Eating and Feeding Disorders Flashcards
What is pica?
when you eat non-food substances over a 1 month period - NOT developmentally appropriate, NOT socially supported
Describe the treatment for pica?
just manipulate the antecepdestimulus so they can’t eat it
self protective devices
train to tell the dif between food and non food
reinforce and redirect
What is rumination and who usually has it?
usually in infants, but also children and adults under considerable distress or with GERD, hiatal hernia etc. - it’s regurgitating food that is then either spit out or swallowed again
HOw do you treat rumination?
you use behavioral analysis to determine triggers, then eliminate the trigger. Make it aversive by flicking their foot while they do it, or distract them right before they do it. improve environment so they’re not bored.
What is avoidant/restrictive food intake disorder and how is it different from anorexia?
It’s avoidance of food or not eating enough of it - that’s all it has in common with AN
Do classical/operant conditioning models work for anorexia and bulimia?
nope
Describe the family dynamic in anorexia?
anorexia generally reflects dysfunction in the family - usually high expectations, over-archieveing, perfection striving and absence of interpersonal warmth
In the James Marcia theory of identify status, what are the two factors that are either present or absent in a person’s identity developent?
crisis and commitment
What are the 4 general identity statuses?
diffusion (following the group) foreclosure (just taking on the adults point of view) moratorium (reflecting on a crisis and trying to figure it out) identity acievement (figured it out!)
What is the scoff questionnaire for anorexia/bulimia?
- do you make yourself sick because you feel full?
2/ do you worry you have lost control over how much you eat - have you recently lost more than one stone in a 2 month period
- do you believe yourself to be fat?
- would you say that food dominates your life?
In addition to eating habits, what is important to ask potential anorexics about?
exercise - frequency and how hard?
What are the two questions that are 100% sensitive and 90% specific for bulimia?
- are you satisfied with your eating patterns?
2. do you ever eat in secret?
What criteria for anorexia was removed for the DSM5?
amenorrhea
What are the two types of anorexia?
restricting type and binge-eating/purging type
What are the BMI severity indicators for eating disorders?
mild = 17
moderate = 16-17
severe = 15-16
extreme BMI less than 15
What’s the mean age of onset for AN?
17
Which is more common, AN or BN?
bulimia
What impulse control disorder is often comorbid with anorexia?
kleptomania
What does mortality usually occur from with AN?
cardiac failure from electrolyte changes in refeeding syndrome (too rapid of weight gain after starving)
What are the indicators for a better progrnosis in AN?
- onset younger age
- clear precipitating factor
- patient admits to feeling hungry through anorexia
- restrictor-type only
What would you see on physical exam in anorexia?
emaciation, amenorrhea, hypotension, hypothermia, bradycardia, lanugo, peripheral edema, hyper-carotenemia (they’ll look orange)
What should be on your DD with anorexia?
malignancy, malabsorption syndrome, hyperthyroidism, diabetes mellitus, hypothalamic tumor, psychiatric disorders
Reduction of what NT activity is associated with AN?
serotonin
Why do you ned to be careful ot what antidepressants you give to those with AN?
SSRIs will actually make it worse because of appetite suprpessant side effect and TCAs can be lethal in those with QT interval problems
What percentage of patients with AN also have bulimia?
40-50%
What are the main criteria for bulimia?
- eating a huge amount of food
- sense of lack of control over eating
- recurrent compensatory behavior
- both eating and compensation occur at least once a week for 3 months
How do you rate severity for bulimia?
the number of compensations per week (mild = 1 to 3, extreme - 14)
What is the lifetime risk for bulimia?
4-8%
what group of people is most commonly affected by bulimia?
single white college women
Is childhood abuse just higher incidence, or also causal in bulimia?
just higher incidence - not causal
Who has higher alcoholism and kleptomania, AN or BN?
BN
What is weight usually in BN patients?
usually normal or slightly below normal
Who has ahigher incidence of substance abuse, men with eating disorders or women with eating disorders?
men
Do men tend to have BN or AN?
BN (2:1)
What group of men are eating disorders more common in?
gay and bisexual
What are the risk factors for bulimia?
- low paternal care
- history of wide weight fluctuations, dieting or exercise
- slim ideal body image
- low self esteem
- EXTERNAL locus of control
- high levels of neuroticism
What comes first in bulimia? binging behavior or vomiting?
binging comes first - precedes vomiting by about a year
On average, how many binging episodes are there a week for those with BN?
about 11.7!
What is the mean caloric intake per binge?
3400 (min 1200, max 50,000)
What is the most common purging behavior?
vomiting (77%)
Although treatment for bulimia is about 70% effective, what is the relapse rate?
63% within first year
overall 1/3 will recover and not relapse after 1 year
