Eating D/o Flashcards
Can discussion of eating d/o be triggering to patients?
Yes
What are some qualities of grounded, healthy eating behaviors?
Flexibility!
+/- Eat when you’re happy, sad, anxious
+/- Reward yourself w/ food
Stop eating when full and eat when hungry
Eating is dependent on self, not anyone else
Eating is not conditional, nor does what you choose to eat impart any judgment about self
Eating may sometimes be a health issue but should never be a ____ issue
moral
Healthy eating is based on ____ of your body
trust
Less health approaches to eating and exercise are ____
rigid/inflexible
Disordered eating is characterized by an unhealthy relationship with food that can develop into _______
an eating d/o
Are eating d/o about food? Explain.
No, food is used as a coping mechanism
Self punishment, self cleansing
Protection or safety, avoidance of intimacy
Proof of self blame instead of blaming others (abuser)
Form of comfort, soothing
Numb, sedation distraction
Attention, cry for help, discharge of tension, anger
Structure, identity, predictability
Loneliness, distracting
What is challenge #1 when it comes to eating d/o? Challenge #2?
#1: Disrupted self-awareness #2: Absence of alternative sources of reinforcement (perfectionism)
Do pts with avoidant/restrictive food intake d/o have low, healthy, or high weight? How does this impact diet and life?
Can have a healthy wt, but dietary restrictions require supplementations or interfere with job/school
What are three examples of developmental influences on hunger? Provide an example for each.
Pain: GERD
Muscle Tone: Suck rate
Respiration: Postural tone
___% chance that a child will show a disgusted face with new food
80%
What is disgust good for evolutionarily?
System designed to protect our bodies from potential pathogens
What kind of intervention is recommended for patients with avoidant/restrictive food intake d/o?
None empirically validated
Should use validation and positive reinforcement and family meal times
What eating d/o is the leading cause of death from suicide?
Anorexia nervosa
Is the restrictive type or binge-eating/purging type of anorexia nervosa more deadly?
Binge/purge
What are the most concerning bodily effects of anorexia nervosa, that cause irreversible damage?
Bone and brain
In adolescence, frequency of onset increases with ____, and there is a sharp age of onset before what age?
age
20 y/o
It is rare to see new cases of anorexia nervosa in pts ___ y/o or ___ y/o
<12 y/o
>mid-20 y/o
Most pts with anorexia nervosa have comorbid _____ d/o
psychological
Pts w/ anorexia nervosa have (lower/higher) rates of substance abuse and OCD
higher
What are nutritional concerns for patients with anorexia nervosa?
Protein: Muscle wasting, repeated injuries
Wt loss, fatigue, amenorrhea, cognitive impairment
Fluids: Dehydration
Osteoporosis, osteopenia, stress fractures
Iron: Anemia, fatigue
Are there any medications that can be used in the tx of anorexia nevosa?
No
What is rumination d/o?
Repeated regurgitation of food over a period of at least 1 month; regurgitated food may be re-chewed, re-swallowed, or spit out
What is the single differentiating factor from Anorexia nervosa and bulimia?
Weight
What time of day do binges usually take place?
Night
What is the cycle of bulimia?
Low self esteem, overconcern with body size and shape, rigid dieting, break from restraint, binge, purge
What are some nutritional concerns specific to bulimia?
Fluids, electrolyte imbalance, protein intake with excessive exercise, normalizing eating patterns, dealing with deprivation sensitive eating
What are tx interventions for bulimia?
CBT + SSRI
___% of individuals in weight-control programs suffer from binge eating d/o
~20%
___% of candidates for bariatric surgery suffer from binge eating d/o
~50%
Are pts with binge eating d/o typically older or younger than patients with anorexia nervosa?
Older
Do pts w/ binge eating d/o show better or worse response to tx than other eating d/o?
better response
Do pts with binge eating d/o have lower or higher rates of psychopathology than non-binging obese individuals?
higher
Are sx such as retching, nausea, heartburn, odors or abdominal pain associated with rumination d/o?
