Eating Disorders Flashcards
Types of Feeding and Eating Disorders?
- Anorexia Nervosa
- Bulimia Nervosa
- Eating Disorder NOS
Diagnostic criteria for Anorexia Nervosa per DSM V?
A. Restriction of energy intake below what is necessary to maintain a healthy weight
B. Intense fear of fat, as evidenced by verbalizations or behaviors that interfere with the maintenance of a healthy weight
C. Body image disturbance, undue influence of body shape/weight on self-evaluation, or persistent denial of the seriousness of low weight
What is Binge eating?
An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
What are the types of AN?
Two subtypes:
Restricting subtype: weight loss is accomplished exclusively through caloric restriction (i.e. dieting, fasting) and/or excessive exercise; the individual has not binged or purged in the last 3 months
Binge-eating/purging subtype: the individual has binged (subjective or objective binge episodes) or purged in the last 3 months
What are the types of AN?
Two subtypes:
Restricting subtype: weight loss is accomplished exclusively through caloric restriction (i.e. dieting, fasting) and/or excessive exercise; the individual has not binged or purged in the last 3 months
Binge-eating/purging subtype: the individual has binged (subjective or objective binge episodes) or purged in the last 3 months
Epidemiology of AN and BN
- AN 1% of adolescent and young women, 2 peaks, 14+18
- BN: 2-4% of adolescent and young women
- 16% of adolescent/young adults in the ER
- Female: male 10 1
- Mortality 5-20% (highest of all psych disorders)
Risk Factors for Eating disorder?
- History of dieting in childhood
- Childhood preoccupation with thin body + pressure about weight
- Sports where leanness is emphasized or scoring is subjective
- 1st degree family members with eating disorder
- Psychiatric illness (ex. suicidality, substance abuse, depression)
Questions to ask when screening for eating disorders?
- Are you satisfied with your eating patterns?
- Do you ever eat in secret?
- Does your weight affect how you feel about yourself?
- Have any family members had an eating disorder?
- Do you currently have or have previously had an eating disorder
Complications of AN?
- Cardio/resp: palpitations, cp, sob, arrhythmia, edema, MVP
- Oral/dental: lacerations, erosions, cavities ? parotid
- Gl: epigastric pain, early satiety, GERD, hematemesis, hemorrhoids, constipation
- Endocrine amenorrhea, ↓libido, ↓BMD, infertility
- Derm: lanugo hair, hair loss, callus/scar, poor healing, brittle nails
- General: weak dizzy, fatigue, syncope, hot flashes, cold
Complications of AN?
- Cardio/resp: palpitations, cp, sob, arrhythmia, edema, MVP
- Oral/dental: lacerations, erosions, cavities ? parotid
- Gl: epigastric pain, early satiety, GERD, hematemesis, hemorrhoids, constipation
- Endocrine amenorrhea, ↓libido, ↓BMD, infertility
- Derm: lanugo hair, hair loss, callus/scar, poor healing, brittle nails
- General: weak dizzy, fatigue, syncope, hot flashes, cold
Eating disorder investigations?
- CBC (anemia, leucopenia, thrombocytopenia)
- Extended Lytes. FBG (↓glucose = malnutrition, ↓extended lytes=vomiting/laxatives, ↑bicarb/BUN/Cr =vomiting/dehydration)
- LFTs (↑vomiting, loss of muscle mass, liver dysfunction, pancreatitis)
- TSH (low normal TSH + T4)
- Beta-hCG
- ECG (arrhythmia, prolonged QTc, T wave inversion)
- Bone mineral density
What is Refeeding syndrome? What are the risk factors? How can you prevent against it?
Potentially fatal shift of fluids (b/c weakened heart) + lytes
• Risk factors
- Little to no intake for >10d
- Abnormal lytes (especially phosphorus) prior to refeeding
- Pt w/ profound/rapid wt loss, Hx of diuretics/laxative/insulin
• Prevention
- Inpatient unit if at risk
- Reefed slowly
- Monitor fluids, extended lytes, vitals, cardiac status
Complications of Eating disorders?
- Mental Health: consider severity / complexity, function and preference when deciding to treat mental health conditions + eating disorder in parallel or sequentially
- Medications: consider the impact on malnutrition on effectiveness of pharmaceuticals, consider adherence concerns (ex medications that can impact weight), offer ECGs to monitor for bradycardia / QT changes / hypokalemia
- Growth/development: consult pediatrics / endocrinology if there is delayed development / growth
- Conception/Pregnancy: counsel on maintaining good mental health, adequate nutrients and offer counseling
Outcomes of AN and BN?
• AN
50% have good outcomes (wt gain, return of menses). 25% have relapse, 25% poor outcome
- Persistent eating peculiarities are common
- 10-20% mortality over 10-30 years
• BN
Few recover without recurrence
- Good prognostic factors:
– onset before age 15.
– achieving healthy body wt within 2 years of diagnosis
When to consider Hospitalization in Eating Disorder?
• Indication Unstable Vitals
- HR <45
- SBP <80
- Temp <35.5 C
- Orthostatic HR >20 or BP >10
- Weight <75% ideal body weight or rapid change)
- Also Consider if unstable bloodwork:
– anemia
– neutropenia
– dehydration
– electrolyte disturbance
– syncope
– risk of arrhythmia
• Suicidality, comorbid psych condition
• Refusing food poorly motivated patient
• Arrested growth / development
SCOFF Questions for Eating Disorders?
