Eating Disorders

Question 1

DSM-V criteria for ANOREXIA NERVOSA.

Answer 1

A. Significantly reduced energy consumption relative to height, age, requirements, resulting in significantly reduced weight.
B. Intense fear of gaining weight.
C. Distorted perception of body image.

Question 2

Severity classification for anorexia nervosa?

Answer 2

Mild - BMI > 17
Moderate - BMI 16 -17
Severe - BMI < 16

Question 3

Risk factors for anorexia?

Answer 3

• personality traits (eg perfectionism)
• psychiatric co-morbidities
• family history of psychiatric illness
• female gender
• adolescent age group
• poor self esteem
• low resilience and poor coping mechanisms
• profession / occupation associated with “thin” or “small” body shape (eg. ballet dancing, gymnastics, athletics)

Question 4

Outline the physical, psychological and behavioural manifestations of anorexia.

Answer 4

BEHAVIOURAL

• not eating food or meals with others
• eating in private
• cooking for others but not eating
• excessive exercise
• exercising through injury or bad weather
• wearing baggy clothes

PSYCHOLOGICAL

• poor concentration
• preoccupation with food, counting calories, body image etc
• low mood
• anxiety

PHYSICAL

• rapid body mass loss
• thinning of hair, skin, nails
• recurrent stress fracture
• dizziness or syncope
• anaemia
• GI upset
• amenorrhea
• ketosis

Question 5

SCOFF Questionarre

Answer 5

S- have you ever made yourself sick (or used laxatives)?
C - do you feel you have lost control?
O - have you recently lost more than one stone (>6.35kg)?
F - do you feel or think you are fat even when others say you are thin?
F - do thoughts of food dominate your life?

A score >2 requires further investigation or work up for AN or BN.

Question 6

Outline appropriate investigations for anorexia nervosa.

Answer 6

FBC
Inflammatory markers (esp. CRP)
UECs
TFTs
CMP
Iron and B12 + folate 
ECG

Question 7

Outline criteria for inpatient management of AN.

Answer 7

• high risk of re-feeding syndrome
• > 1kg weight loss per week for multiple weeks
• SBP < 80 mmHg
• postural drop > 20 mmHg
• pulse < 50 bpm
• temp < 35.5 or > 38.0
• Na < 125
• K < 3
• any abnormal values for Ca, Mg or PO4
• any abnormality on ECG
• blood glucose < 3.0 mmol / L

Question 8

Mechanism of re-feeding syndrome plus complications / risks?

Answer 8

• during prolonged fasting 5-7 days), fat and protein are main sources of energy (metabolism is catabolic)
• introduction of glucose causes a surge of insulin, which promotes anabolic metabolism and production of ATP
• ATP requires phosphate, which is moved from extra cellular to intracellular space
• characteristic features of re-feeding syndrome are hypophosphatemia, hypokalaemia, hypomagnessemia, hypoglycaemia, low thiamine and water and sodium retention

Risks / complications include:

• arrhythmias
• seizures
• neurological deficits
• tremor and ataxia
• acute renal failure
• rhabdomyolysis

Question 9

DSM-V criteria BULLEMIA NERVOSA.

Answer 9

A. Recurrent episodes of binge eating, which is defined as one or both of the following features:
- eating in a set period of time, more than what a healthy person would eat
- loss of control over eating
B. Compensatory mechanisms to prevent weight gain (eg laxative use, vomiting, excessive exercise)
C. Episodes of binging and purging occur on average once per week for a three month period
D. Episodes do not occur exclusively in the context of AN

Question 10

Severity of bullemia nervosa?

Answer 10

Mild: 1-3 compensatory mechanisms
Moderate: 4-7 compensatory mechanisms
Severe: 8 - 13 compensatory mechanisms
Extreme: > 14 compensatory mechanisms

Question 11

Outline principles / stages of FAMILY BASED THERAPY.

Answer 11

Phase One - Food is medicine
• parents are responsible for restoring weight
• parents govern meal-time
• food is viewed as medicine
• do not engage in anorexic debate
• speak to individual and eating disorder as seperate entities

Phase Two - Transfer of control
• control of food is transferred back to individual one meal at a time
• ongoing monitoring

Phase Three - Adolescent developmental issues
• adolescent has all control over meals
• discussions around food are no longer the centre of parent-child interaction

Question 12

Outline clinical manifestations of BULLEMIA NERVOSA.

Answer 12

✔️ fluctuations in weight
✔️ fatigue and weakness due to recurrent vomiting +/- electrolyte losses
✔️ tooth decay
✔️ parotid gland enlargement
✔️ swollen appearance around the eyes and jaw (due to oedema)
✔️ Russell’s sign –> swelling of the knuckles
✔️ trouble concentrating

Question 13

DSM-V criteria for BINGE EATING DISORDER.

Answer 13

A. Recurrent episodes of binge eating.
B. Binge eating is characterised by THREE or more of the following:
✔️ eating more than usual in a set period of time
✔️ eating past the point of feeling full
✔️ eating large amounts of food, even when physically not hungry
✔️ eating in secrecy / private
✔️ feeling guilty or embarrassed afterwards
C. Symptoms cause marked clinical distress.
D. Compensatory mechanisms are NOT present (unlike bulimia nervosa)
E. Binging episodes occur at least once per week for a duration of three months.