Eating disorders Flashcards
What are the characteristic features of anorexia nervosa
Deliberate weight loss
Intense fear of fatness
Distorted body image
Endocrine disturbances
What are the causes of anorexia nervosa
Predisposing
- Genetics, female, early menarche, sexual abuse, dieting behaviours, low self-esteem, perfectionism, societal views of beauty, bullying, stressful life event
Precipitating
- Adolescence, puberty, criticism about weight/eating, social pressure to be slim
Perpetuating
- Starvation causes neuroendocrine changes that perpetuate anorexia, perfectionism, societal pressures
What is the epidemiology of anorexia nervosa
F»M
Onset around mid adolescence
What is the ICD-10 criteria for anorexia nervosa
Fear of weight gain
Endocrine disturbances causing amenorrhoea/loss of sexual interest
Abnormally low body weight
Deliberate weight loss (restricted intake, excessive exercise)
Distorted body image
> 3 months, in absence if binging/cravings
What are the additional clinical features of anorexia nervosa
Fatigue
Hypothermia
Bradycardia
Arrhythmias
Peripheral oedema
Headaches
Social isolation
Symptoms of depression/obsession
What are the investigations for anorexia nervosa
Bloods
- FBC, U&Es, TFTs, LFTs, lipids, cortisol, sex hormones, glucose, amylase
VBG
- Metabolic alkalosis in vomiting
- Metabolic acidosis in laxative use
DEXA scan
ECG
Questionnaires
What are the differentials for anorexia nervosa
Bulimia nervosa
Eating disorder not otherwise specified
Depression
OCD
Schizophrenia
Organic causes
- Diabetes, hyperthyroidism, malignancy
Substance misuse
What is the management of anorexia nervosa
Biological
- Treat medical complications, SSRIs
Psychological
- Psycho-education, CBT, cognitive analytic therapy, interpersonal psychotherapy, family therapy
Social
- Support groups, self-help methods
Thorough risk assessment
What is the aim of treatment for anorexia nervosa
Inpatients
- Gain 0.5-1kg per week
Outpatients
- Gain 0.5kg per week
When should anorexia nervosa patients be hospitalised
BMI <14
Suicide ideation
What is refeeding syndrome
Changes in phosphate, magnesium, and potassium
Can get cardiac failure
Due to insulin surge with increased food intake
What is bulimia nervosa
Uncontrollable binge eating
Compensatory weight loss behaviours
Overvalued ideas about weight/body image
What is the bulimia nervosa cycle
Compulsion to eat
Binge eating
Fear of fatness
Compensatory weight loss behaviours
- Vomiting, laxative use, excessive exercise, periods of starvation
What are the risk factors for bulimia nervosa
Predisposing
- Female, family history, early onset puberty, diabetes, childhood obesity, abuse, bullying, low self-esteem, developed countries
Precipitating
- Early menarche, perceived pressures, criticism, family dieting
Perpetuating
- Previous mental health problems, low self-esteem, perfectionism, obsessive personality, environmental stressors
What is the ICD-10 criteria for bulimia nervosa
Behaviours to prevent weight gain
Preoccupation with eating
Fear of fatness
Overeating (>2 episodes per week for 3 months)
