Eating Disorders Flashcards
What are some eating disorders?
- Anorexia nervosa
- Bulimia nervosa
- Binge eating disorder
- Avoidant-restrictive food intake disorder
What are some feeding disorders?
- Pica
- eating disorder in which people compulsively eat one or more nonfood items, such as ice, clay, paper, ash, or dirt.
- Rumination-regurgitation disorder
Explain main points of the case and differential diagnosis:
21 year old female admitted to medical assessment via GP, due to concerns regarding weight
▪ Weight was 29kg in clinic (height 5ft 2inch) = BMI 11.7
▪ Returned from first year of university, no issues noted
▪ Over summer has been less sociable, less outgoing, not meeting friends nor engaging in hobbies or interests. Not sleeping well nor feeling refreshed or energised
▪ Subjectively notes a loss of appetite, food isn’t as nice. Eating to stay alive. Was a vegetarian, now vegan
▪ History of anxiety, and trialled antidepressants last year, but found counselling more helpful
Important
- Past medical history of mental health
- Vegan
- Female and young
- Eating to stay alive
Differentials
- Addisons
- Eating disorder
- Depression
- Anxiety
- Thyroid
- OCD
- Pregnancy
Which people are most at risk in eating disorders?
- Type 1 diabetes (T1DE) → diabulimia
What are the risk factors, complications, and management of eating disorders? (&symptoms and side effects)
Risk factors
- Young people
- Family history
- Trauma
- Stress
- Female
- Perfectionist
Complications
- Refeeding syndrome
- Malnourished
- Osteopenia (less bone layering)/osteoporosis
- Cardiac problems (ECG changes)
- Mismanagement
- Scrutiny or certainty about weight measurements
- Compensatory behaviour
- Purging
- Exercising
- Starvation
Specialist management
- PIC line (not long as then GI tract problems)
- NG lines → still stimulate GI tract
- Therapy (counselling)
Symptoms and side effects
▪ Bradycardia – prolonged QTc and arrhythmia
▪ Hypothermia
▪ Hypotension
▪ Amenorrhoea
▪ BM suppression
▪ Wasting and fatigue/weakness
▪ Growth deficiency
▪ Constipation, bloating
▪ Irritable, low, cognitive issues
▪ Neuropathy
▪ Dry skin, lanugo hair
▪ Anaemia
▪ Electrolyte imbalance
▪ Renal failure/kidney stones
Most common eating disorders?
- Binge eating disorder (most common) almost half develop bulimia or obese
- Bulimia nervosa (common) and 50% anorexia nervosa patients may develop bulimia
What is the main pathology behind eating disorders (1 main one)?
▪ The overvaluation of shape and weight is central to most Eating Disorders (bar ARFID)
% of patients with eating disorders?
ARFID → Avoidant Restrictive Food Intake Disorder
OSFED → Other Specified Feeding and Eating Disorder
What is the aetiology of eating disorders?
Biological
- Heritability - 70% MZ twins
- A child is 10 times more likely to suffer from an eating disorder if they have a family history of eating disorders.
- Between 58% and 76% of anorexia nervosa occurrences can be attributed to genetic factors.
- Nearly 10% of patients with either anorexia or bulimia have a relative who also has an eating disorder.
- Ongoing Genetic Studies on 5HT-2A and 5HT-1A
Psychological
- Temperament (self esteem and hopelessness)
- Attachment (trouble expressing emotions)
- Early feeding issues
- Life events
- Stress and self esteem
- Body concerns
- Impulsivity and perfectionism traits
Social
- Culture
- Profession and influence (encourage thinness)
- Turbulent childhood
- Family and interpersonal relationship difficulties
- Bullying or history of abuse
- Social Media?
Explain anorexia & its impact long term
- Fear of fatness/weight gain – with an overvalued idea of body, weight or controls
- Consequently acts to prevent restoration or maintenance of ‘normal weight’, reduces intake, purges or increases expenditure
- Results in weight loss or maintaining a low weight (BMI <18, or 5th centile for y/p) and metabolic/endocrine disruption*
*May also be considered rapid weight loss (20% TBW) with other criteria met
Long term impact
▪ Interrupts living – development, milestones, biological processes
▪ High morbidity/co-morbidity
▪ High mortality (medical complications, suicide)*
▪ *20% patients die within 20 years of diagnosis
Explain bulimia nervosa
▪ Overvalued idea of body (shape), weight (eating) and control – in this case a thin ideal, and fear of fatness
▪ Binge* represents a loss of control, very distressing
▪ Compensate – vomit, laxative, exercise, stimulants
▪ Pre occupied with food
▪ Often patients have had Anorexia Nervosa, or been obese
▪ Usually have a normal, to overweight BMI
▪ *rapid, past fullness, not hungry, disgust/guilt after
Explain binge eating disorder
▪ Like Bulimia but without the compensation behaviour
▪ Perceived lack of control
▪ Distressing
▪ Severity is linked to the overvalued idea of body, weight or control
Explain ARFID (avoidant restrictive food intake disorder)
▪ Avoid or restrict food intake, appear to have little interest in food
▪ May be related to sensory issues, or experiences of eating
▪ Outcome is weight loss, nutritional deficiency, dependence of supplements or medically supported feeding, poor physical health
▪ No overvalued idea of weight, eating or control Biological Food trauma Negative predictions
Explain SEED (severe enduring eating disorder)
- Consistently unwell for ten years or more
- Have already had one complete therapeutic treatment/intervention
- Usually multiple Specialist Eating Disorder Unit (SEDU) admissions
- Our focus shifts to maintaining weight, improving quality of life and preventing admissions
Explain OSFED (other specified feeding and eating disorder)
- Difficulties that do not meet the diagnostic criteria of other Eating Disorders
- But do have a significant impact on the persons life, health and functioning
Explain BMI
▪ <18.5 underweight
▪ <15 Mod risk (Exit SEDU)
▪ <13.5 High risk (need admission)
▪ <12.0 Very high risk (intense Rx)
What are some investigations in eating disorders?
▪ DEXA scan – gain weight is the treatment!
▪ Echocardiogram
▪ ECG
▪ SUSS (sit up stand test)
Explain refeeding syndrome
▪ Very low BMI
▪ Rapid weight loss
▪ Co-morbid (alcohol)
▪ Cancer/sepsis/acute illness
▪ Those needing parenteral feeding
▪ Maintain serum electrolytes at the expense of intracellular stores
▪ When fed, your body starts to build and moves serum electrolytes intracellular, causing serum depletion – leads to multiple complications
Explain cardiac, respiratory, neuromuscular affects from refeeding syndrome
Explain anorexia nervosa management (Biopsychosocial)
Explain bulimia nervosa management (Biopsychosocial)
