EATING DISORDER Flashcards
Persistent disturbance of eating that impairs both health and psychological functioning
(1) Anorexia nervosa
(2) Bulimia nervosa
(3) Binge eating disorder
(4) Pica
(5) Rumination disorder
Consider a broad differential when evaluating a patient with weight loss, examples
include but not limited to:
(a) Hyperthyroidism
(b) Malignancy
(c) Diseases of the GI tract
(d) Chronic Infectious diseases
(e) Affective disorders (depression)
Screening tools for psychiatric causes can help differentiate between an eating disorder
and other causes of weight loss:
(a) Do you make yourself Sick because you feel uncomfortably full?
(b) Do you worry you have lost Control over how much you eat?
(c) Have you recently lost more than One stone (14 pounds) in a three month period?
(d) Do you believe yourself to be Fat when others say you are thin?
(e) Would you say that Food dominates your life?
Anorexia Nervosa
(1) Estimate lifetime prevalence of
0.6%
Anorexia Nervosa
More common in women
(a) Ratio ranges from 10-20:1
Anorexia Nervosa
Median age of onset
18
Anorexia Nervosa
(a) Neuroimaging studies have shown
structural brain changes
Anorexia Nervosa
Eating behavior, motivation and reward
Dopamine
Anorexia Nervosa
Mood, impulse control, obsessive behavior
Serotonin
Anorexia Nervosa
Diagnostic Criteria (DSM V)
(a) Restriction of energy intake that leads to low body weight
1) Taking into account the sex, age, developmental trajectory, and physical
health
(b) Intense fear of gaining weight or becoming fat or persistent behavior that
prevents weight gain, despite being underweight
(c) Distorted perception of body weight and shape, undue influence of weight and
shape on self-worth, or denial of the medical seriousness of one’s own low body
weight
(6) Common physical exam findings
(a) Low BMI (<17.5)
(b) Emaciation
(c) Hypothermia
(d) Bradycardia
(e) Hypotension
(f) Hypoactive bowel sounds
(g) Xerosis (dry and scaly skin)
(h) Brittle hair and hair loss
(i) Lanugo body hair
(j) Abdominal distention
Bulimia nervosa
Estimated lifetime prevalence of
1.0%
Bulimia nervosa
Three times more common in women than men
(1.5% vs 0.5%)
Bulimia nervosa
Median age of onset of
18 years
Bulimia nervosa
Diagnostic Criteria
(a) Recurrent episodes of binging and purging and inappropriate compensatory behavior to prevent weight gain 1) Self-induced vomiting 2) Misuse of laxatives 3) Diuretic use 4) Enemas 5) Fasting 6) Excessive exercise 7) Occurring on average at least once per week for three months
Bulimia nervosa
Associated features
(a) Mild psychosocial impairment seen in about 78% and severe impairment in 16%
(b) Body weight usually within or above normal range
(c) Neurocognitive functioning (decision making) impaired
(d) Emotional dysregulation is common
(e) Self- harm is often seen
(f) Additional psychiatric disorders are common:
1) Anxiety, depression, PTSD, substance abuse, ADHD, conduct disorders,
personality disorders
