Eating Disorders Flashcards

1
Q

Eating disorders (EDs) are ______________ disorders characterized by abnormal and maladaptive eating and related behaviors that result in significantly impaired health and quality of life

A

biopsychosocial

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2
Q

Current categorization of EDs is based on signs, symptoms, and behaviors

Eating disorders have the __________- mortality rate of all mental health disorders, surpassed only by opioid addiction

A

second highest

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3
Q

_________
○ Family history of an eating disorder or dieting, family history of mental health conditions

A

Biological

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4
Q

_____________
○ Perfectionism, anxiety, body dissatisfaction, cognitive rigidity

A

Psychological

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5
Q

___________
○ Weight stigma or discrimination, bullying, trauma, food insecurity, appearance ideal internalization, people from racial and ethnic minority groups, historical trauma

A

Sociocultural

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6
Q

Restriction of energy intake relative to requirements leading to a significantly low body weight (weight that is less than minimally normal or expected)
● Intense fear of gaining weight or becoming fat, or persistent behavior that interferes with weight gain
● Disturbance in the way in which one’s body weight or shape is experienced

A

anorexia nervosa

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7
Q

As of 2013 with 5th edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-5)
○ No _____ criteria for Anorexia Nervosa
○ ____________ no longer criteria

A

weight

Amenorrhea

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8
Q

During past 3 months, the individual has not engaged in recurrent episodes of binge eating/purging. Generally presents with weight loss accomplished through dieting, fasting, and/or excessive exercise

A

Restricting type anorexia nervosa

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9
Q

During past 3 months, the individual has engaged in recurrent episodes of binge eating/purging

A

Binge/Purge type anorexia nervosa

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10
Q

anorexia nervosa is Between ____ and ____ of females
____ to____ of males will

People between ages ____ with anorexia have 10 times the risk of dying compared to their same-aged peers
● Estimated _____ mortality rate

A

0.9%
2.0%

0.1%
0.3%

15-24
10%

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11
Q

Levels of Severity of AN Based on BMI

● Mild: ≥____
● Moderate: _______
● Severe: _______
● Extreme: <___

A

17
16-16.99
15-15.99
15

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12
Q

Two-thirds of people with anorexia also showed signs of an _______ disorder before the start of their ED

Childhood _______________ traits, such as perfectionism, having to follow the rules, and concern about mistakes, were much more common in women who developed eating disorders than women who didn’t

A

anxiety

obsessive-compulsive

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13
Q

AN Physical Characteristics

A

● Cachectic
● Muscle wasting
● Look younger than age
● Dry, brittle hair
● Dry skin
● Lanugo (lil fuzzy hair for warmth)
● Cold intolerance

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14
Q

___________
Recurrent episodes of binge eating

Recurrent inappropriate compensatory behavior(s) in order to prevent weight gain

Binge eating and compensatory behaviors occur at least ____ a week for _________

Self evaluation is unduly influenced by body shape and weight

A

Bulimia Nervosa

once
3 months

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15
Q

discrete period of time, a larger amount of food in a given time than most people would eat, sense of lack of control over eating during the episode

A

Binge

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16
Q

Bulimia Nervosa Compensatory Behaviors

A

● Self-induced vomiting
● Laxative abuse
● Diuretic abuse
● Excessive exercise
● Fasting

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16
Q

Bulimia Nervosa
● Between ____ and _____ of females and ____ to _____ of males will develop bulimia
● Estimated______ mortality rate

A

1.1%
4.6%

0.1%
0.5%

3.9%

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16
Q

Levels of Severity of BN
● Mild: ____ episodes/week
● Moderate: ____ episodes/week
● Severe: ____ episodes/week
● Extreme: ____ episodes/week

A

1-3
4-7
8-13
14+

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17
Q

● Recurrent episodes of binge eating is ___________
○ Eating, in a discrete period of time (ex: within a 2-hour period), an amount of food that is larger than most people would eat in a similar period of time.
○ A sense of lack of control over eating during the episode

A

Binge Eating Disorder

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17
Q

BN Physical Characteristics

A

● Weight and body size will vary
● Scarring of the knuckles
● Parotid gland enlargement
● Erosion of dental enamel & dental carries

