Eating Disorders Flashcards
Define eating disorder
Eating disorders are characterised by persistent disturbance of eating or eating-related behaviour which leads to altered intake or absorption of food and causes significant impairment to health and psychosocial functioning.
Define Anorexia Nervosa
Restriction of food intake or persistent behaviour which interferes with weight gain and leads to low body weight (BMI for age <5th percentile in children/young adults | BMI <17.5kg for adults)
Anorexia nervosa is associated with body image disturbance and an intense fear of gaining weight.
Define Bulimia Nervosa
Recurrent (at least once per week for 3 months) episodes of uncontrolled eating of an abnormally large amount of food over a short time period (binge eating) followed by compensatory behaviour such as self-induced vomiting, laxative abuse or excessive exercise.
Define binge-eating disorder
Recurrent episodes of binge eating in the absence of compensatory behaviours. Episodes are marked by feelings of lack of control.
Define EDNOS
Eating disorder not otherwise specified - symptoms of an eating disorder such as anorexia nervosa, or bulimia nervosa, which do not meet the precise diagnostic criteria
Define avoidant restrictive food intake disorder
characterised by the person avoiding certain foods or types of food, having restricted intake in terms of overall amount eaten, or both
Beliefs about weight and shape do not contribute to the avoidance or restriction of food intake
Define diabulimia
an eating disorder in a person with diabetes, typically type I diabetes, wherein the person purposefully restricts insulin in order to lose weight
Define orthorexia
an unhealthy obsession with eating “pure” food. Food considered “pure” or “impure” can vary from person to person
Define pica
Someone eats non-food substances that have no nutritional value, such as paper, soap, paint, chalk, or ice.
For a diagnosis of pica, the behaviour must be present for at least one month, not part of a cultural practice, and developmentally inappropriate
What are the risk factors for an eating disorder
Female sex
Adolescence and early adulthood
Being overweight as a child
Anxiety, depression
Perfectionism, low self-esteem, body dissatisfaction, societal idealisation, professional/recreational pressure
Household stress, social isolation, poor social support
FHx eating disorder, psychiatric disorder or substance misuse
Chronic diseases affected by diet (such as diabetes or coeliac disease).
What is the epidemiology of eating disorders
Estimates suggest that over 700,000 people in the UK have an eating disorder, 90% of whom are female
Onset risk is highest in adolescents and young adults
Anorexia nervosa is the leading cause of mortality from any mental health disorder
BED is identified more often in males and at an older age than other eating disorders — it is often associated with obesity.
What are the psychological symptoms of Anorexia Nervosa
Intense fear of gaining weight
Pre-occupation with food and weight
Distortion of body image
Low self-esteem, perfectionism
What are the behavioural symptoms of anorexia nervosa
Selective about food
Avoids eating with others
Avoids eating (not hungry, already eaten)
Refusing foods they used to enjoy
Repeated weighing, measuring
Purging, excessive exercise, appetite suppressant medication or diuretic use
What are the physical symptoms of anorexia nervosa
Amenorrhoea/oligomenorrhoea
Loss of libido
Delayed onset puberty
Dry skin
Hair loss
Weakness, fatigue
Constipation
dizziness, fainting
What are the behavioural symptoms of Bulimia nervosa
Binge eating (eating with a feeling of no control) with compensatory behaviour:
Vomiting
Purging
Fasting
Excessive exercise
Laxative use
Diuretic use
Diet pill use
In-between binges there may be attempts to restrict eating
What are the psychological symptoms of Bulimia Nervosa
Fear of gaining weight (usually a sharp threshold)
Over-evaluation of self-worth
Mood disturbance, symptoms of anxiety
Persistent pre-occupation and craving for food
Feelings of guilt and shame about binge-eating
Self-harm
What are the physical symptoms of Bulimia Nervosa
Bloating
Fullness
Lethargy
Gastro-oesophageal reflux
Abdominal pain
Sore throat
What are the symptoms of Binge-eating disorder
consuming an excessive amount of food in a discreet time period accompanied by a sense of loss of control over eating at that time, where they may eat more rapidly than normal, eat until uncomfortably full or when not hungry and experience significant distress and feelings of guilt and shame
What are the signs of anorexia nervosa on examination
Weight and height: <5th centile, <17.5 BMI
Obs: May show bradycardia, postural tachycardia/hypotension, hypothermia
General: pallor, cold extremities, prolonged CRT, dehydration, lanugo hair (fine hair on face/hands/feet), oedema
+ Sit up-squat-stand (SUSS)
What is the Sit up-squat-stand (SUSS) test
The sit up test — the person lies flat on a firm surface such as the floor and has to sit up without, if possible, using their hands.
The squat test — the person is asked to rise from a squatting position without, if possible, using their hands.
What are the signs of bulimia nervosa on examination
Weight and height: usually normal range
Obs
General: Russell’s sign: knuckle calluses from induce vomiting
ENT: dental enamel erosion, Salivary gland enlargement
Cardio: arrhythmia (secondary to hypoK+)
What investigations should be done for a suspected eating disorder
History + collateral history
Bedside: SCOFF, ECG, CBG, urinalysis, pregnancy test (for amenorrhoea)
Blood: FBC, ESR, U&Es, LFTs, glucose, TFTs, oestradiol, LH/FSH, lipid profile
Other: DEXA scan
What are the potential results for the following investigations in patients with an eating disorder: ECG, FBC, U&Es, LFTs, glucose, TFTs
ECG: QT prolongation, bradycardia, arrythmia
FBC: anaemia, leucopenia, thrombocytopenia, pancytopenia
U&Es:
- Vomiting/laxative abuse: Hypokalaemia
- Excess water intake: hyponatraemia
- Dehydration: elevated electrolytes
LFTs: malnutrition → enzyme elevation
Glucose: hypoglycaemia
TFTs: low T3
What are the red flags for admission for a patient with an eating disorder
BMI <15 OR weight loss >1kg a week
Hypothermia
Cardiovascular instability (bradycardia <40, postural tachycardia/hypotension, QT prolongation)
SUSS 2 or less
Suicide or self harm risk
Concurrent infection
Abnormal blood tests - electrolyte imbalance, hypoglycaemia
Refeeding syndrome risk
Syncope
Severe abdominal pain