Eating disorders

Question 1

Key factors about eating disorders

Answer 1

• In developed countries → higher rates of eating disorders than meningococcal disease in children
• Greater incidence compared to TIIDM and IBD

Question 2

Epidemiology of eating disorders

Answer 2

• Peaks at mid teens to mid twenties
• Affects all areas of student life

Question 3

Screening tools for eating disorders

Answer 3

• SCOFF questionnaire
  
  • Make yourself sIck because you feel uncomfortably full
  • Worry about having lost control over how much you eat
  • Lost more than one stone (5.35kg) in three month period
  • Believe yourself to be fat when others say you are too thin
  • Fgood dominates your life 4

Question 4

Eating disorders as obsessive weight losing disorder

Answer 4

• Obsessive fear of fatness
• Avoidance of food and sources of calories
• Range of compulsory ‘compensatory’ behaviours when food cannot be avoided
• Behaviours are the only way to avoid experiencing anxiety

Question 5

Anorexia nervosa

Answer 5

• Restriction of intake to reduce weight
• Relies of compulsive compensatory behaviours when food cannot be avoided
  
  • Self-induced vomiting
  • Laxative abuse
  • Excessive exercise
  • Abuse of appetite suppressants/ diuretics
• Anorexia consideration → weight 15% below ideal body weight
• Fear of weight gain
• Absence of menstrual cycle, greater than 3 cycles (post-monarchal women)

Question 6

Presentation of anorexia nervosa

Answer 6

• Cold intolerance
• Blue hands and feet
• Constipation
• Bloating
• Delayed puberty
• Primary and secondary amenorrhea
• Dry skin
• Fainting
• Hypotension
• Lanugo hair
• Scalp hair loss
• Early satiety
• Weakness, fatigue,
• Short stature
• Osteopenia, osteoporosis

Question 7

Bulimia nervosa

Answer 7

• Episodes of binge eating with sense of loss of control
• Binge eating followed by compensatory/ purging behaviour
  
  • Self-induced vomiting
  • Laxative abuse
  • Diuretic abuse
  • Excessive exercise
  • Fasting
  • Strict diet
• Bine-compensatory behaviours occur minimum of 2 times a week for three months
• Dissatisfaction with body shape and weight

Question 8

Presentation of bulimia nervosa

Answer 8

• Mouth sores
• Pharyngeal trauma
• Dental caries
• Heartburn, chest pain
• Oesophageal rupture
• Impulsivity
  
  • Stealing
  • Alcohol
  • abuse
  • Drug/ tobacco
• Muscle cramps
• Weakness
• Bloody diarrhoea
• Irregular periods
• Fainting
• Swollen parotid glands
• Hypotension

Question 9

Binge eating disorder

Answer 9

• Similar to bulimia nervosa → absence of purging behaviours
• Ongoing and repetitive cycles
  
  • Unusually fast eating, alone
  • Unusually large amounts consumed
  • Uncomfortably full, ‘buzzed’ after eating
  • Embarrassment, shame, guilt, depression

Question 10

Avoidance of calorie intake

Answer 10

• Diet → becoming vegetarian, vegan
• Touching food or grease
• Developing dislikes, pickiness, even ‘allergies’
• Interpreting all symptoms as allergies or indigestion
• Eating slowly, only eating at certain imes
• Avoiding parties and social occasions
• Spoiling, messing with food, bizarre combinations
• Refusing to eat more than person who eats least
• Medication abuse → appetite suppressant → gum, cigarettes,

Question 11

Getting rid of calories

Answer 11

• Self-induced vomiting
• Chewing and spitting
• Over exercise → often secret
• Overactivity
  
  • Obsessive housework
  • Fidgeting
  • Twitching
  • Never sitting down
• Cooling → inadequate dress, open windows
• Blood letting
• Medication abuse
  
  • Alternative medications
  • OTC
  • Stimulants
  • Pain killers to allow further exercise

Question 12

Other eating disorder behaviours

Answer 12

• Body checking
  
  • Repeated weighing
  • Mirror gazing
  • Self-measurement
  • Self-photography
  • Trying particular tight clothes
• Displaying emaciation to elicit shocked response
• Compulsive browsing of social media
• Deliberatie self-harm

Question 13

Psychological consequences of eating disorders

Answer 13

• Extreme value of low weight and thin/ lean shape → resembles religious belief
• Obsessive weight-loss as the only solution
• Changed cognitive style → narrowed focus of interest, cannot see bigger picture
• Unable to interpret emotion → similar to Aspergers (improves with better nutrition)

Question 14

Mood disorders in eating disorders

Answer 14

• Higher rates of depression, anxiety, obsessionally and loss of concentration in malnourished brains
• Depression rarely responds to medications at low weight
• Anxiety eating followed by guilt after eating

Question 15

Social consequences of eating disorders

Answer 15

• Withdrawal from friendships and loss of interest in sexual relationships
• Turns other people into mere obstacles to the eating disorder

Question 16

Physical consequences of eating disorders

Answer 16

• Starvation
  
  • Physical damage
  • Poor repair and resistance
  • Heart damage
  • Reduced immunity and infection
  • Anaemia
  • Bone loss
  • Fertility problems
• Purging behaviours
  
  • Neurochemical disruption → seizures
  • Heart arrhythmias
• Altered growth
  
  • Heigth
  • Pubertal development
  • Brain growth → frontal lobe
  • Renutrition is crucial

Question 17

Predisposing factors of eating disorders

Answer 17

• Genetic predisposition
  
  • OCD
  • Anxiety
  • Perfectionism
• Perinatal factors
• Life events and trauma
• Perpetuating consequences of starvation and avoidance

Question 18

Precipitating factors of eating disorders

Answer 18

• Puberty
  
  • Physical effects of hormonal changes in brain → psychological response to physical changes
• Dieting or non-deliberate weight loss
• Increased exercise
• Stressful event
  
  • Neglect
  • Abuse
  • Difficult transition → between schools, deaths, losses, family break-up
  • Exams

Question 19

Perpetuating factors of eating disorders

Answer 19

• Consequences of ‘starvation syndrome’
  
  • Delayed gastric emptying → sensation of fullness interpreted as fatness
  • Narrowed focus → avoidance of interpersonal interests
• Obsessionally
  
  • Phobia of fat
  • Body checking amplifying self-image concerns
• High expressed emotion in family → delay recovering

Question 20

Death in eating disorders

Answer 20

• aHighest in anorexia nervosa than any psychiatric disorder
• High risk of premature death
• Half direct consequence of starvation and other half from self-harm

Question 21

Management of eating disorders

Answer 21

• Re-feeding
• Therapy
  
  • MANTR (40 sessions)
  • SSCM (20 sessions)
  • CBT-ED
  • Self-help
• Inter-professional therapy
• SSRI → fluoxetine
• Olanzapine (antipsychotic)
• Specialised family therapy

Question 22

Approach to treating eating disorders

Answer 22

• Diagnosis → not an accusation
• Patient are obliged to their illness to defend their weight loss
• Patience and urgency
• Empowerment fo parents and adults working against illness