Eating disorders Flashcards
anorexia nervosa prevalence
most common cause of admissions to child wards
90& are females
diagnosis anorexia nervosa
DSM 5 criteria:
1. Restriction of energy intake relative to requirements leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health.
2. Intense fear of gaining weight or becoming fat, even though underweight.
3. Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or denial of the seriousness of the current low body weight.
management anorexia nervosa adults
individual eating disorder focused cognitive behavioural therapy
maudsley anorexia nervosa treatment for adults
specialist supportive clinical management
1st line management anorexia nervosa children
anorexia focused family therapy
2nd line is CBT
prognosis anorexia nervosa
up to 10% will die
anorexia nervosa features
reduced BMI
bradycardia
hypotension
enlarged salivary glands
anorexia nervosa physiological abnormalities
hypokalaemia
low FSH, LH, oestrogens and testosterone
raised cortisol and growth hormone
impaired glucose tolerance
hypercholesterolaemia
hypercarotinaemia
low T3
bulimia nervosa define
a type of eating disorder characterised by episodes of binge eating followed by intentional vomiting or other purgative behaviours such as the use of laxatives or diuretics or exercising
diagnostic criteria bulimia nervosa
DSM 5:
recurrent episodes of binge eating (eating an amount of food that is definitely larger than most people would eat during a similar period of time and circumstances)
a sense of lack of control over eating during the episode
recurrent inappropriate compensatory behaviour in order to prevent weight gain, such as self-induced vomiting, misuse of laxatives, diuretics, or other medications, fasting, or excessive exercise.
recurrent vomiting may lead to erosion of teeth and Russell’s sign - calluses on the knuckles or back of the hand due to repeated self-induced vomiting
the binge eating and compensatory behaviours both occur, on average, at least once a week for three months.
self-evaluation is unduly influenced by body shape and weight.
the disturbance does not occur exclusively during episodes of anorexia nervosa.
bulimia nervosa management
referral for specialist care
bulimia nervosa focused guided self help for adults, if after 4 weeks ineffective - individual eating disorder focussed CBT
bulimia nervosa focused family therapy for children
can trial high dose fluoxetine - lacks evidence
types of eating disorders
anorexia nervosa
bulimia nervosa
binge eating disorder
other specified feeding or eating disorder
avoidant restrictive food intake disorder
anorexia nervosa essential features
adults- BMI <18.5
children - BMI for age, <5th percentile or failure to gain weight as expected
rapid weight loss (>20% total body weight within 6 mths)
anorexia nervosa definition
persistent pattern of restrictive eating or other behaviours aimed at establishing or maintaining abnormally low body weight
includes fasting, choosing low calorie diet, excessive slow eating small amounts, hiding food, chewing and spitting, purging behaviours, increased energy expenditure
involves excessive preoccupation with body, weight and shape
anorexia nervosa patterns
restricting pattern - restricted intake or increased energy expenditure
binge-purge pattern - episodes of binging and purging
anorexia nervosa most common
children
bulimia nervosa features
frequent, recurrent episodes of binge eating - once a week or more over a period of at least 1 month
repeated inappropriate compensatory behaviours to prevent weight gain - once a wek over a period of at least a mth
excessive preoccupation with body weight
marked distress about pattern of binge eating
sx does not meet criteria for anorexia nervosa
buliminia nervosa additional fx
binges may be objective or subjective - core feature is loss of control over eating
typically distressing, guilt
may be associated with weight gain over time
binges characteristics
eating larger amount of food
lack of control during episode
eat rapidly and until uncomfortably full
eating when not hungry
secretive
binge purge cycle
strict dieting
diet slips
binge eating
purging to avoid weight gain
feeling of shame
and repeat
builima nervosa peak age of onset
15-25yrs
binge eating disorder
frequent, recurrent episodes of binge eating
for once a week or more over a period of 3 months
discrete period of time
loss of control
not usually accompanied by compensatory behaviour to prevent weight gain
marked distress about pattern
ddx binge eating disorder
prader-will syndrome
depression
EUPD
medication
