Eating Disorders Flashcards
What is an eating disorder?
Symptoms serve some kind of purpose that goes beyond weight loss, food as comfort, an addiction, and beyond a need to feel special or in control
What are five examples of purpose?
- Comfort
- Numbing
- Cry for help
- Self-punishment
- Avoidance of intimacy
What are ED’s not?
- Vanity (self-love or self-absorption)
- Diets
- Obsession with food
- Obsession with exercise
- Fun
- Easy to treat
- Discriminatory-they affect all cultures and socioeconomic levels
Describe disordered eating.
Problematic eating patterns that are not practiced at a high enough frequency or severity to merit the formal diagnosis of an eating disorder (still very serious)
What is the progression of disordered eating?
No disordered eating thoughts or behaviors, some thoughts and behaviors, frequent thoughts and behaviors, severe eating disorder
What percent of disordered eating will progress to an eating disorder?
40%
What are a few factors that influence an eating disorder?
- Genetics
* Comorbid disorders (occurring at the same time or one another)
What are a few comorbid disorders?
- Anxiety
- Depression
- Attention deficit disorder/attention deficit hyperactivity disorder
- Post-traumatic stress disorder
- Obsessive compulsive disorder-restrictive ED
- Addiction-40% of substance abuse patients have an eating disorder (often lead to binge eating)
- Borderline personality disorder
What are a few factors influencing ED?
• Significant weight loss as a child or adolescent due to illness
• Neonatal and maternal factors (prematurity, SGA, or experiences in utero
• Trauma (changing schools, including starting college, interpersonal event such as sexual assault)
• Media
• Environment
-peers
-family-history of chronic diets, stress example separation/divorce enmeshment
What is an enmeshed family?
Family that allows individual members little or no autonomy or personal boundaries-strongly discouraged from developing their own feelings and preferences
What are the SCOFF questions?
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry that you have lost Control over how much you eat?
- Have you recently lost more than One stone (14lbs) in a 3-month period?
- Do you believe yourself to be fat when others say you are too thin?
- Would you say that Food dominates your life?
What are the seven types of eating disorders and what are the three most important?
- Pica
- Rumination Disorder
- Anorexia Nervosa (AN)
- Bulimia Nervosa (BN)
- Binge-eating disorder (BED)
- Avoidant/Restrictive food intake disorder (ARFID)
- Other specified feeding or eating disorder (OSFED)
What is PICA characterized by?
Eating inedible things or craving and chewing substances that have no nutritional value
What do people with PICA normally eat?
- Ice
- Clay
- Dirt
- Paper
- Paint
- Hair
What is rumination disorder described as?
Regurgitating and re-swallowing food (may start with GERD) but is comforting to the person
What provides a protective effect against AN?
Testosterone (reason men are less affected)
Which eating disorder has the highest death rate?
AN
What are three areas of the body anorexics are proud of?
Collar bones, hip bones, thigh gap
Define restricting type of AN.
Weight loss primarily achieved through dieting/fasting/excessive exercise
Define binge-eating/purging type of AN.
Energy restriction with the presence of episodes of binge eating or purging
What results in difficult decision making for people with ED?
Insula in the brain
What are a few medical complications of AN?
- Bradycardia, hypotension
- Mitral valve prolapse (common)
- Arrhythmias
- Refeeding syndrome
- ECHO changes
- Dry skin, Alopecia, Lanugo hair
- Constipation
Define Binge eating.
Eating a large amount of food in a short period of time. (A sense of lack of control)
How do people that binge eat purge food?
- Vomiting
- Laxatives
- Fasting for days (following a binge)
- Excessive exercise (more common in men)
Define Avoidant/Restrictive Food Intake Disorder (ARFID)
Eating or feeding disturbance as manifested by persistent failure to meet appropriate nutritional/energy needs (also must meet one or more of the characteristics)
What is ARFID characterized as?
- Significant weight loss
- Significant nutritional deficiency
- Dependance on enteral feeding of oral nutritional supplements
- Marked interference with psychosocial functioning
Is there evidence of a disturbance in the way one’s body or shape is experienced?
No-and also not attributable to concurrent medial condition (related to texture problems)
What is other specified feeding or eating disorder (OSFED) characterized as?
• Atypical anorexia nervosa • BN of low frequency • BED of low frequency • Purging disorder • Night eating syndrome -eating large amounts of food after awakening from sleep -associated with low melatonin levels
What are a few other lesser-known ED?
- Food addiction
- Diabulimia
- Orthorexia nervosa
- Drunkorexia
- Pregorexia
- Post-bariatric surgery transitions
Define diabulimia.
Individuals who have type 1 diabetes who reduce their insulin to loose weight
Define drunkorexia.
Self-imposed starvation or binge eating/purging combined with alcohol abuse. It can result in alcohol intoxication and electrolyte imbalance
Define Pregorexia.
Attempting to remain slim through their pregnancy in order to drop the weight quickly following childbirth
Define Post-Bariatric Surgery Transitions.
They may experience eating avoidance following surgery (grazing, nibbling, picking) and fear of gaining weight
Define food addiction.
Experience pleasure from the anticipation of eating, the ability of foods, or the actual eating of foods. Uncontrollable cravings surrounding highly palatable food or excessive eating
Define Orthorexia Nervosa.
- Obsession with the healthfulness of foods and this interferes with daily life
- Extreme rigidity surrounding food content and food preparation
- Identity and spirituality are rooted in food
How do you properly refeed?
- Collect electrolyte levels before initiating nutritional support
- Restore circulatory volume and closely monitor vitals
- NEVER administer rapid IV fluids (because of sodium)
- Daily labs to monitor electrolytes for the first 1-2 weeks when caloric intake increased (phosphorous, potassium, and magnesium)
- Start 1400-1600 kcal/day and increase by 300-400 kcal every 3-4 days until goal weight
Define refeeding syndrome.
Potentially fatal shifts in fluids and electrolytes that may occur in malnourished patients receiving artificial refeeding (enterally or parentally)
How is cognitive behavioral therapy beneficial?
• Food journaling (what they ate/drank and how they feel about it
• Behavioral contracts
-agreement that the patient makes with others to changes a maladaptive behavior
-written contract that places the responsibility for weight gain or other behavioral change on the patient
How is pharmacotherapy beneficial?
- Adjunct to behavioral therapy
- Limited efficacy with AN
- SSRI’s used with BN
- Tricyclic antidepressants (TCA) are effective in BN
What should patients journal?
What they ate and drank and how they feel about it
What is a behavioral contract?
-an agreement that the patient makes with others to change a maladaptive behavior
