Eating disorders

Question 1

What is the DDx of eating disorders?

Answer 1

• Endocrine: DM, Hyperthyroidism
• GI disorders: Malabsorption, IBD
• Genetic (Turner syndrome)
• Psychiatric disorders (MDD, Bulimia)
• Cancers …

Question 2

Anorexia nervosa is often associated with …………………………

Answer 2

Obsessive-Compulsive personality traits

Question 3

What is the epidemiology of anorexia nervosa?

Answer 3

• 10:1 female to male
• Onset 13-14 ys (hormonal influence)
• 17-18 ys (environmental influence)

Question 4

Difference between Restricting type and binge-eating/purging type of anorexia nervosa?

Answer 4

Restricting > Fasting, excessive exercises
Binge-eating > eating followed by vomiting or laxative use
* both wanna lose so much weight (compared to bulimia nervosa)

Question 5

How a patient with anorexia nervosa would look like?

Answer 5

• Amenorrhea, hypotension, hypothermia
• Labs: hyponatremia, hypochloremic, hypokalemic, ANEMIA, METABOLIC ALKALOSIS

Question 6

What are the DDx criteria for anorexia nervosa?

Answer 6

1- Low BMI (low calories intake)
2- Intense fear of gaining weight
3- Disturbed body image

Question 7

What is the treatment of anorexia nervosa?

Answer 7

1- FOOD/NUTRITION !!
2- Psychotherapy (CBT, Family therapy)
3- Supervised weight gain programs

Question 8

What is refeeding syndrome?

Answer 8

• Electrolyte and fluid shifts that occur in severely malnourished patients
• Complications:
  Arrythmias, Respiratory failure, Delirium, Seizures

Question 9

Anorexia nervosa and Bulimia nervosa holds a huge risk for developing ………………………..

Answer 9

Cardiac arrythmias (due to electrolytes imbalances mainly hypokalemia*)

Question 10

What is the difference between bulimia nervosa and anorexia nervosa?

Answer 10

Anorexia: Low BMI
Bulimia: Normal or High BMI

Question 11

Diagnostic criteria for Bulimia nervosa?

Answer 11

• Recurrent episodes of binge eating
• Recurrent inappropriate attempts to compensate over-eating
• These behaviors occur at least once a week for 3 months**
• Perception of self-worth is influenced by body weight and shape

Question 12

Define binge eating

Answer 12

• Excessive food intake within a 2-hours period accompanied by a sense of lack of control

Question 13

How to know if patient is getting rid of food through vomiting or laxative abuse?

Answer 13

1- Vomiting: Russell’s Sign (dorsal hand scars), parotid swelling, dental erosions, metabolic alkalosis.
2- Laxative abuse: metabolic acidosis (loss of HCO3), diarrhea

Question 14

Tx of Bulimia nervosa?

Answer 14

1- Antidepressants plus therapy: Fluoxetine (SSRI) > most effective
2- Nutritional counseling & education
3- Psychotherapy (CBT, group or family therapy)

Question 15

What is binge-eating disorder?

Answer 15

• Those feel emotional stress after binge-eating but they dont try to vomit or use laxatives.
• Patients are not fixated on their body shape & weight.

Question 16

Diagnostic criteria for binge eating disorder?

Answer 16

• Recurrent episodes of binge eating + >3 of following:
  1- Eat fast
  2- Eat until uncomfortably full
  3- Eat large amount even when not hungry
  4- Eating alone due to embarrassment
  5- Feeling disgusted, depressed, guilty after eating
• Must occur at least once a week for 3 months

Question 17

How would a patient with binge-eating disorder look like?

Answer 17

• Typically obese and suffer from medical conditions (DM, Hyperlipidemia, CVS diseases)

Question 18

What is the management of binge-eating disorder?

Answer 18

• Psychotherapy (CBT, interpersonal therapy)
• Strict diet & Exercise program
• Comorbid depression or anxiety must be treated