Eating Disorder Flashcards
Anorexia Nervosa
- Highest mortality rate of all mental illness (relapse rate 50%)
- PATHO: extreme fear of obesity/weight gain
A.) Restricting Type: diet, fast, rigorous exercise
B.) Binge-Eating/ Purging Type: primarily restricts but does engage in some binge eating or purging behavior
BMI ( Anorexia )
- Mild: > 17
- Moderate: 16-16.99
- Severe: 15-15.99
- EXTREME: < 15
Clinical Manifestations (Anorexia)
- Low weight
- Amenorrhea
- Hypothermia
- Hypotension/ Bradycardia
- Orthostatic Hypotension
- Decreased Bone Density/
- Osteoporosis
- Hypoglycemia
- Acrocyanosis ( blue/purple color on hands and feet)
- ELECTROLYTE IMBALANCE ( low K, Mag, Ca, Phos, Na) –>EKG changes: PROLONGED QT INTERVAL AND ST WAVE ABNORMALITIES CAN LEAD TO DEATH
Bulimia Nervosa
- Binge eat then purge
- Purge ( compensatory mechanism)
- Self- induced vomiting
- Misuse of laxatives, diuretics, enemas
- Fasting
- Excessive exercise
Severity ( Bulimia- based on how much pt purges per week )
- Mild: 1-3 episodes a week
- Moderate: 4-7/ week
- Severe: 8-13/ week
- Extreme: 14 or more/ week
Comorbidity (bulimia)
MDD, bipolar, anxiety, borderline personality disorder, substance abuse
Medical Complication
- Weight fluctuations
- Dehydration and electrolyte imbalance CAN LEAD TO DEATH
- Tooth enamel erosion
- frequent heart burn
- Russel sign- scarred knuckles
Reasons and causes of anorexia and Bulimia
- LEARNING THEORIES/FAMILY DYNAMICS
1. Primary games: get to avoid.
2. Secondary gains: gets attention.
3. Tertiary games: shifts areas of conflict – patient gets attention, family stop arguing - POWER/CONTROL: often triggered by stressor/traumatic life event.
- COGNITIVE/BEHAVIORAL: learned behavior with positive reinforcement.
- Genetics
- Environmental: society, culture, peer behaviors
Binge Eating disorder
-Repeated episodes of uncontrolled binge, eating with significant distress.
- Do not use compensatory behaviors repeated binge leads to obesity.
Comorbidity: MDD, bipolar, anxiety, substance use, obesity, heart, disease, DM, and hypertension.
Causes:
1. Genetics
- Psychological and environmental factors: low self esteem, reduced coping, adverse childhood events ( sexual abuse, social pressures.)
PICA
- Persistent, eating of substance with no nutritional value.
- Dirt/paint/paper clips.
- Undigested objects – dangerous – intestinal blockage.
- Treatment: close monitoring / reward appropriate eating
Rumination disorder
- Undigested food be returned to mouth – rechewed, re-swallow or spit out.
- Associated with intellectual development disorders and neglect. - Treatment distraction.
Goal of eating disorder treatment
Restore, nutritional status – weight restoration program.
What is Refeeding Syndrome?
-Occurs when a malnourished individual begins to eat normally – eat carbs – rapid discharge of insulin, which leads to a decrease in phosphorus.
Increase risk for refeeding syndrome if:
1. Rapid weight loss, or profound, weight loss (little or no food for five days.)
2. Abnormal EKG/low phosphorus as baseline.
3. History of diuretics, laxative, or insulin misuse.
S/Sx: weakness, swelling of the legs/feet difficulty breathing altered, mental status, seizures, and heart failure.
- CAN LEAD TO DEATH; NEED TO REFEED, SLOWLY AND SUPPLEMENT ELECTROLYTES.
Eating disorder Treatment: CBT
Behavior modification:
- they must perceive control of treatment for it to be successful.
- Contract for privileges based on weight gain.
Cognitive therapy;
- confront eating disorder brain irrational, thinking, and modify distorted thoughts about body image
Psychopharmacology
No meds are approved for anorexia
