Eating Disorder Flashcards
What are the 3 main clinical symptoms related to having an eating disorder?
- restricting - planned limitation of food intake, chronic dieting, ritualized caloric intake count
- purging- behaviors to expend or limit calorie intake [exercise, vomit, laxative, diuretics, enemas]
- binging - eating more in 2 hours than a normal person of similar size/activity level, unable to control eating during a binge
What are the main psychological symptoms related to having an eating disorder?
Thoughts [cognitions]
- low self-esteem
- body shape
- body weight
- perfectionism
- food
Feelings [emotions]
- Anxiety- GAD, separation anxiety, OCD
- often presents somatically as upset stomach/nausea - Depression - bulimia/binge-eating
What vital signs do you look for in the medical workup for eating disorders?
What would you look for on the PE?
Vitals:
- BP lying, sitting, standing
- HR >50 with no orthostatic change
- height, weight, BMI [although BMI is not diagnostic or evidence based]
PE:
- cachexia - loss of muscle, fat
- cardiac- bradycardia, hypotension, arrythmia
- GI- bloating, delayed emptying, ab pain
What percent body fat is necessary for menstruation?
20-25 to start, 25 to be fertile
When will electrolytes be altered in eating disorders?
What changes would you see? [5 things decrease, 2 increase]
In purging disorders [vomiting, laxatives] you would see: Decreases: 1. hypokalemia 2. hypomagnesia 3. hypochloric metabolic alkalosis 4. hypoglycemia 5. anemia, pancytopenia
Increases:
- elevated salivary amylase
- serum cholesterol increases because the liver is constantly releasing it due to catabolized fat
What is refeeding syndrome?
What are the implications?
Refeeding syndrome is when an anorexic person has been in starvation [less than 500 calories] for 5 days or more and their metabolism has changed
When food is resumed, demands for phosphorus, b-vitamins, K and Mg exceed available reserves and acute depletion occurs leading to—>
1. cardiac arrythmia
2. sudden death
Optimal bone health depends on the Ca intake ages ______to _____.
When should bone scans be done in a suspected eating disorder?
What are z-scores for osteopenia, porosis, athletes?
Optimal bone health depends on Ca from 10-25.
Bone scans should be done if a person has:
1. amenorrhea
2. 6 months at low weight
Z-scores should be high for athletes so if they are low-normal, consider it to be low.
Osteopenia = -1 to -2.5
Osteoporosis = -2.5 and below
What is the diagnostic criteria for anorexia nervosa according to DSM5?
- restriction of calorie intake leading to
- low weight for age, sex, developmental history, physical health - intense fear of gaining weight
- undue influence of weight/body shape on self-evaluation; denial of seriousness of low body weight
Subtypes:
- restricting - during the last 3 months they did not have recurrent binging or purging behavior
- binge-eating/purging type - during the last 3 months the person has engaged in recurrent acts
What is the most common age of onset for anorexia nervosa?
What is the prevalence ?
What are the 2 most common comorbid illnesses?
14-18 years old
1% of 12-23 year old women, with a 3-10% mortality, 50% recovery
Comorbid with:
- anxiety- social phobias, separation anxiety, OCD
- depression
What 2 major characteristics are present in a culture with Anorexia?
- availability of food
2. society where thinness is valued and linked to beauty
What is the etiology of anorexia nervosa?
Multifactorial:
- biological - genetics, neural circuits, temperament
- psychological - personality, food behavior, body image
- social - dieting, relationships
A patient has been brought in by her mother because she is demonstrating odd food behaviors such as:
- chewing excessively
- hoarding/hiding food
- rearranging food on the plate
- secrecy around bizarre behaviors
She says her daughter is a perfectionist.
The daughter denies that she is hungry but has other somatic complaints like a “nervous stomach”. What are these clinical features indicative of?
Anorexia nervosa- restricting type
On physical exam of a patient you note:
- cachexia- with loss of fat/muscle, cold intolerance, hypoglycemia, elevated cholesterol
- hypotension, bradycardia, arrythmia
- delayed gastric emptying, bloating, ab pain
- downy, wooly hair, edema
- leukopenia, anemia
- osteoporosis
What are these signs/symptoms indicative of?
anorexia nervosa restricting type
In addition to cachexia, cardiac problems, GI problems, anemia/leukopenia, osteoporosis and lanugo [wooly hair] what other medical findings suggest PURGING subtype of anorexia nervosa?
