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NB3 > Eating Disorders > Flashcards

Eating Disorders Flashcards

1
Q

What is a purge?

A

Use of vomiting, laxatives, diuretics or enemas to eliminate calories

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2
Q

What is a binge?

A

Definition of a Binge:
• Eating a large amount within a discrete period (i.e. an amount “definitely larger than most people would eat under a similar circumstance”)

• Eating is out of control during the episode

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3
Q

What are the types of eating disorders?

A
  1. Anorexia nervosa
  2. Bulimia nervosa
  3. Binge-eating disorder
  4. Unspecified eating disorder
    These disorders are under the “Feeding & Eating Disorders” category of DSM-5
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4
Q

What are the Anorexia nervosa diagnostic criteria?

A

Diagnostic Criteria:
1. Restriction of food that leads to a person being significantly underweight.
• Underweight is defined as having a body mass index (BMI) < 18.5 kg/m2.

  1. Intense fear of gaining weight (evidenced by extreme preoccupation, frequent assessment, behaviors that interfere with weight gain etc.)
  2. Body image disturbance (e.g. belief of being overweight, denying seriousness of low weight)
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5
Q

What is a normal BMI ?

A

(Normal BMI range: 18.5 – 24.9 kg/m2)

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6
Q

What are the classifications of Anorexia Nervosa?

A

Mild- 17 – 18.49 (grey zone, use clinical judgement

Moderate- 16 – 16.99 (“clearly” below normal)

Severe- 15 – 15.99

Extreme- less than 15

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7
Q

What are the subtypes of Anorexia Nervosa?

A

Based on recent behavior over the last 3 months

  1. Binge-eating/purging Type:
    • If the person recurrently binges AND/OR purges
  2. Restricting Type:
    • The person does NOT recurrently binge or purge
    • Weight loss is maintained through dieting, fasting +/- over exercising
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8
Q

What are the epidemiology of the Anorexia Nervosa?

A

Over 90% of affected persons are females however, the prevalence data for males is scarce.

  • Onset: Bimodal (average: 17 years)
  • First peak (12-15 years) and
  • Second peak (15-21 years)
Interests/Occupations:
• Modeling, beauty competitions 
• Gymnastics
• Ballet dancing
• Wrestling
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9
Q

What are the contributing factors?

A

Psychological and Social Factors
• Cultural pressures to be thin
• Difficulty establishing autonomy from parents during adolescence ( a “control”
issue)
• Perfectionist trait
• Low self-esteem
• Weight loss is reinforced (internally & externally)

Biological Factors
• Genetic susceptibility to anorexia
• A person may inherit biochemical alterations that leads to obsessiveness.
• Cultural pressures may direct the obsessiveness to body image.

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10
Q

Whaat are the associated features Anorexia Nervosa?

A 
Symptoms:
• Amenorrhea
• Decreased sex drive 
• Constipation
• Hair loss
  • PhysicalExamination:
  • LowBMI
  • Hypothermia,bradycardia,hypotension
  • Lanugo(soft,finebaby-likehair)
  • Dry skin, brittle nails
  • Investigations:
  • Anemia, leukopenia, low bone mineral density, hypercholesterolemia
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11
Q

What are the main physical features of Anorexia Nervosa?

A

Indicators of excessive vomiting (Binge eating/purging subtype):

  1. Calloused knuckles → Russell’s sign
  2. Dental enamel erosion
  3. Salivary gland inflammation
    a) Parotid gland hypertrophy
    b) Chipmunk cheeks
  4. Subconjunctival hemorrhage
  5. Hypochloremia, hypokalemia
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12
Q

How is Anorexia Nervosa treated?

A

Typically, a patient is not self-referred, since anorexia tends not to distress the patient.

• Treatment is typically family initiated.

➢ In-patient Hospitalization:

• Weight gain is the immediate goal for in-patient care.
• Combined with behavioral principles (e.g., operant conditioning) to encourage
weight gain.
• An attendant often supervises the patient to thwart attempts to lose weight

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13
Q

How can therapy lead to Anorexia Nervosa?

A

➢ Cognitive-Behavioral Therapy
• In-patient or out-patient
• It is an essential component of treatment
• Used to change the patient’s attitude about food and weight and learn how to
break destructive eating habits.

➢ Pharmacological Therapy
• No FDA approved drug for treating anorexia
• Limited to treatment of medical complications and comorbid psychiatric conditions

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14
Q

What are the outcomes of Anorexia Nervosa?

A
  • In a controlled environment such as in-patient care, there is good short-term prognosis.
  • However, long-term prognosis tends to be poor after patients are released home.

• Outcome is variable: some may fully recover, have relapses, or progressively
deteriorate.

• Many medical complications can result, ranging from minor to major (hormone deficiency, organ failure, brain changes, suicide) with approximately 20% mortality rate

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15
Q

Describe the diagnostic criteria of the Bullimia Nervosa

A

1.Recurrent binge eating

  1. Recurrent inappropriate compensatory behavior for binge
    • Purging (e.g. vomiting, laxatives, diuretics, enemas)
    • Non-purging (fasting and/or excessive exercise)
  2. The binge/inappropriate compensatory behaviors must occur
    ≥ once a week for 3 months
  3. Self-evaluation is unduly influenced by body shape and weight
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16
Q

What are the features of Bullimia Nervosa?

