eating disorders Flashcards

1
Q

how common are eating disorders

A

anorexia nervosa lifelong prevalence - 0.1-0.9%
75% of AN cases occur <22y/o

5-10% of young women attending surgery will have eating disorders - unknown in 50% of cases

5-10% of adolescent girls have used pathological weight reducing techniques

~90% cases present in F

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2
Q

prevalence of eating disorders in developed countries

A

children more likely to suffer from an ED than meningococcal disease

incidence of AN in adolescence > both T1DM and IBD

1% in F , 0.5% in M
20% in adolescent diabetic population (pre-teen F w/ DM - 8% (full syndrome/sub-threshold) ED)

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3
Q

eating disorders in students

A

peak onest mental illness mid teens-20s
increase in mild-moderate eating disorders

can affect all areas of student life

a lot of patients wished their school had noticed their illness in time to have treatment before going to uni

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4
Q

screening tools - SCOFF questionnaire

A

≥2 +ve answers = eating disorder is likely

do you make yourself Sick because you feel uncomfortably full
do you worry you have lost Control over how much you eat
have you recently lost > One stone (14lb/6.35kg) in a 3mth period
do you believe yourself to be Fat when others say you are too thin
would you say that Food dominates your life

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5
Q

AN and other eating disorders as obsessive weight losing disorders

A

obsessive fear of fatness

avoidance of food and other sources of calories

range of compulsive compensatory behaviours when food cannot be avoided

in time, these behaviours are the only way to avoid the experience of anxiety and there are 2y physical and psychological consequences of starvation

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6
Q

what is anorexia nervosa

A

restriction of intake to reduce weight

relies on compulsive compensatory behaviours when food cannot be avoided - self-induced vomiting, laxative abuse, excessive exercise, appetite suppressant/diuretic abuse

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7
Q

when is a patient considered anorexic

A

if they are 15% below ideal body weight/BMI ≤17.5

fear of weight gain

[absence of the menstrual cycle or amenorrhoea (<3 cycles)] - no longer part of diagnostic criteria but still important to ask about

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8
Q

physical features of AN

A

cold intolerance, blue hands and feet

constipation, bloating

delayed puberty, short stature

1y/2y amenorrhoea

dry skin, lanugo hair, scalp hair loss

fainting, hypotension

early satiety

weakness, fatigue

osteopenia, osteoporosis

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9
Q

what is bulimia nervosa

A

episodes of binge eating with a sense of loss of control

binge eating is followed by compensatory behaviour of the purging type (self-induced vomiting, laxative abuse, diuretic abuse) or non-purging type (excessive exercise, fasting, strict diets)

binges and compensatory behaviour must occur a minimum of 2x/wk for 3ths

dissatisfaction w/ body shape and weight

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10
Q

signs and symptoms of bulimia nervosa

A

mouth sores, pharyngeal trauma, dental caries, swollen parotid glands

heatburn, chest pain, oesophageal rupture

impulsivity - stealing, alcohol abuse, drugs/tobacco

muscle cramps

weakness

blood diarrhoea

irregular periods

fainting, hypotension

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11
Q

what is binge eating disorder

A

similar to BN, absence of purging behaviours

ongoing and repetitive cycles often include: 
unusually fast eating, usually alone 
unusually large amounts consumes
uncomfortably full
often buzzed after eating - short lived
embarrassment, shame, guilt, depression
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12
Q

manifestations of avoidance of calorie intake

A

diets - becoming vegetarian, vegan

not touching food/grease

developing dislikes, pickiness, even ‘allergies’

interpreting all symptoms as allergy or indigestion

eating very slowly, only eating at certain times

avoiding parties and social occasions

spoiling/messing of food, bizarre combinations

refusing to eat more than the person who eats least, rules about always finishing last etc

medication abuse - appetite suppressants, gum, cigarettes, OTC, alternative medication, internet medications

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13
Q

manifestations of getting rid of calories

A

self-induced vomiting

chewing and spitting out

over-exercise - often secret

overactivity - obsessive housework, fidgeting, twitching, never sitting down, fetching one item at a time, carrying heavy loads

cooling - inadequate dress, open windows etc

blood letting

medication abuse - alternative, OTC, internet, XS caffeine and stimulants, laxatives, ipecac, pain killers to allow exercise despite damage

