Eating Disorders Flashcards
What are the core features of anorexia nervosa?
Low body weight
Self-induced weight loss
Body image distortion
What does body weight have to be to be classed as anorexia nervosa?
> 15% less than expected
BMI <17.5
What methods are commonly used to lose weight in anorexia nervosa?
Diet restriction
Excessive exercise
Vomiting
Use of medication
What is body image distortion in anorexia nervosa?
Self-perception of being fat, with intrusive dread of fatness that leads to self imposed low weight threshold
What are physical symptoms of anorexia nervosa?
Cold sensitivity
Poor sleep
Reduced concentration
Amenorrhoea
What are some endocrine complications of anorexia nervosa?
Fertility problems Raised GH levels Altered TFT Metabolic (hypoglycaemia, hypokalaemia, hyponatraemia) Osteoporosis Growth arrest
What oral complications can be seen in anorexia nervosa?
Dental caries
What cardiovascular complications can be seen in anorexia nervosa?
Hypotension
QT prolongation
What GI complications can be seen in anorexia nervosa?
Bloating
Delayed gastric emptying
What neurological complications can be seen in anorexia nervosa?
Peripheral neuropathy
Cognitive impairment
What dermatological complications can be seen in anorexia nervosa?
Dry skin
Hair loss
Languo hair
What are the subtypes of anorexia nervosa, and describe them
Restricting - weight loss primarily accomplished by restricting food intake and excessive exercise
Binge-purge - regularly engaging in binge-eating, purging or both
What signs of anorexia nervosa can be seen in their general appearance?
Cyanosis Cold peripheries Dry skin Muscle wasting Languo hair Signs of dehydration Russell's sign - calluses on the knuckles or back of hand due to repeated self-induced vomiting over long periods of time
What cardiac signs of anorexia nervosa can be seen on examination?
Low HR Low BP Postural hypotension QT prolongation T wave changes Hypokalaemia
What MSK signs of anorexia nervosa can be seen on examination?
Reduced muscle power
Unable to perform sit up-squat-stand test
How is BMI used to assess risk in anorexia nervosa?
16-17.5 - low to moderate risk
15-16 - moderate risk
13-14.9 - high risk
<13 or rapid weight loss >1kg/week - very high risk
What blood test abnormalities are seen in anorexia nervosa?
Low sodium (water loading, SIADH secondary to chest infection) Low potassium (vomiting, laxative abuse) Raised transaminases Metabolic alkalosis (vomiting) Hypoglycaemic Leukopenia, anaemia Raised urea, creatinine
What are the options for location of management for adults and children with anorexia nervosa?
CAMHS - community, outpatient or inpatient
Adult - outpatient or inpatient
What is involved in community management of children with anorexia nervosa?
Psychiatric and physical assessment to determine risks and further management
What is involved in outpatient management of anorexia nervosa?
Family based treatment Individual therapy Dietitian Monitor refeeding risk Medications (olanzapine, SSRI) if co-morbid conditions, and to help distress
When is inpatient management considered in anorexia nervosa?
If severely underweight and physical health compromised
What is involved in inpatient management of anorexia nervosa?
Medical support depending on physical health
Family based treatment
Individual therapy
Dietitian
Monitor referring risk
Medications (olanzapine, SSRI) if co-morbid conditions, and to help distress
Meal time support
What is refeeding syndrome?
Potentially fatal metabolic response to too rapid re-feeding after a period of starvation
Who is most at risk of refeeding syndrome?
Severely underweight
Rapid weight loss
Minimal intake in preceding 7-14 days
What are the core features of bulimia nervosa?
Recurrent food binges
Preoccupation with food
Recurrent compensatory actions to avoid weight gain after binges
Body image distortion
What is the criteria for food binges in bulimia nervosa?
At least once a week for minimum 3 months
What are the features of food binges?
Large amount of food consumed over short period of time
Loss of control of how much they eat
Feeling of elation and release at start of binge
Feelings of regret following binge
What is BMI like in bulimia nervosa?
May be within healthy range or fluctuating
What physical complications can be seen in bulimia nervosa?
Oesophageal erosions Oesophageal perforation Peptic ulcers Gastric perforation Seizures (due to electrolyte imbalance) Dehydration Dental caries Arrhythmia
What are management options for bulimia nervosa?
Guided self-help
CBT
SSRI
Inpatient if serious medical complications
What is avoidant restrictive food intake disorder?
Avoidance and/or restriction of certain foods or types of food for a variety of reasons
What could avoidant restrictive food intake disorder be due to?
Sensory issues with texture, smell etc.
Concern about consequences of eating particular foods (e.g. vomiting)
Little interest in eating
What are management options for avoidant restrictive food intake disorder?
Tailored to individual’s needs
Anxiety driven: CBT, SSRI
Co-morbid ASD: help to manage sensory problems
Dietitian
What is meant by ‘other specified feeding and eating disorders’?
A group of disorders that do not fit the exact diagnostic criteria for AN, BN or binge eating disorder but mimic them in some way
Common and just as serious
What are examples of other specified feeding and eating disorders?
Atypical anorexia
Bulimia nervosa of low frequency and/or limited duration
Binge eating disorder of low frequency and/or limited duration
Purging disorder
Night eating syndrome
What is atypical anorexia?
All symptoms of anorexia but weight remains within the ‘normal’ range
What is bulimia nervosa of low frequency and/or limited duration?
All symptoms of bulimia but the binge-purge cycles do not happen as often or over as long a period of time
What is binge eating disorder of low frequency and/or limited duration?
All symptoms of binge eating disorder but the episodes do not happen as often and last for less time
What is purging disorder?
Where purging occurs to affect their weight or shape, but not as a part of binge-purge cycles
What is night eating syndrome?
Where someone repeatedly eats at night, either after waking from sleep, or by eating a lot of food after their evening meal
What is the management of other specified feeding and eating disorders?
Offer the treatment recommended for the type of ED your symptoms are most similar to
