Eating disorder Flashcards
Anorexia nervosa
characterised by loss of body weight and refusal to eat, Appetite is usually intact
Bulimia nervosa
characterised by recurrent and frequent binge eating with or without vomiting
Being eating disorder
Binge eating disorder is a variant of bulimia nervosa with occasional, once a week, binge eating.
Pica
eating of non-nutritional substances
Rumination disorder
repeated regurgitation of food, usually beginning in infancy or childhood
Avoidant/restrictive food intake disorder
disorder is a lack of interest in food or eating resulting failure to thrive.
DSM 5 Anorexia Nervosa
A. intake and weight: restriction of energy intake relative to requirements, leading to a signi cantly low body weight in the context of age, sex, developmental trajectory, and physical health. Signi cantly low weight is de ned as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected
B. fear or behaviour: intense fear of gaining weight or of becoming fat, or persistent behaviour that interferes with weight gain, even though at a signi cantly low weight
C. perception: disturbance in the way in which one’s body weight or shape is experienced, undue in uence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight
Mx of anorexia
Psycotherapy - family based for kids, address food and body perception, coping mechanisms, health effects. CBTB
Hospital if <13 BMI, unstable, Suicidal eg hypovolemia for IV fluids, HR less then 40
Refeeding syndrome
SSRI if depression
Cx of anorexia
Refeeding syndrome Osteoporosis Hyper K Dehydration Suicide
Refeeding syndrome
a potentially life-threatening metabolic response to refeeding in severely malnourished patients resulting in severe shi s in uid and electrolyte levels
complications include hypophosphatemia, congestive heart failure, cardiac arrhythmias, delirium, and death
prevention: slow refeeding, gradual increase in nutrition, supplemental phosphorus, close monitoring of electrolytes and cardiac status
DSM V for Bulimia
A.recurrent episodes of binge-eating; an episode of binge-eating is characterized by both of the following
- eating, in a discrete period of time, an amount of food that is de nitely larger than what most individuals would eat during a similar period of time and under similar circumstances
- a sense of lack of control over eating during the episode
B recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, enemas, or other medications, fasting, or excessive exercise
C the binge-eating and inappropriate compensatory behaviours both occur, on average, at least once a week for 3 mo
D self-evaluation is unduly in uenced by body shape and weight
E the disturbance does not occur exclusively during episodes of AN
Clinical features of Bulimia
- fatigue and muscle weakness due to repetitive vomiting and fluid/electrolyte imbalance
- tooth decay
- swollen appearance around angle of jaw and pu ness of eye sockets due to uid retention • reddened knuckles, Russell’s sign (knuckle callus from self-induced vomiting)
- trouble concentrating
- weight uctuation over time
Mx of Bulimia
• admission for signicant electrolyte abnormalities
• biological: treatment of starvation e ects, SSRIs ( uoxetine most evidence) as adjunct
• psychological: develop trusting relationship with therapist to explore personal etiology and
triggers, CBT, family therapy, recognition of health risks
• social: challenge destructive societal views of women, use of hospital environment to provide
external patterning for normative eating behaviour
prognosis of Bulimia
• relapsing/remitting disease
• good prognostic factors: onset before age 15, achieving a healthy weight within 2 yr of treatment • poor prognostic factors: later age of onset, previous hospitalizations, individual and familial
disturbance
• 60% good treatment outcome, 30% intermediate outcome, 10% poor outcome
Clinical features of anorexia
Fatigue and weakness Poor concentration fainting constipation lanugo body hair orthostatic hypotension bradycardia dehydration cardiac arrhythmias Hairloss shorter stature Hypothermia eroded dental enamel scars on dorsum of hand dependent oedema Increased fractures amenorrhoea
