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
binge eating dsiroder additional features
can be associated with weight gain
may be normal or low weight
preoccupation with body weight and shape
BED prevalence
in europe 1.9% for women, 0.3% for men
other specified feeding and eating disorders
atypical anorexia
purging disorder
rumination-regurgitation disorder
pica
avoidant-restrictive food intake disorder
weight loss
nutritional deficiencies
dependence on oral supplements or tube feeding
negatively affected health of individual
impairs functioning
not motivated by preoccupation with body weight
ARFID ddx
unavailability of food
food allergies
hyperthyroidism
mental disorder
due to medication
ARFID additional reasons
lack of interest in eating/low appetite
certain sensory characteristics
concerns for consequences of eating
ARFID additional fx
high levels of distractibility
high levels of emotional arousal and extreme resistance
no difficulty generally eating foods within preferred range
under or normal weight
negative impact on functioning
not for purpose of losing weights
higmost common comorbid conditions
depression
OCD
social anxiety
autism
subtance abuse
binging and purging association
EUPD
eating disorder why
mechanism for difficult emotions
feel les anxious, more confident
provide sense of being special
barrier to engaging with tx
predisposing factors biologicsl
genes
neurotransmitters
hormones
physical illness or allergies
family hx
predisposing factors psychological
low self esteem
lack of control
self identity
hx of depression
personality traits
interpersonal styles
emotional processing
thinking styles
predisposing factors social
hx of bullying
trauna
stressful life events
difficult interpersonal relationships
competitive sports
household
preciptating factors biological
puberty
physical illness
weight loss
precipitating factors psychological
low mood
senseof a lack of control
precipitating social
interpersonal problems
transitions
grief/loss
social media/diet culture
perpetuating factors
effects of starvation - euphoria
reduced sex drive
feeling of control
sense of identitiy
numbing of emotions
sense of achievement
reinforcement from others
eliciting care from other
ability to avoud transitions, events
social media
hx eating disorder
hx of eating disorder
current pattern of eating
mechanism of weight control
attitudes to weight and shape
current mood and anxiety sx
physicalsx
periodsand bones
general mental health assessment
risk assessment (IN:BMI<15 -not drive)
eating gisorder physical examB
BMI
cachexia
signs of dehydration
lanugo hair
russel’s sign
salivary gland enlargement
heart rate (bradycardia)
BP (hypotension)
temperature (low)
hydration
muscle power - sit up squat stand test
eating disorder investigations
FBC, UE, LFT, bone profile, TFT, MG,GLU
ECG (prolonged QT)
dexa scan
physical effects of eating disorders
sick euthyroid syndrome
bradycardia
reduced body temp
anaemia
hair thins
low BP
weak muscles
osteoporosis
kidney stones
low K, Mg and Na
constipation
amenorrhoea
infertility
bruise easily
bulimia - stomach ulcer, irritated or rupture oesophagus, tooth enamel erosion, gym disease
guidelines eating disorders
Medical emergencies in eating disorders (MEED)
refeeding syndrome
hypo phopshataemia, magnesaemia, kalaemia, vitmain defiency, fluid retention
…arrhythmias
sodium retention and extracellular fluid expansion, thiamine deficiency - congestive cardiac failure
neurological probelms
poor ventilatory function
rhabdomyolysis
thrombocytopenia
requires specialist management
binge eating disorder tx
guided self help
group CBT
individual help
anorexia difficult to treat
ego syntonic
recovery bulimia
50-70%
relapsing and remiting
anorexia nervous outcome
highest mortality
4 in 5 due to physical
1 in 5 due to suciide
46% fully recover
predictability of outcome
motivation
short duration of illness
level of severity
onset during adolescence
good family function
lack of comorbid condition
refeeding syndrome further mx
replace B vitamins
anorexia physical signs
anorexia - thinning hair, peripheral oedema, hypotension, loss of muscle mass
long term complications of anorexia
werencieks’ encephalopathy, bradycardia, osteoporosis
adult anorexia mx
CBT-ED, MANTRA, SSCM
