eating disorders Flashcards
eating disorders in males
emphasis on fitness
lean muscularity
stringent weight requirements for certain sports
higher incidence in homosexuals
populations most frequently diagnosed with eating disorders
white
affluent
well-educated
adolescent and female
factors contributing to eating disorders
vulnerable personality
female
hx of obesity
uncontrolled dieting
genetics
onset of puberty
major life changes or stressors
family functioning style
sociocultural emphasis on slimness
perfectionism
impulsivity
etiology of eating disorders
genetic: strong genetic component
neurobiological: altered brain serotonin contributes to the dysregulation of appetite, mood, impulse control
psychological: eating disorders are learned behavior that has positive reinforcement
environmental: childhood trauma
psychological factors of eating disorders
low self esteem
feelings of inadequacy, lack of control in life
depression, anxiety, stress, loneliness, trauma
interpersonal factors of eating disorders
troubled relationships
difficulty expressing emotions
hx of being teased based on size/weight
hx of physical/sexual abuse
social factors of eating disorders
culture pressure of thinness
narrow definitions of beauty
biological factors of eating disorders
irregular hormone functions
genetics
co-morbidities and dual diagnoses in eating disorders
associated between depression, anxiety, and eating disorders
anorexia have hx of anxiety
binge-purge behavior have co-morbid alcohol or substance abuse problem
bulimia frequently co-exists with major depression
treating eating disorders
rarely seek help
not motivated to change
often leave treatment
some recover spontaneously, whereas others have long term problems
anorexia nervosa
refusal to maintain body weight appropriate for age, intense fear of gaining weight or becoming obese
severely distorted body image
refusal to acknowledge the seriousness of wt loss
restricting type AN
individuals that do not regularly engage in binge eating or purging
calorie count and excessive exercise
binge eating and purging type AN
regularly engage in binge eating or purging behaviors
self induces vomiting or misuse of laxatives, diuretics or enemas
physical characteristics of AN
low body weight
lack of energy, fatigue
muscular weakness
decreased balance, unsteady gate
low body temp, BP, pulse rate
tingling in hands and feet
thinning hair or hair loss
lanugo
heart arrhythmias
loss of periods
low testo levels
etiology of AN
biological factors (genetics/neurobiological)
psychological factors
environmental factors
warning signs of AN
dramatic weight loss
preoccupation with food, calories, grams of fat, and dieting
refusal of certain foods, progressing to avoidance against whole food catagories
risk factors of AN
female
hx of eating disorders
history of obesity
dieting
over exercising
low self esteem
body dissatisfaction
lack of assertiveness
hx abuse
comorbid conditions
distorted body image
media
fashion industry
being an athlete
clinical course of AN
onset in early adolescence
chronic condition with relapses characterized by significant weight loss
often preoccupied with food
may develop bulimia nervosa
poor outcome related to initial lower minimum weight, presence of purging, and earlier age of onset
CAN BE CURED
complications due to weight loss/starvation
musculoskeletal: loss of muscle mass, fat, early onset osteoporosis
metabolic: hypothyroidism, hypoglycemia, electrolyte abnormalities
cardiac: bradycardia, hypotension, loss of cardiac mass, small heart, arrhythmias, chest pain, sudden death
GI: delayed gastric emptying, bloating, constipation, abdominal pain, gas and diarrhea, GERD, hemorrhoids
Reproductive: amenorrhea, irregular periods, loss of libido, infertility
dermatologic: dry cracking skin, brittle hair and nails, lanugo, edema, acrocyanosis, yellowish skins
hematologic: leukopenia, anemia, thrombocytopenia, hypercholesterolemia, hypercarotenemia
neuropsychiatric: abnormal taste, apathetic depression, mild organic mental symptoms, sleep disturbances and fatigue
complications of eating disorders due to purging
erosion of enamel, seizures, fatigues, weakness, milk organic metal symptoms, ipecac cardiomyopathy, arrhythmias, Russel’s sign
initial goal treatment of AN
assess suicidal ideation
initiating nutritional rehabilitation
later goal treatment of AN
Resolving conflicts around body image disturbance
increasing effecting coping
addressing underlying conflicts r/t maturity fears and role conflict
family therapy
treatment modalities of AN
hospitalization usually necessary
intensive therapies
refeeding syndrome
serious and potentially fatal condition caused by sudden shifts in electrolytes that help body metabolize food.
treatments of AN
precise meal times, adherence to selected menu
observation during and after meals and regularly scheduled weigh ins
constant monitoring during bathroom trips
long term treatment provided on outpatient basis
meds for AN
fluoxetine helpful for compulsive behaviors after pt has reached maintenance wt.
when is hospitalization required for eating disorders?
extreme electrolyte imbalance or weight below 75% of ideal body weight
less than 10% body fat
daytime HR less than 50 bpm
systolic bp less than 90
body temp less than 96
arrhythmias
what is an acceptable BMI?
18.5-24.9
Bulimia Nervosa
recurrent episodes of binge to avoid weight gain through purging. such as self inflicted vomiting, diuretics, enemas, emetics, or excessive exercise or fasting
risk factors for BN
high achievers
social pressure to be thin
depression
chaotic family
outgoing
angry
impulsive
substance abuse
clinical course of BN
few outward signs
binge and purge in secret
treatment often delayed for years
typically normal body weight
once tx is over typically there is complete recovery except is depression and personality disorders present
they feel shame, guilt, and disgust regarding binging and purging
warning signs of BN
disappearance of large amounts for food
finding wrappers and containers
evidence of purging, frequent trips to the bathroom after meals, signs and or smells of vomiting, laxatives or diuretic wrappers
unusual swelling of cheeks and jaws
Russells sign
discoloration or staining of teeth
withdraw from usual friends and activities
symptoms of BN
enamel erosion
xerostomia (dry mouth)
tooth decay
treatment of BN
hospitalization if experiencing life threatening complications/SI
treatment is usually outpatient
stabilizing and normalizing eating, stop the binge-purge cycle
teaching health boundaries
reshape dysfunctional thoughts
CBT,DBT
meds for BN
SSRI’s- fluoxetine, is the most effective in conjunction with CBT
behavioral techniques such as using food diary
nutritional counseling
group psychotherapy and support groups
family therapy
Binge eating disorder
recurrent episodes of binge eating with accompanying marked distress and impaired control over behavior
causes and comorbidities of BED
lower dietary restraint and higher in weight
BED occurs in normal-weight/overweight and obese
genetic
most common psych disorders with BED
bipolar, MDD, anxiety, SUD
low self esteem, body dissatisfaction, deduced level of coping and adverse childhood events
symptoms of BED
frequent episodes of eating large quantities of food in short periods of time
out of control, over eating
depressed, guilty, or disgusted by behavior
eating when not hungry, eating alone, uncomfortably full
upper and lower GI problems that bring attention to HCP’s.
consequences of BED
HTN
high cholesterol
heart disease
DM
GI diseases
Gallbladder disease
musculoskeletal problems
treatment of binge eating disorders
hospitalization not usually required
individual or group CBT
DBT
nutritional counseling
support groups
psychopharmacology (SSRI’s, Vyvanse)
