Eating Disorder Flashcards
What is an eating disorder?
A mental disorder defined by abnormal eating habits which negatively affect a person’s physical or mental health.
What is anorexia nervosa?
Pathological desire for thinness which is most common in adolescence and has a significant mortality of 15%, with majority due to physical complications. The diagnostic criteria includes:
-> Low body weight which is 15% less than expected
-> Self-induced weight loss via purging, excessive exercise
-> Body image distortion with imposed low weight threshold
-> Endocrine disorders with amenorrhea, raised cortisol
-> Delayed/arrested puberty
What is the epidemiology of anorexia nervosa?
Affects more women than men
Mean age of onset is 16-17 years old
Prognosis has a high mortality figure with a poor prognosis being chronic illness, late age of onset and bulimic features with vomiting and purging.
What are the risk factors for anorexia nervosa?
Female
Family history
Sexual abuse
Occupational or recreational pressure
History of dieting
Low self-esteem
Obsessional traits
Co-morbidity with anxiety or EUPD/BPD
What is the aetiology of anorexia nervosa?
Genetic concordance with monozygotic twins
Adverse life events such as sexual abuse and dieting behaviour in family
Premorbid personality of neuroticism
Severe life stresses
What are the clinical features of eating disorders?
Refusal to maintain bMI
Weight below BMI less than 17.5
Rapid weight loss
Lack of insight and resistant to intervention
Social withdrawal
Excessive weight loss and use of laxatives
What are the physical features of anorexia nervosa?
Primary/Secondary amenorrhea
Constipation, abdominal pain and dysphagia
Fatigue and intolerance to cold
Lanugo fine hair over the body
Delayed puberty
What are the investigations for eating disorders?
FBC for ESR and , urea and electrolytes to assess vomiting or laxative or diuretic use
Glucose levels to test hypoglycaemia
ECG to test for sinus bradycardia, arrythmia and signs of ischaemia
DEXA bone scan
BMI
What are the complications of anorexia nervosa?
Impaired concentration
Bradycardia
Dry skin and brittle hair
Impaired renal function
Osteoporosis
Delayed gastric emptying and constipation
Amenorrhea and infertility
Osteoporosis
How is anorexia nervosa assessed?
->Full psychiatric history for onset and risk of self harm
->Full medical history for physical consequences, dietary patterns and weight changes
->Physical examination for weight, height, physical signs of starvation and investigations
What does a high ESR indicate?
High erythrocytes sedimentation rate indicates inflammation and signals an organic cause.
What are the physical risk signs for severe anorexia nervosa?
Rapid weight less over 0.5kg per week
Heart rate less than 40bpm
Low core temperature
Low K+, Na+ and Mg2+
Low albumin
Prolonged Qt interval, bradycardia and T wave changes
What is the management for anorexia nervosa in under 18’s?
Family therapy
CBT
Adolescent focused psychotherapy
What is the psychological management for anorexia nervosa?
Frequent CBT sessions 40 sessions over 40 weeks
Psychodynamic therapy
Dietetic counselling
Maudlin anorexia treatment for adults
What is the physical management for anorexia nervosa?
Oral supplementation for electrolyte imbalances
Managing healthy weight gain and maintenance to gain 0.5kg a week
Monitoring U&Es and electrolytes
What is re feeding syndrome?
Severe electrolyte disturbances with low concentration of K+, Mg2+ and K+ during re feeding orally or enterally.
This can cause cardiac complications, renal impairment and liver function abnormalities.
What is bulimia nervosa?
Eating disorder characterised by repeated binges and compensatory behaviours, characterised by:
Preoccupation with eating
Irresistible craving for food
Binges
Behaviours like vomiting, use of appetite suppressants or periods of starvation
An overvalued ideal body shape and weight.
What is the epidemiology of bulimia nervosa?
Affects more women than men
Occurs across all socioeconomic groups
Onset in mid-adolescence and presents in early 20s
What are the risk factors for bulimia nervosa?
Parental or childhood obesity
Family dieting and history of eating disorders
Severe life stressors
Premorbid personality of perfectionism and low self esteem
Parental high expectations
Which physical signs are specific to bulimia nervosa?
Bloating of fullness
Lethargy
Heartburn and reflux
Oesophageal erosion
Gastric ulcers
Pancreatitis
Electrolyte disturbances
Dental erosion
What are the signs on physical examination for bulimia?
Salivary glands like the parotid is swollen
Oedema
Erosion of dental enamel
Russel’s sign: pattern of calluses on the knuckles due to frequent purging
What does investigations for bulimia nervosa show?
Low serum potassium
Hypochloremia
Metabolic alkalosis from vomiting
Metabolic acidosis from laxatives
Renal function and electrolytes
What is the management for bulimia nervosa?
Under 18’s are reccomended bulimia-focused family therapy
Bulimia guided self-help programme
Fluid and electrolyte monitoring
Dental reviews
Slow reduction in laxatives
Managed as an outpatient in the community
NICE guidelines do not recommend medications
What are the complications of bulimia nervosa?
Haematemesis
Metabolic abnormalities from electrolyte imbalances of excessive vomiting
Enlargement of salivary glands
Risk of progression to anorexia
What is the questionnaire used for anorexia and bulimia?
SCOFF
1) SICK: Do you make yourself sick because you feel uncomfortably full?
2) CONTROL: Do you worry that you have lost control over how much you eat?
3) STONE: have you lost more than one stone in 3 months?
4) FAT: Do you believe yourself to be fat when others say you’re too thin?
5) FOOD: Do you think about food constantly?
What is binge eating disorder?
Frequent binge eating episodes without purging, leading to negative and social psychological problems.
Characterised by eating fast in a short space of time, even when not hungry. May purchase food in advance and eat alone, with feelings of shame following a binge.
What is the management for binge eating disorder?
Self-help programmes
CBT
Psychotherapy
SSRI
Monitoring weight and physical observations
What are the electrolyte abnormalities in bulimia nervosa?
Metabolic alkalosis, hypochloraemia and hypokalaemia.
What are the electrolyte abnormalities in bulimia nervosa?
Metabolic alkalosis, hypochloraemia and hypokalaemia.
