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
What are physical health risks of eating disorders?
▪ Starvation
▪ Compensatory behaviour
▪ Scrutiny or certainty about weight measurements
▪ Re feeding
▪ Chronic – osteopenia/osteoporosis
▪ Mismanagement
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 physical health complications of eating disorders?
▪ Bradycarida – prolonged QTc and arrhythmia
▪ Hypothermia
▪ Hypotension
▪ Amenorrhoea → stopped menstruating
▪ BM suppression (blood glucose low)
▪ Wasting and fatigue/weakness
▪ Growth deficiency
▪ Constipation, bloating
▪ Irritable, low, cognitive issues
▪ Neuropathy
▪ Dry skin, lanugo hair (baby hairs - to keep you warm)
▪ Anaemia
▪ Electrolyte imbalance
▪ Renal failure/kidney stones
What blood problems can happen in eating disorders?
▪ Neutropenia – risks
▪ Anaemia of chronic disease
▪ Creatinine is usually low (fluid balance)
▪ Sodium usually normal (fluid balance)
▪ U&Es usually stable, but monitoring is essential for re-feeding
▪ ALT and AST usually raised in chronic starvation
▪ Albumin low (oedema risk)
▪ Sick euthyroid
▪ Elevated cholesterol (catabolic)
▪ Sex hormones reduced
What are some investigations in eating disorders?
▪ DEXA scan – gain weight is the treatment!
▪ Echocardiogram
▪ ECG
▪ SUSS (sit up stand test)
What are complications of purging?
Hypokalaemia and hypochloraemia
What are complications of laxatives?
If laxative use results in diarrhea, your body can become dehydrated. Diarrhea can also lead to electrolyte imbalance.
- rectal bleeding
- bloody stools
- severe cramps or pain
- weakness or unusual tiredness
- dizziness
- confusion
- skin rash or itching
- swallowing difficulty (feeling of lump in throat)
- irregular heartbeat
What are complications of exercise in eating disorders?
Rhabdomyolysis, kidney problems, fasciculations
What is fear driven falsification?
Faking the results (e.g. putting weights under wig to make them look heavier on the scales) can lead to problems