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14
Q

other (non eating) eating disorder behaviours

A

body checking - repeated weighing, mirror gazing, self-measurement, self-photographing, tight clothes

displaying emaciation to elicit reassuringly shocked attention

pro-ana websites/social media/contacting fellow sufferers

thinspirations

self-harm if rules are broken

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15
Q

why are behaviours associated w/ eating disorders harmful

A

they are not just handicaps to the weight gain

they damage QOL and maintain the disorder

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16
Q

psychological consequences of eating disorders

A

core psychopathology - extreme overvaluation of low weight and thin shape - willing to sacrifice even other highly valued things to the cause

obsessive weight losing feels like a solution, not a problem

cognitive style shows reduced central coherence and narrowed focus of interest - difficulty in seeing the bigger picture

starved person is unable to interpret emotion - improves w/ better nutrition

17
Q

eating disorders and other mental health issues

A

malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food

depression at low weight rarely responds to medication

anxiety eating in company, followed by guilt after eating

18
Q

coping mechanisms in eating disorders

A

people who rely on eating-disordered behaviour to solve their problems fail to develop other ways to cope w/ life, tolerate distress or feel rewarded and fulfilled

19
Q

social consequences of eating disorders

A

isolation - other people become obstacles to the eating disorder

withdrawal from friendships and relationships

lying, cheating, stealing

highest value is put on recovery of interpersonal life

20
Q

physical consequences of eating disorders - starvation

A

physical damage

poor repair and resistance

heart damage

reduced immunity to infections

anaemia

bone loss

fertility problems

20
Q

physical consequences of eating disorders - starvation

A

physical damage

poor repair and resistance

heart damage

reduced immunity to infections

anaemia

bone loss

fertility problems

21
Q

physical consequences of eating disorders - purging behaviours

A

neuro-chemical disruption
special damage to brain - seizures, and heart - arrhythmias

potassium is only one crude measure of the issue

22
Q

physical consequences of eating disorders - young people

A

good nutrition is required to allow growth

height, pubertal development, brain growth and development (esp frontal lobe)

re-nutrition is more urgent the younger the patient

23
Q

hypothesis for causes of eating disorders

A
  • social pressures to be slim are the most important cause
  • other factors must be involved
  • run in families
24
causes of anorexia
genetic predisposition - OCD, anxiety disorders, perfectionism perinatal factors - birth trauma, premature, pregnancy issues and MH, early development life events and trauma perpetuating consequences of starvation and of avoidance
25
precipitating factors of eating disorders
puberty dieting or even non-deliberate weight loss increased exercise - endorphin release and addiction stressful life events
26
precipitating factors of eating disorders - puberty
physical effects of hormonal changes on the brain also physiological response to body changes
27
precipitating factors of eating disorders - stressful life events
neglect, abuse difficult transitions e.g. to high school, to uni deaths and losses, separations and family breakup bullying, sometimes perceived bullying occurs as a consequence of a disorder stresses
28
perpetuating factors of eating disorders
consequences of starvation syndrome: - delayed gastric emptying - sensations of fullness interpreted as fatness - narrowing focus - avoidance of interpersonal interest, changes of values so that food becomes most salient stimulus obsessionality - phobia of fat increases as avoidance increases body checking - amplifies body image concern families, school, clinical staff - high EE in family (and other carers) may delay recovery - sometimes end up colluding with illness just to pacify sufferer
29
mortality in AN
AN has the highest mortality rate of any psychiatric disorder of pts hospitalised w/ AN and followed for up to 40yrs: - 20% died prematurely as a result of AN - ~1/2 from direct consequences of starvation and other 1/2 from self harm (may or may not have been truly suicidal) modern specialist units are associated w/ lower mortality rates still multiplies risk of premature death at least 10x
30
outcomes for AN
high mortality rate avg time for recovery (where it occurs) - 6-7yrs specialist centres report some recoveries after decase
31
management of AN
re-feeding CBT - ED (40 sessions), mantra (20 sessions), CBT incl self-help for normal weight BN alternatively IPT or fluoxetine 60mg daily (any high dose antidepressant) olanzapine - aids w/ obsessional thoughts specialised family work for AN - esp younger pts
32
approach to management of AN
diagnosis remember pts are obliged by their illness to defend their weight losing behaviour what the pt says isn't the same as what the pt is able to do patience and urgency - takes yrs for psychological recovery, physical recovery cannot wait in the period of max growth empowerment of parents and adults working against the illness together