eating disorders Flashcards
how common are eating disorders
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
prevalence of eating disorders in developed countries
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)
eating disorders in students
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
screening tools - SCOFF questionnaire
≥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
AN and other eating disorders as obsessive weight losing disorders
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
what is anorexia nervosa
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
when is a patient considered anorexic
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
physical features of AN
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
what is bulimia nervosa
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
signs and symptoms of bulimia nervosa
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
what is binge eating disorder
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
manifestations of avoidance of calorie intake
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
manifestations of getting rid of calories
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
other (non eating) eating disorder behaviours
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
why are behaviours associated w/ eating disorders harmful
they are not just handicaps to the weight gain
they damage QOL and maintain the disorder
psychological consequences of eating disorders
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
eating disorders and other mental health issues
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
coping mechanisms in eating disorders
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
social consequences of eating disorders
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
physical consequences of eating disorders - starvation
physical damage
poor repair and resistance
heart damage
reduced immunity to infections
anaemia
bone loss
fertility problems
physical consequences of eating disorders - starvation
physical damage
poor repair and resistance
heart damage
reduced immunity to infections
anaemia
bone loss
fertility problems
physical consequences of eating disorders - purging behaviours
neuro-chemical disruption
special damage to brain - seizures, and heart - arrhythmias
potassium is only one crude measure of the issue
physical consequences of eating disorders - young people
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
hypothesis for causes of eating disorders
- social pressures to be slim are the most important cause
- other factors must be involved
- run in families
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
precipitating factors of eating disorders
puberty
dieting or even non-deliberate weight loss
increased exercise - endorphin release and addiction
stressful life events
precipitating factors of eating disorders - puberty
physical effects of hormonal changes on the brain
also physiological response to body changes
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
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
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
outcomes for AN
high mortality rate
avg time for recovery (where it occurs) - 6-7yrs
specialist centres report some recoveries after decase
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
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
