Eating and Feeding disorders Flashcards
Progression of eating and feeding disorders
- normal eating
- rf (low SE, diet, parental, media ideal bodies)
- partial-sx ED (binge and diet)
- full-syndrome ED
- treatment
Criteria for ED
- consistently below or above caloric needs to maintain wt
- accompany by anx and guilt (varies with dx)
- occur w/o hunger or fails to satiate
- physio imbalance or medical comps
Mortality of ED
26% suicide attempt
- 2nd highest mort rate of AMI besides opioid dx
Factors that influence ED
genetics, puberty onset, female, vuln personality, uncontrolled diet, major life chx and stressors, fam fxn style, societal focus on thinness, perfectionism, impulsivity, hx obesity
psych fx that infleunce ED
dec self-esteem, inadequatecy, lack of control, anx/dep, loneliness, trauma
interpersonal fx that influence ED
relx prob, emo expression, hx teased for size/wt, hx abuse
social fx that infl
culture glorify thinness, narrow beauty definition, external value on bod
biological fx that influence ED
hor fxn, genetics
- altered 5-HT (alter mood, appetite, impulse control)
Enviro fx that influence ED
child trauma and sex abuse, culture
- hx abuse = poorer outcomes
ED common comorbidities
- anorexia and anx
- binge and alc/sub use
- bulimia and dep, sub use, personality dx
Are ppl with ED hard to tx
- rarely get help
- leave tx early
- unmotivated
- some recover spon but some lifetime probs
Anorexia nervosa
- char: intense fear of wt gain, severely distorted body image, restrict cal r/t requirements with sig low BMI during last 3M
- low body wt relative to age, sex, phys health, dev trajectory
- diff in taste and satiety that may make not want to eat
types of anorexia
- Restricting type - no binge/purge; diet, fast, and/or excess exercise in last 3M
- Binge eat and purge type - self-vom or lax, diuretic, enema with periods of cal restriction in last 3M
s/s anorexia
- BMI (15% or more below expected for age, ht, activity level)
- amenorrhea (post-puberty)
- peripheral edema
- lanugo
- mottled cool skin or extremities
- fatigue, weak
- constipation, low BP, pulse, temp
- dec bone density
- abnormal labs
- dec renal
- anemia pancytopenia
When will someone with AN have altered electros?
If they purge
Epidemiology of AN
fem, adol and young adults, athletes, queer
- comorb with BPAD, anx, OCD, dep, PTSD, trauma, AUD/SUD
etiology of Anorexia
- genetic corr with MDD, anx, OCD, schiz
- glucose and lipid metab?
- Tryptophan and 5-HT synth
- internalized thin bod and deficit in bx control in response to distress
Psych and cog eti fx r/t anorexia
- struggle with emo ID, reg, process
- exhibit low distress tolerance and deficit in bx control in response to distress
- ego-syntonic dx
ego-syntonix dx
know actions are harmful but benefits outweight risks
rf for anorexia
fem, fam, obese, diet, overexac, low self-esteem, body dissat, lack assertion, other ED, hx abuse, comorbid, distorted body image, media, fashion, athletics
Warnings of ED
- dramatic wt loss
- preocc with food and cals
refused to eat some foods or whole categories - comments about feeing fat or overwt or anx about wt gain
- denial of hunger
- food rituals
- excuses for meals
- excess exercise
- w/d from fam, friends
Clinical course of anorexia
- chronic relapse and sig wt loss, 50% 1 year relapse
- continue to be preocc with food
- 10-25% get bulimia
- 1/5 die with suicide
- poor outcome r/t min wt, presence of purge, early onset
Comps of anorexia
- lose fat and muscle
- osteoporosis
- metabolic hypo thy, hypoG, electro abnorm
- cardiac brady, hypoT, lose cardiac muscle, small heart, chest pain, sudden death, arrhythmia
- GI bloat, dec emptying, gas and diarr, GERD, hemorrhoids
- reprod infert and dec libido
- dry and brittle skin, lanugo, edema, dec wound healing, acrocyanosis, yellow skin
- ab taste sens, apathetic dep, mild mental sx, sleep disturb, fatigue
What might cause dec taste sensation?
dec zinc
Lab findings for anorexia
leuko, anemia, thrombocytopenia, hyperchol, hypercarotenemia
Hospitalization criteria for anorexia
- extreme electro imbalance
- wt under 75% of ideal body wt
- under 10% body fat
- HR under 50 BPM
- systolic BC under 90
- temp under 96
- arrhythmias
Tx for anorexia once medically stable
- nut rehab, health tech and promotion
- resolve body image and conflict, inc coping, often hospital, intensive therapy, partial outpt
- wt restoration program to 90% ideal BW
- precise mealtime with obs and schedule
- observe when go br and see visitors
- potential refeeding sx
- milieau therapy to dec anx, dysphoria, dec self-esteem, lack control
Refeeding syndrome
- when starving, body shifts to preserve fat and prevent muscle b/d
- switch glucose to fat and pro based energy
- when nutrients restored, insulin stim glycogen, fat, and pro synth; process requires minerals like mag and phos
- serious condx with shifts in electros that help body metabolize food
- can cause dec mag, K, P, vits, thiamin
How to avoid refeeding syndrome
slowly increase nutrition
Long term bio tx for anorexia
There aren’t any…fluoxetine for OCD
therapies for anorexia long-term
- no specific
- none is best - adol CBT, family-based, insight oriented (for adol)
- integrative yoga, massage, acupuncture, bright light therapy
Bulimia nervosa
recurrent binge (1500-5000k in 2h), compensatory bx to avoid wt gain thru purge like self-vom, lax, diuretics
epidemiology of bulimia
- increasing in women 25-45
- later adol onset
- often comorb mood/anx dx, SUD, AUD!!
