Eating disorder Flashcards
7 types of eating disorder
Anoreixia N, Bulimia BED OSFED ARFID Pica Rumination
Anorexia Nervosa
3 characteristics
physical (1)
Restriction of energy intake relative to requirements le
ading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
Anorexia Nervosa
3 characteristics
Psychology (2)
- Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain even though at a significantly low weight.
- Disturbances in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or lack of recognition of t
Subtypes of anorexia nervorsa
- Restricting type: No recurrent binge eating nor purging behaviors for the last 3 months.
- Binge eating/purging type: Recurrent binge-eating and/or purging behaviors.
Prognosis AN
• Patients with illness onset before 17 y.o. achieve a better outcome than adult onset. Higher rate of full recovery and lower mortality rate in adolescents than in adults
• Pre-pubertal onset confers a more difficult course.
• Relapsing course
• In adults, time to complete remission is 5 to 6 years
Patients with illness onset before 17 y.o. achieve a better outcome than adult onset.
Higher rate of full recovery and lower mortality rate in adolescents than in adults.
• Pre-pubertal onset confers a more difficult course.
• Relapsing course.
• In adults, time to complete remission is 5 to 6 years.
The primary goal of DE treatment: the steps and key points
- Target on adequate nutrient intake.
- First, the weight-target intervention won’t do until the patient can eat a normal portion of food with diversity.
- During the treatment (including relapsing) do not suggest intuitive eating.
The best treatment is to stick on the meal plan. - Encourage group meal time.
- Ensure 6 meals a day
Common observed diet patterns in AN (10)
- Gradual decrease of food intake
- Removal of high energy food.
- Gradual decrease of portion sizes.
- Limited to bulky nutrient-poor foods
- Rigid schedule of eating.
- Limited food choices/amount of calories.
- Fat avoidance the main phobia.
- Food avoidance related to digestive symptoms.
- Vegetarianism and veganism.
- fluid avoidance or excessive fluid intake.
- Excessive dieting,_____ food preoccupation
- Excessive concerns about weight, shape or health
- Excessive_____perfectionism
- Cognitive___ rigidity
- Self-___denial
- Social___withdrawal
- Extreme focus on ___ob or school work
- Anxiety
- excessive food preoccupation
- weight, shape, health
- perfectionism
- rigidity
- denial
- withdrawal
- job or school work
- Anxiety
Anaroxia Nervosa: severity measurement
Based on BMI BMI 17 and +: mild BMI 16 -16.99: moderate BMI 15-15.99: severe BMI less than 15: extreme
Bulimia nervosa: Four characteristics
- recurrent episode of ____
- Recurrent inappropriate ____ to prevent weight gain
- Self-evaluation is unduly influenced by _____ and _____
- Repetitive at least ___ times /week for __ months
- recurrent episode of binging eating
- Recurrent inappropriate compensatory behaviour to prevent weight gain
- Self-evaluation is unduly influenced by body shape and weight
- Repetitive at least 1-3 times /week for 3 months
Two significant characteristics of recurrent episodes of binge eating:
- Eating in a _____time with _____ of food
- Sense of _______ during an episode
- Eating in a discrete amount of time ( within 2 hours) with large amount of food
- Sense of lack of control over eating during an episode
Bulimia: Severity measurement
Average number of binge-eating episodes per week Mild: 1-3 Moderate: 4-7 Severe: 8-13 Extreme: 14+
Common characteristics of BN individua
- Obsessive thoughts focused on _____
- Excessive concerns about ___ and ____
- Long term ____
- No short term ___ when reaching abstinence
- Obsessive thoughts focused on restricting and binge eating
- Excessive concerns about weight and shape
- Long term weight gain
- No short term weight loss when reaching abstinence
Common observed diet patterns in BN and BED (7)
Dr. Ffcab
• Dieting history • Removal of meals • fasting • Avoidance of high energy dense food • Carbohydrates phobia • Binge-eating ‘forbidden food’ usually found in binge content
Purging disorder
purging w/o binging
Night-eating syndrome
eat large amounts of food after the evening meal, often waking up during the night to eat
BED
binge eating disorder
Bulimia vs BED
BED does not have sense of loosing control of food; BED without restriction going back to normal diet.