[4]
- hypokalemia [ST, T wave EKG changes], hypomagnesia, hypochloric met. alkalosis
- salivary gland enlargement with elevated salivary amylase; pancreatic inflammation with elevated amylase
- esophageal, gastric erosion
- dental enamel erosion
- seizures, neuropathies due to electrolyte imbalance
What is the mortality for anorexia nervosa?
What % recover completely?
What % significantly improve and function well?
What subtype has a worse outcome?
5-15% mortality
25% recover completely, 25% improve and function well
RESTRICTING TYPE IS WORSE
What are the 3 branches of treatment for a person with anorexia nervosa?
- hospitalization to restore nutritional state
- patient weighed daily [blindfolded]
- fluid intake/output recorded
- supervised meals/bathroom trips
- feeding by NG if necessary [add food slowly b/c of refeeding syndrome!!!] - Psychotherapy
- CBT = monitor eating habits, feelings, problems with relationships; cognitive restructure problem
- Family therapy = BEST OUTCOME [90% recover] where parents take control of nutrition then the patient is gradually involved - pharmacotherapy for comorbid disorder [depression, anxiety], bone mineral management
For long term recovery of anorexia nervosa, the patient needs to do what 3 things?
- develop self-esteem
- understand their emotions
- improve relationships
recovery has nothing to do with ideas of FOOD or BODY IMAGE
What are the DSM5 criteria for bulimia nervosa? [5]
- Recurrent binge-eating with
- significant overeating during discrete period
- lack of control over eating binges - recurrent compensatory action
- vomit, laxative, enema, diuretic - binge/purge at least 1x a week for 3 months
- self-eval is influenced by body shape/weight
- NOT during anorexia
What is the prevalence of bulimia in young women?
What is the age of onset?
What is the M:F ratio?
How does it differ from anorexia in terms of patient weight?
1-3% of young women with a later onset than anorexia.
The M:F ratio is 1 to 10
Anorexia- patient is underweight
Bulimia- patient is normal or overweight
What is the etiology of bulimia nervosa?
Multifactorial:
- biological- genetics, temperament, neural circuits
- social - dieting, relationships
- psychological - body image, personality, food behavior
What are the 5 main clinical features of bulimia?
- binging - precedes vomiting by 1 year, loss of control in the binge
- purging - vomiting at will, decreases bloated feeling
- post-binge anguish
- concerned about body image/sexual attractiveness
- comorbid conditions
What conditions are comorbid with bulimia?
- depression
- impulse control disorder
- substance abuse
- personality disorder
- anxiety
- dissociative disorders
- sexual abuse
What is the prognosis for bulimia?
What is recovery rate?
It is poorly studied but thought to be better than anorexia.
- less likely to obtain treatment, but milder
- chronic disorder with wax/wane
50% recover, 20% continue to meet full criteria
What is treatment for bulimia?
- psychotherapy
- CBT to interrupt cycles of binging/dieting
- address dysfunctional beliefs about food, weight, self - pharmacotherapy
- SSRI [fluoxetine]
- if comorbid bipolar add lithium or valproic acid
What adjustments were made from DSM4 to DSM5 that will allow more people to be diagnosed with anorexia and bulimia, and less with eating disorder NOS?
Anorexia
-dropped amenorrhea
Bulimia
- included reducing freq. from 2x weekly to 1x weekly
What is binge-eating disorder?
What are the 2 subtypes?
recurrent episodes of binge-eating where the patient:
- eats within a 2 hr period an amount of food that is significantly larger than most people would eat during a similar period
- lack of control over eating during the episode
Subtypes:
- anorexia-like = person has low weight [but not as low as anorexia], fixation on health, anxiety
- bulimia-like = person is distressed by purging, emotional overreating, binge LESS than DSM for bulimia
What 5 features describe the binge associated with binge-eating disorder?
- too fast
- uncomfortably full
- large amounts of food when not physically hungry
- eating alone b/c embarrassed of how much they eat
- disgusted with oneself, depressed, guilty
