Eating disorders Flashcards
What is the epidemology of anorexia nervosa?
0.1-0.9% of population will have anorexia nervosa at some point.
Most cases occur before the age of 22 and are in females (although it does present in males).
30-50% will develop a long term problem.
Anorexia nervosa is the psychiatric condition with the highest mortality rate,
What is the screening tool used for anorexia nevosa or bulimia nervosa?
SCOFF questionaire
If patients score 2 or more positive answers, then an 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 more than One stone (14 pounds or 6.35 kg) in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?
What is the criteria for 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, abuse of appetite suppressants / diuretics
Considered anorexic if he/she is 15% below ideal body weight/BMI 17.5 or <
Fear of weight gain- even if they are tired of their illness and want to recover, they will still have this fear
[In postmenarchal females, absence of the menstrual cycle or amenorrhoea (greater than 3 cycles)]- this is no longer part of the criteria but is good to be aware of
What symptoms can anorexia nervosa present with?
This condition often presents with symptoms other than weightloss, so be aware of this and keep it in the back of your mind. These symptoms will usually stop once good nutrition is established and weight gain maintained.
It can present with the symptoms:
Cold intolerance
Blue hands and feet
Constipation
Bloating
Delayed puberty
Primary or secondary amenorrhea
Dry skin
Fainting
Hypotension
Lanugo hair
Scalp hair loss
Early satiety
Weakness, fatigue
Short stature
Osteopenia & osteoporosis
What are the criteria for 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 nonpurging type (excessive exercise, fasting, or strict diets).
Binges and the resulting compensatory behaviour must occur a minimum of two times per week for three months
Dissatisfaction with body shape and weight
How do anorexia nervosa and bulimia nervosa differ?
Firstly bulimia nervosa has the binging behaviour which anorexia nervosa does not necessarily have.
However some anorexia nervosa can have binging and purging behvaiour. If someone does have binging and purging bahvaiour and has a BMI of less 17.5 then they would not be diagnosed with bulimia nervosa but would be diagnosed with anorexia nervosa -purge and binge subtype.
What are the symptoms of Bulimia nervosa?
Mouth sores
Pharyngeal trauma
Dental caries
Heartburn, chest pain
Esophageal rupture
Impulsivity:
Stealing
Alcohol abuse
Drugs/tobacco
Muscle cramps
Weakness
Bloody diarrhoea
Irregular periods
Fainting
Swollen parotid glands-can be very painful
hypotension
Due to all the purging these patients can often have damage to their mouth and oesophagus caused by vomiting regularly. If this behaviour has occured over a long period of time this damage may be irreversible.
What are the criteria for binge eating disorder and how is it treated?
Similar to bulimia nervosa; absence of purging behaviours.
Ongoing and/or repetitive cycles often include:
unusually fast eating, usually alone.
unusually large amounts consumed.
uncomfortably full; often “buzzed” after eating.
embarrassment, shame, guilt, depression.
This condtion is often treated using CBT which gthe patients respond well to including group session and can be managed as an outpatient.
What type of behaviours can be seen in eating disorders?
Avoidance of calorie intake behaviours:
diets – becoming vegetarian, vegan
not touching food or grease- fearful fat will be absorbed through the skin
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 or messing of food, bizarre combinations - can’t explain why they do strange things with food, it is thought that this is the result of starvations effect on the brain.
Refusing to eat more than the person who eats least, rules about always finishing last etc
Medication abuse - Appetite suppressants – including gum, cigarettes - alternative, OTC & www medications
Getting rid of calories:
Self-induced vomiting
Chewing & spitting out
Overexercise – 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- not common
Medication abuse – including alternative, OTC & www medications, excessive caffeine and stimulant consumption – laxatives, ipecac, pain killers to allow exercise despite damage
Other eating disorder behvaiours:
Body-checking’– repeated weighing, mirror gazing, self-measurment, self-photographing, trying on particular tight clothes, checking you can fit fingers round wrists, feeling for hip bones through pockets
Displaying emaciation to elicit reassuringly shocked attention
Cruising ‘pro-ana’ websites/facebooking/emailing fellow sufferers
Competing with self and others to attain lower and lower targets
Compulsive browsing of gossip magazines and websites – celebrities, ‘thinspirations’
Deliberate self harm if ‘rules’ are broken
What are the psycholoical and social consequences of an eating disorder?
The core psychopathology - extreme overvaluation of low weight & thin/lean shape – resembles religious belief, with the ‘adherents’ 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 & narrowed focus of interest – a difficulty in seeing the ‘bigger picture’
And a starved person is unable to interpret emotion – as in Aspergers- which can cause damage to meaningful relationships
Malnourished brains experience depression, anxiety, obsessionality and loss of concentration on anything but food.
Depression at low weight rarely responds to medication.
People who rely on eating-disordered behaviour to ‘solve’ their problems fail to develop other ways to cope with life, tolerate distress or feel rewarded and fulfilled
Anxiety eating in company, followed by guilt after eating.
What are the physical consequences of an eating disorder?
Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity to infections, anaemia, bone loss, fertility problems
Purging behaviours cause neuro-chemical disruption with special damage to brain (seizures) and heart (arrhythmias). Potassium is only one crude measure of the problem
Young people need good nutrition to allow growth – height, pubertal development, brain growth and development (especially frontal lobe growth), so re-nutrition is more urgent the younger the patient
What are the predisposing factors of an eating disorder?
Genetic predisposition – OCD, anxiety disorders, perfectionism
Perinatal factors- did mum have postnatal depression, did this impact the early development?
Life events – and traumas
Preciptating factors of eating disorders
Puberty – physical effects of hormonal changes on the brain , also psychological response to body changes
Dieting or even non-deliberate weight loss
Increased exercise- particularly seen in dancers and other sports people
Stressful life events
neglect, abuse, difficult transitions eg to High School or from school to uni, deaths and losses, separations and family breakup, bullying (but sometimes ‘perceived bullying’ occurs as a consequence of a disorder), stresses – especially exams
What are the perpetuating factors of an eating disorder?
- Delayed gastric emptying - sensations of fullness interpreted as fatness,
narrowing focus with avoidance of interpersonal interest, change of values so that food becomes the most salient stimulus.
Obsessionality. Phobia of ‘fat’ increases as avoidance increases. ‘Body checking’ amplifies body image concern
Families, School, Clinic staff
High EE (expressed emotion) in family(and other carers) may delay recovery- families may be so worried that they end up compromising to make the child happy
What is the treatment for eating disorders?
Re-feeding.
CBT –ED, ( 40 sessions)Mantra (20 sessions) SSCM( 20 sessions) CBT(including self-help) for normal weight Bulimia Nervosa
Alternatively IPT, or fluoxetine 60mg daily -usually for people with binging
(in fact any antidepressant in high dose)
Olanzapine
Specialised family work for anorexia nervosa, particularly for younger patients