ARFID:Characteristics (4)
- _____that fail to meet appropriate _____needs
- Regardless of _____and ______
- Regardless the concerns on_____
- The severity excesses normal if in the context of another condition or disorder
- Eating or feeding disturbance that fail to meet appopriate nutritional/ energy needs
- Regardless of food availability and cultural factors
- Regardless the concerns on body shape or weight
- The severity excesses normal if in the context of another condition or disorder
4 Common Pattern in ARFID: one or more appeared
- Significant weight loss
- Significant nutrition deficiency
- Dependence on eternal feeding or oral nutritional supplements
- Marked interference with psychosocial functioning
Prevalence:
• Broad range of eating disturbances more commonly seen in childhood (may also happen in adulthood)
potential cause
• May develop from food refusal to _____ ( distracted or forced feeding)—- parent’s pressure
• ______ is common in ARFID
• Unresolved in____
• Adults with ARFID referred to ED programs;
- May develop from food refusal to maladaptive coping strategies ( distracted or forced feeding)—- parent’s pressure
- Anxiety is common in ARFID
- Unresolved in 3-10% of ARFID children
- Adults with ARFID referred to ED programs;
Prevalence of BED
which population has the highest number?
post-bariatric surgery patients 40%
What causes an ED? Co-mobility
effective disorder: Anxiety disorder,Post traumatic stress disorder
Personality disorder
other stress:
Effective disorder, Attention deficit hyperactivity disorder, Obsessive compulsive traits/disorder
4 the negative impact of vomiting ( bulimia compansary behavior)
• Dehydration
• Digestive resistance
• Recurrent Binge eating
Long term weight gain
the negative causes of laxatives (2)
- Dehydration and electrolytes loss
* Hyperaldosteronemia and edema
if suddenly stopping laxatives? what to expect
there will be a water intension, which causes weight gain …
If it has been a long-term history, refer to the doctor.
Usually start as re-feeding first, then stop the laxitive… to gradually recover the digestive function
what you should tell the patient who plan to stop laxatives?
Total abstinence or gradual decrease
• Adequate energy intake, rich in fibers and fluid
• Weight gain to be expected
• May require medical supervision
Type1 DM & ED: lab, physical and mental indications • High level of \_\_\_\_ • Frequent episodes of \_\_\_\_\_\_ • Frequent \_\_\_\_\_\_ • Poor \_\_\_\_\_ monitoring • Negative attitude toward \_\_\_\_\_\_ • Excessive preoccupation toward \_\_\_\_\_\_\_ • Low intake of \_\_\_\_\_\_\_ • Excessive exercise
- High HbA1c
- Frequent episodes of ketoacidosis
- Frequent hospitalisations
- Poor glycemic monitoring
- Negative attitude toward diabetes
- Excessive preoccupation toward weight and body shape
- Low intake of carbohydrates
- Excessive exercise
SCOFF
5 questions on questionnaire
that detects ED
what are 5 Body image aware behaviours?
- Frequent weighing
- Measuring
- Body checking
- Comparing themselves to others
- Social network (ideal body image
describe restrictive- binge circle
- restrictive behavior
- hunger+ stress or negative emotions
- Guilt or fear to gain weight
- compensatory behavior
Fat distribution after AN restoration
• AN adolescent females lose more _____ while adult females lose more _______
• Partial wt gain in adolescent females leads to greater fat mass deposition in _____ than other body regions
• After short term partial or complete wt restoration, adults show a _______phenotype with respect to health age-matched controls
• Central fat distribution is associated with ______, and it does not adversely affect e.d. psychopathology or cause distress in female adults
• Abnormal central fat distribution seems to _____ after long term maintenance of complete wt restoration
• central body fat while adult females lose more peripheral fat
• Partial wt gain in adolescent females fat mass deposition in the trunk region
• adults: a central adiposity phenotype with respect to health age-matched controls
• associated with increased insulin resistance.
• normalize after long term maintenance of complete wt restoration
- no extra fat gain, just fat displacement
the four steps that ED causes negative health impact.
- Restrictive and bulimic behaviors
- Nutritional consequences
- Physical and psycho-social deterioration
- Loss of functional capacity
give four common clinical signs/ complications with restrictive eating: skin, cardiovascular prob, endocrine changes, muscle-bone-dental,digestive systems,kidney function, brain, cognitive changes, psychological changes.
- acrocyanosis
- hypotension, loss of heart muscles, arrhythmia, braycardia
- feel cold, amenorrhea/ impotency
- osteoporosis, stress fracture and dental caries
- SMA syndrome, early satiety
- water-retention
- brain atrophy change, neurocognitive functioning impairment
give four common clinical signs/ complications with bulimia/purging: skin, cardiovascular prob, endocrine changes, muscle-bone-dental,digestive systems,kidney function, brain, cognitive changes, psychological changes.
