Eating Disorders

Question 1

Physical presentation

Behavioural presentation

Answer 1

Systematic review
Anemia - Fatigue, SOB, fainting
Amenorrhea
Lanugo, hair loss
Weight change
Arrythmias, electrolyte imbalances
Dental erosion, knuckle scarring from induced vomiting
Constipation
Gastric ulcers/GI disturbance

Purging, excess exercise, laxative, binging

Question 2

Risk factors for developing an ED

Answer 2

Western female
AN - teens
BN - 20s
High achievers/perfectionist/obsessional traits
Influences from parents, social media
Weight related bullying
AN <=> BN

Question 3

AN

• diagnosis
• management

Answer 3

Restriction of food => significantly low body weight in context of age, sex, developmental stage and physical health

Intense fear of weight/fat gain even though underweight

Disturbance in self-body perception

• body weight, shape has significant impact on self esteem
• denial of severity of current low body weight

Specialist management
1st line - CBT-ED
-children offered FT-AN

Question 4

BN

• diagnosis
• management

Answer 4

Both occur once a week for 3 months

• Recurrent binging with lack of control
• Recurrent compensatory behaviours to prevent weight gain (vomiting, purging, laxatives

Self image linked to body shape and weight

Specialist management
1st line - self guided help
-can add CBT-ED
-can also add fluoxetine
-children offered FT-BN

Question 5

Diagnostic criteria for EDNOS

Answer 5

Do not meet all criteria for AN/BN but have some features

Question 6

When to admit with an eating disorder

Answer 6

Severely compromised physical health

• BMI below safe range, rapid rate of weight loss
• Bradycardia, postural hypotension, ECG changes
• Hypothermia, reduced muscle power on SUSS test
• Abnormal blood tests/concurrent infection

Risk of refeeding syndrome - period of extended catabolism interrupted by carbohydrate metabolism

Acute mental health risk

Lack of support at home

May need to use MHA as last resort
-forcefeeding is an option

Question 7

Refeeding syndrome

• prevention
• management

Answer 7

Low PO4,K,Mg, abnormal fluid balance => organ failure

Prevention if at high risk - 1st 2 days - 50% of requirement

Management -
-VitB, K, PO4, Mg supplements + gradually increase energy intake over 1wk