Eating Disorder

Question 1

Prevelance

Answer 1

NORMAL WEIGHT teens” 40-60% believe themselves to be too heavy
At any given time, 60% of female teens are on a diet
70% of female teens report body shape is important to their self-worth
½ of teen girls and 1/3 of teen boys use unhealthy means of controlling weight

Question 2

Prevalence:

Answer 2

anorexia: 0.4%
Bulimia: 1.5%
Binge Eating Disorder: 0.8-1.6%
3:1 F/m
mid teens onset
higher rates among of Annorexia among non-latina whites

Question 3

DSM:

Answer 3

low body weight (BMI <18.5kg/m2, less than 5 percentile (numbers are all different for children becasue of development scale)

Intense fear of gaining weight or becoming fat despite being underweight

Denial

Question 4

Subtypes of annorexia

Answer 4

restricting type
binge-purge type
severity:
mild: BMI>17
Moderate: BMI: 16-17
Severe: BMI: 15-16
Extreme: BMI: <15

Question 5

LO: Identify societal and personal risk factors for eating disorders

Answer 5

Family history of anorexia
*ADOLESENCE who go on a diet and lose weight is a precipitating factor

Onset of puberty
Athletics
Life/family stressors
Anxious, obsessive personality structure
Low conflict, highly controlling family dynamics

Question 6

Health consequences of AN

Answer 6

10-20% mortality rate (all-cause: starvation, suicide, other health complications)
HIGHEST IN ANY PSYCHIATRIC DISORDER
(some is suicide, but some is the heart disease associated with annorexia)

Orthostasis or hypotension
Bradycardia, arrhythmia, heart failure
Bone loss / osteoporosis

Question 7

Physical changes related to AN:

Answer 7

more CSF on T2 weighted brain scan
Brain shrinking!

Cerebral atrophy – associated with weight loss, not just low BMI

Question 8

Treatment of AN – Evidence

Answer 8

1: medical stabilization/restoration of weight

Evidence based treatment; Family based treatment (learning to refeed in a healthy way, and then handing control back over to the teenager)

Family Based Treatment is Also called the Maudsley Method (name of hospital in London where started)

Question 9

Prognosis:

Answer 9

of Thirds: 1/3 Recover, 1/3 have milder symptoms, and 1/3 have chronic severe course

If still young, parents can still enforce some reshaping of your eating habits and you can still recover

If you’ve been annorexic for 7 years as an adolescent, there’s a very low chance for remission

Question 10

DSM-5: Bulimia Nervosa

Answer 10

Recurrent episodes of binge eating
Recurrent episodes of compensatory behavior (purge)
vomiting, laxatives, diuretics, excessive exercise
Binge and purge occur >1x/week for at least 3 months
(IF YOU VOMIT 12X IN A ROW, THAT’S 1 PURGE)

Question 11

*IF NOT UNDERWEIGHT AND STARVING YOURSELF _______

IF YOU ARE OVER WEIGHT AND PURGING AFTER MEALS _______

Answer 11

YOU CAN’T BE DIAGNOSED WITH AN

YOU CAN BE DIAGNOSED WITH BULIMIA

Question 12

IF YOU ARE DIAGNOSED WITH BULIMIA:

Answer 12

YOU CAN’T ALSO HAVE ANNOREXIA

Question 13

RISK FACTORS BULIMIA:

Answer 13

CHILDHOOD OBESITY (BEING PICKED ON FOR BEING OVERWEIGHT)
EARLY PUBERTAL MATURATION
TRAUMA HISTORY-SEXUAL ABUSE
SELF-HARM, CUTTING
SEVERE FOOD RESTRICTION (TABOO- NO WHITE FOODS) YOU END UP THINKING ABOUT THAT ONE THINGS ALL DAY, AND THEN YOU TRIGGER A BINGE AND HAVE 12

Question 14

Treatment of BN

Answer 14

CBT + SSRI
High dose fluoxetine (60mg/day)
*Contraindicated = bupropion (Wellbutrin)
Increased seizure risk

Question 15

Treatment of BN

Answer 15

CBT + SSRI
High dose fluoxetine (60mg/day)
*Contraindicated = bupropion (Wellbutrin)
Increased seizure risk

Question 16

DIALECTIBAL BEHAVIORAL THERAPY

Answer 16

TREATMENT FOR BN, chain analysis, mindfulness, etc
so you purged, what triggered it? What happened right before? What about before that? Then you identify the warning signs and you are able to protect against them in the future

Question 17

Prognosis – BN

Answer 17

1/3 remit every year, 1/3 relapse into full diagnostic criteria

later you start, the worse off

Question 18

*distinguishing factor of AN vs BN:

Answer 18

AN: underweight; BN: Normal or overweight

AN: dopes with stress/emotions by not eating

BN: copes with stress by eating

AN: focus on just losing more and more, the thinner the better

BN: tend to focus on an “ideal” weight

AN: denial; BN: shame

Question 19

*distinguishing factor of AN vs BN:

Answer 19

AN: underweight; BN: Normal or overweight

AN: dopes with stress/emotions by not eating

BN: copes with stress by eating

AN: focus on just losing more and more, the thinner the better

BN: tend to focus on an “ideal” weight

AN: denial; BN: shame

Question 20

Binge Eating Disorder

Answer 20

Recurrent episodes of binge eating
Associated with 3 or more of:
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not physically hungry
Eating alone due to embarrassment of amount eaten
Feeling disgusted, depressed, or guilty afterward

Question 21

*Binge Eating Disorder

Answer 21

Recurrent episodes of binge eating WITHOUT PURGING

Associated with 3 or more of:
Eating more rapidly than normal
Eating until uncomfortably full
Eating large amounts when not physically hungry
Eating alone due to embarrassment of amount eaten
Feeling disgusted, depressed, or guilty afterward

NOT ALWAYS OBESE BUT MOST LIKELY

Question 22

note: group therapy

Answer 22

harmful for AN and BN bc they get together and compare each other’s shape and share secrets

Binge Eating disorder:
helpful to talk openly about addiction

Question 23

No to #1 or yes to any of other 3 is a positive screen and other questions should be asked!!!

Answer 23

Are you satisfied with your eating patterns?
Does your weight affect the way you feel about yourself?
Have any members of your family suffered from an eating disorder?
Do you currently suffer from or have you ever suffered from an eating disorder?