- Russell’s sign, nose bleeding
- dizzyness, dehydration + eletrolyte imbalance, k deficit, heart palpitation, arrhythmia
- T3 T4 imbalance– feel cold, irregular menstrual cycle
- perimolysis (dental issue due to acidic erosion )
- swollen salivary glands, esophagitis, hematemesis(vomiting blood)
Lab finding and explanation
• Glucose: L___ H ____
• Glucose: L (malnutrition) H (insulin omission among diabetics)
Lab finding and explanation
• CPK H (muscle breakdown) L (reduced muscle mass)
Lab finding and explanation
sodium L
• Sodium: L (water loading or laxatives)
Lab finding and explanation
Potassium L
• Potassium: L (vomiting, laxative, diuretics, refeeding)
Lab finding and explanation
Magnesium L
• Magnesium: L (poor nutrition or refeeding)
Lab finding and explanation
phosphorus L
• Phosphorus L (refeeding syndrome)
Lab finding and explanation
Chloride L, H
• Chloride: L (vomiting) H (laxatives)
Lab finding and explanation
bicarbonate H
• Bicarbonate: H (vomiting) L (laxatives)
Lab finding and explanation
BUN H
• BUN: H (dehydration)
Lab finding and explanation
creatinine H
• Creatinine: H (dehydration, renal dysfunction)
Lab finding and explanation
Amlayse
• Amylase H (salivary origin - vomiting)
Lab finding and explanation
ALT, AST and total bilirubin H
liver dysfunction
T/F malnutrition causes the low level of albumin
F; not until very severe malnutrition
common lab in patient with AN
normal K, high bicarbonate and anemia (but usually won’t show until being re-fed)
example: medication causes BED
the meds for ADHD Vyvanse
the four steps of treatment
- normalize eating behaviours
- weight gain ( if less than 18.5)
- abstinence of compensatory behaviors
- healthy attitude towards foods, wt and body image
MI
motivational interviewing
FBT
Family based treatment
Psycho-social interventions
for adolescent pt with AN, and why to use this approach?
FBT
b/c the parents will in charge to kid’s behaviour change
Psycho-social interventions
for pt with BED or BN
Cognitive Behavioral Therapy: recognize the disordered cognition, prescribing the proper behavior
Dialectical Behavioral Therapy
InterPersonal Therapy
why may appear hypoglycemia after refeeding, especially after eating?
b/c there was no glycogen in the liver
Nutrition assessment: list 3 specific parts
- Personal and family wt history
- Detailed food intake assessment
- History of the eating disorder
- History of the eating disorder
• Clinical signs and symptoms of malnutrition
Admission criteria for hospitalization (7)
- Severe or rapid weight loss
- Severe binge-eating and purging
- Medical complications: unstable vital signs, cardiac abnormalities, electrolytes imbalance
- Lack of response to outpatient treatment
- Severe psychiatric co-morbidity: suicide tendency, self-harm….
- For laxative withdrawal
- To clarify a diagnosis: hypoglatremia, coma, etc
describe sequential model of care
- out-patient counselling
- day program 14 h/wk
- day hospital 40 hrs/wk
- hospitalization 3 m.o.
ED program– weight gain: goal
500g /week if BMI < 20
ED program– Meal planning
Portion, energy, times of meal, food introduction
- Establish a regular pattern of eating 5 to 6 times a day
- Introduce food that have been last removed from diet
- Increase gradually energy intake
- Use portion controlled foods: emphasize portion is a vague size but not an amount
ED program: Behavioural strategies
- weight
- eating environment
- cognitive identification
- Stop from weighting oneself
- use regular size of dish
- serve normal serving of food
- stop measuring food
- eat with the one who has a positive influence
- self-identify the eating symptoms and triggers; and limit the triggering food until ready to reintroduce
describe the plate-by-plate approach for weight gain
50% grain/starch + 1/4 protein 1/4 F/V + diary drink
describe the plate-by-plate approach for weight restoration
33% grain/starch + 33% protein + 33% F/V + diary drink
why there is ambivalence in ED treatment?
because ED is a non-linear process— may have weight fluctuation and may be affected by emotional and psychological change.
Why MI
working with ambivalence is key in motivational interviewing approach
Approaches to refeeding in patients with AN:
(T/F) In mildly and moderately malnourished, choose lower calorie re-feeding.
F, it is too conservative
Approaches to refeeding in patients with AN:
(T/F) Higher calorie re-feeding associates with increased risk for RS under close
medical monitoring and electrolyte correction.
F. it is safe to use HC Refeeding approach
how to manage high calorie intake?
meal-based approaches or combined NGT+meals
Hospitalization:
goal of weight gain
1kg / week
Hospitalization: re-feeding approach (3)
- oral re-feeding
- no access to bathroom after meals.
- liquid supplements to replace what is not completed.
Hospitalization: re-feeding approach—- liquid, food choices, qunatity, f/v
liquid: limit liquid intake (prescription of water)
food: fear or real disliking
food choice: gradually introduce food with small frequent feeding. limit the food that patient may refuse to eat.
F/V: sufficient fibers but reduce the raw F/V to avod discomfort.