Etiology of bulimia
- eating dysreg, dec 5-HT, fam
- psych - impulsive, non-nurturing fam, poor interpersonal relx, anx, self-esteem
- enviro - internal thin body, child sex/phys abuse
Triggers of bulimia
stress, dec body image, food, restriction
DSM criteria for bulimia
binge/purge weekly for 3M
facts about bulimia
- older onset (18)
- usually not life-threat
- more prevalent
- tx outpt
- better outcomes
- more lower
- meds effective
Clinical course of bulimia
- few outward, not phys ill
- at/near normal wt
- b/p in secret
- tx delayed for years
- tx start when control of eating is last
- ind social butterfly and overwhelmed
- big rules about food/restrict
- shame, guilt, disgust
- compulsive/impulsive in other areas
- often couple recovery when tx done except if dep/personality dx present
rf for bulimia
AN hx, dep, interrelx prob, impulsive, inc anx/compulsions, SUD
Warning signs of bulimia
binge eat, eat secret, purge bx, rigid exercise regimen, life schedule to make time for binge, w/d from fam, wt loss, parotid swelling, callus hands, knuckles from vom, dental caries, tooth erosion and stains
s/s bulimia
- sz, fatigue, weak, mild mental
- cardiac - ipecac cardiomyopathy, arrhythmia
- Russells (callus on back of hands)
- dental erosion
- xerostomia
- parotid gland swelling
NC for bulimia tx
- determine pt perceptions
- phys assess with labs
- daily activity, incl exercise
- self hx suicide, NSSI
- eating habits, diet
- specific shape and wt
tx for bulimia
- hospital if life threat (often outpt)
- stable and normal eating
- restructure dysfxn throughts
- healthy boundary setting
- nut counsel
- bx tech like diary
- CBT first line
- SSRI second line
- also DBT, group psycho
Which therapy tx will you not use with bulimia
NOT fam bc of age
Binge eating disorder
- recurrent binge with distress and impaired control over such bx
- an avg weekly for 3M
- not assoc with compensatory bx like with BN
What is the most common ED
binge eating dx
epidemiology of BED
fem, normal/overwt, equal among racial/ethnic, 1/2 risk genetic, most have other dx
- low self esteem, body dissat, prob coping, food insecure, hx trauma, adverse child event, normal or overwt
BED s/s
freq large quantity in short time, feel out of control, dep, guilty, disgusted
- eat when not hungry, eat alone, eat until uncomf full
- upper and lower GI probs
What often brings people with BED to the dr
GI probs
Cues to assess for with BED
- pt perception
- psych hx
- phys assess
- triggers
- nut pattern
- hx wt cyclin
- hx foods/freq of binge
Health consequences of binging
HTN, inc chol, HD, DM, GI, gallbladder, mskl
BED tx
- often not hospital
- pt prefer term “unhealthy BMI” over “wt prob” or “heavy”
- explore feelings and triggers
- pharm SSRI, lisdexamfetamine dimesylate
- ind or group CBT, DBT, support group
Pica
eat subs w/o nut value
- childhood for few months in M and F
Pica intetrvention
bx interventions like reward good eating
- monitor eating bx
Rumination disorder
- undigested food returned to mouth then rechewed and swallowed or spit out
- dx after 1 M sx at any age, often 3-12M onset
- occurs more freq with intellectual disability
- childhood neglect predis fx to dev dx
Rumination disorder NC
- reposition infant and small kids during feeding
- improve intx btwn caregiver and child and make mealtimes pleasant
- distract kid when bx starts
- may need for therapy
Avoidant/restrictive food intake dx (ARFID)
- can cause sig wt loss, nut def, dependence suppl or enteral feeding
- food avoidance r/t strong dislike d/t sensory qualities of food (appearance, color, smell, texture, temp, taste)
ARFID epidemiology
M and F infants and early child
- personal anx and fam anx
ARFID tx
- bx mod for food
- tx anx and dep sx
- edu on specific bx techniques
When can pt with anorexia switch to outpt partial hospitalization?
Stable - maintain contracted wt, normal VS, and inc abstinence from ED bx
hospitalization for BN
- syncope
- K under 3.2
- Cl under 8
- esophageal tears
- hemoptysis
- arrhythmia
- intractable vom
- SI