No, contrary to what someone may expect based on what one usually sees with vomiting
In rumination d/o, the act of regurgitation is described as ____ and ____
The regurgitation is effortless or unforced
What conditions must be r/o before dx a pt with rumination d/o?
Must r/o acid reflux and/or other GI d/o could be causing sx
Rumination disorders occurs across all age ranges, in (men/women/both)
both sexes
Rumination d/o are most common in what age ranges/populations?
infants, young children and children w/ developmental disabilities
What is the minimum age for dx of pica d/o?
2 y/o
What is pics d/o?
When a pt eats nonnutritive substances on a persistent basis
Pics d/o is common in _______ and individuals w/ _______ as well as those with “pure” medical d/o involving _______ (i.e. ______)
pregnant women intellectual disabilities nutrient deficiency (iron deficiency)
T/F: Pica d/o may be confused with cultural practices, which would disqualify a pt for the dx of pica d/o
T
Geophagy or eating dirt, is a common cultural ritual across the world during pregnancy, for religious ceremonies or as a remedy for dz not pica d/o
What PE findings are common in pts with pica d/o? (x3 + examples)
Manifestations of toxic ingestion (lead poisoning)
GI manifestations (mechanical bowel problems, constipation, ulcerations, perforations, and intestinal obstructions)
Dental (severe tooth abrasion, surface tooth loss)
What are potential complications associated with Pica d/o?
Complications of lead toxicity – Neurologic, hematologic, endocrine, cardiovascular, and renal effects
GI tract complications – Mild (constipation) to life-threatening (hemorrhage and obstruction)
Nutritional effects – Iron and zinc deficiency syndromes (not firmly established)
How do you tx a pt with pica d/o?
No specific tx, behavioral strategies/therapy most effective
~____% of bulimics steal food by shoplifting or other means
~10%
What are some specific PE findings for a pt with bulimia nervosa?
(A lot of s/s overlap with anorexia nervosa, these are specific to bulimia)
Calluses on the dorsum of the hands
Dental erosion/caries
Esophageal erosions/tears
Hypocalemia/hypokalemic alkalosis
What are the 3 methodologies for vomiting that a pt with bulimia may report? Which method is most common?
Most will induce vomiting
Some can learn to vomit at will
Some pts abuse emetics (ipecac)
In a pt with bulimia, a binge may at first bring feelings of ______, which is followed by _____ and _______
relief from tension
guilt
feelings of disgust
What is the Russell sign and what d/o is it associated with?
Calluses on knuckles from self induced vomiting
Binge eating d/o
What are PE findings in a pt with binge eating d/o?
Skin turgor, CV system, hair, teeth, weight (height)
Russell sign
Edema of the extremities
Delayed or interrupted pubertal development
Atrophic breasts
What comorbid conditions are common in patients with binge eating d/o? Which one is the most common?
#1: Major depression Anxiety disorders, Schizophrenia, Substance abuse, Obsessive compulsive d/o, Personality d/o
What are the three main goals of eating d/o treatment?
Restore normal nutritional state (Anorexics normal weight, Bulimics normal metabolic balance)
Modify pt’s maladaptive eating behaviors
Help change the pt’s distorted/erroneous beliefs about weight loss/themselves
T/F: There are no life-threatening risks in re-feeding of severe malnutrition
F: there are!
What are indications for hospitalization for a pt with anorexia nervosa?
<75% ideal body wt or ongoing wt loss despite intensive tx Refusal to eat Body fat < 10% HR <50/min day, <45/min asleep Systolic BP <90 Orthostatic change in pulse >20 beats/min or BP> 10 mmHg Temperature <96 degrees F Arrhythmia Suicide risk
What are indications for hospitalization for a pt with Bulimia?
Syncope Serum K+ < 3.2mmol/L Serum Cl <88 mmol/L Esophageal tears Cardiac arrhythmia including prolonged QTc Hypothermia Suicide risk Intractable vomiting Hematemesis Failure to respond to outpatient therapy
