitive behavioral therapy
SSRIs (Fluoxetine)

Question 19

What is eating disorder NOS?

Answer 19

any combo of eating symptoms that doesn’t quite reach significance

Question 20

What is binge-eating disorder?

Answer 20

recurrent episodes of binge eating
3 or more of following associated w binge: eating rapidly, until uncomfortably full, large amounts when not physically hungry, eating alone because feel embarrassed, disgusted depressed or guilty afterward

Question 21

What is the epidemiology of binge eating disorder?

Answer 21

usually normal, overweight or obese
generally teens and adults
associated w mood disorders