A

There are no subtypes of bulimia nervosa

• Persons typically have a BMI in the normal range or are slightly overweight (normal BMI = 18.5 – 24.99 kg/m2).

  • Compare this to AN where the BMI is low
17
Q

Describe Bullimia Nervosa Epidemiology

A

• More than 90% of persons with bulimia nervosa are women.

  • Onset:
  • Average age of onset: 18 – 20 years
  • Women often have a history of both anorexia nervosa and bulimia nervosa, but at different times
  • Occupations:
  • Modeling, beauty competitions
  • Gymnastics
  • Ballet dancing
  • Wrestling
18
Q

What are the contributing factors of the Bullimia Nervosa?

A

Psychological and Social Factors
• Societal pressures to be thin +/- a means to improve self-esteem
• Strict dieting results in a broken diet and impulsivity, “all or none” eating (i.e.
binging)
• Fear of weight gain after binge leads to inappropriate compensatory behavior

Biological Factors
• A person may inherit biochemical changes (low serotonin) that leads to impulse control problems.

19
Q

What are the associated features of Bullimia Nervosa?

A

• Indicators of excessive vomiting
• Seen in both bulimia and anorexia (subtype: binge-eating/purging
type)

  • Physical Consequences:
  • Electrolyte imbalance - ↓K, ↓Cl
  • Consequences of excessive vomiting
  • Enamel erosion
  • Parotid gland enlargement - more likely in BN
  • Knuckle calluses
20
Q

What is the treatment for Bullimia Nervosa?

A

A patient typically initiates treatment (after several years of symptoms)→the disorder is distressful to the patient.

  • Treatment tends to be out-patient based.
  • CBT is essential
  • Fluoxetine is the only FDA-approved medication for bulimia
  • With greater motivation to change, prognosis is better for bulimia nervosa than anorexia nervosa
21
Q

What is the prognosis of Bulimia Nervosa?

A

• Intervention soon after diagnosis has better prognosis

• Outcome: half recover fully with treatment; others have a chronic course
with relapsing symptoms.

  • Having associated problems with depression or substance use has poorer prognosis
  • Medical complications tend to be fewer and less severe than in anorexia, but morbidity and mortality may still result (e.g. from hypokalemia, suicide)
22
Q

What’s the diagnostic criteria of the binge-eating disorder?

A
  1. Binge eating (as per bulimia criteria)
  2. Bingeing is associated with features such as:
    A. Rapid eating
    B. Eating until uncomfortably full
    C. Eating when not physically hungry
    D. Eating alone due to shame about quantity
    E. Feeling disgusted/guilty/depressed after binge
  3. No inappropriate compensatory behavior
  4. The binge behavior must occur more than once a week for 3 months
23
Q

Describe onset of binge eating disorder

A
  • Epidemiology:
  • Approximately 2% with a less skewed female bias
  • Onset & Course:
  • Symptoms often start in adolescence
  • Cross-over to other eating disorders is uncommon
  • Etiology:
  • Unknown but distinct from bulimia nervosa
  • In binge-eating disorder, dysfunctional dieting tends not to precede bingeing
24
Q

What are the features of Binge Eating Disorders?

A

Associated with obesity (BMI ≥ 30 kg/m2)
• High BMI is not required for a diagnosis

  • Obesity without bingeing is a distinct condition:
    • Not all obese people binge eat.
    • There is greater distress/functional impairment in binge-eating disorder than in non-bingeing obesity
      • Health consequences of binge-eating disorder are similar to those of obesity •
25
Q

How is binge eating treated?

A

Treatment:

• Cognitive-behavioural therapy, antidepressant drugs and the stimulant drug, lisdexamfetamine

26
Q

What is an unspecified eating disorder?

A

Many patients do not meet the criteria for either Anorexia Nervosa, Bulimia Nervosa or Binge-eating disorder but have subclinical eating problems.

The diagnosis would be “unspecified eating disorder”

  1. A woman with a BMI = 22 kg/m2 who frequently purges but does not binge eat • Purges→AN(binge-eating/purgingsubtype)orBN
    • Does not binge eat→not BN, not BED
    • Normal BMI→not AN
  2. A woman with a BMI 25 kg/m2 binges and purges but only once a month
    • Binge and purge→AN (binge eating/purging subtype) or BN
    • Criteria for duration and frequency: >1 / week for 3 months
27
Q

How do we screen for eating disorders?

A

SCOFF Questions

SCOFF Questions
❑Sick→Do you make yourself sick because you feel uncomfortably full? ❑Control→Do you worry you have lost control over how much you eat?
❑One→Have you recently lost more than one stone (14 lb.) in a 3-month period? ❑Fat→Do you believe yourself to be fat when others say you are too thin? ❑Food→Would you say that food dominates your life?
A score of ≥ 2 indicates a likely eating disorder.

NB3 (33 decks)

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