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18
Q

Binge episodes associated with three or more of the following:
■ Eating much more _____ than normal
■ Eating until feeling ___________
■ Eating large amounts of food when not feeling physically _____
■ Eating ______ due to embarrassment or shame
■ Feeling ______ with oneself, depressed, or very guilty afterwards
● Marked distress regarding binge eating is present
● Not associated with recurrent use of inappropriate compensatory mechanisms

A

rapidly
uncomfortably full
hungry
alone
disgusted

19
Q

Other Specified Feeding or Eating Disorders (OSFED)

A

● Atypical AN
● Atypical BN
● Atypical BED
● Purging Disorder
● Night Eating Syndrome

20
Q

There is nothing ‘atypical’ or abnormal about Atypical Anorexia
● All of the criteria for anorexia nervosa are met except that the individual’s ___________
● AAN is far more prevalent than AN
○ Subthreshold anorexia occurs in 1.1% to 3.0% of adolescent females
● Should be treated with the same urgency and care as AN

A

weight is within or above the “normal range”

21
Q

_______- is Eating or feeding disturbance (avoidance, lack of interest, sensory, etc.) resulting in failure to meet nutritional needs associated with 1 or more of the following:

○ Significant weight loss/failure to grow
○ Significant nutritional deficiency
○ Dependence of enteral feeding/oral supplements
○ Marked interference with psychological functioning

● No ________ issues
● Associated symptoms:
35.3% __________
26.5% ____________
20.6% ___________ and/or sensory issues

A

ARFID

body image

abdominal pain
fear of vomiting
generalized anxiety

22
Q

Complications with Anorexia Nervosa
_______________
○ Bradycardia, orthostatic hypotension, arrhythmias, reduced left ventricular mass and systolic
dysfunction
● _______________
○ Delayed gastric emptying, decreased small bowel motility, constipation, abdominal bloating
● Osteopenia & osteoporosis
● Fluid & electrolyte imbalances
● Slowed growth; Delayed puberty
● Amenorrhea
● Decreased ability to concentrate urine
● Dizziness & confusion
● Death

A

Cardiovascular complications
GI complications

23
Q

Medical Complications: BN
● Chronic vomiting
○ Dehydration, hypokalemia, alkalosis, esophagitis, mild hematemesis, Mallory-Weiss __________tears
○ Rare: esophageal or gastric rupture

A

esophageal

24
Q

● Chronic laxative abuse
○ Diarrhea, dehydration, ________, intestinal ______

A

rectal bleeding
reliance on drugs for contraction

25
Q

● Diuretic abuse
○ Dehydration, _________

A

hypokalemia

26
Q

Laxative Abuse
● Work with the physician to get your patient off laxatives
● Requires regular monitoring of labs
● Can result in ____________ to GI system

A

permanent and severe damage

27
Q

Two types of laxatives? Examples?

A

● Osmotic laxatives
○ Miralax and Colace

● Stimulant laxatives
○ Senna, Ex-Lax, Dulcolax

28
Q

osmotic laxatives mechanism vs stimulant?

A

osmotic brings water in and stimulant acts on nervous system to contract your muscles

29
Q

● Constellation of metabolic alterations that occur within the first few weeks of refeeding a starved patient is called ________
● Rapid shift of _________ from bloodstream to cells due to _______=>hypophosphatemia,hypomagnesemia, hypokalemia
● Respiratory distress, paresthesias, lethargy, edema, muscle weakness, cardiac arrhythmias, hemolysis
● Can be life-threatening

A

Refeeding Syndrome
electrolytes
insulin

30
Q

Most at Risk for Refeeding Syndrome

● Any 1 of the following:
○ BMI <___
○ Weight loss >____% in the past _______
○ Little to no nutritional intake for >_____
○ Low levels of ________ before feeding

A

16
15%
3-6 months
10 days
K+, Phos, or Mg

31
Q

● Or any 2 of the following: (refeeding syndrome)

○ BMI <_____
○ Weight loss >____% in the past ______
○ Little to no nutrition for >______
○ History of _____________, including insulin, chemotherapy, antacids, or diuretics

A

18.5
10%
3-6 months
5 days
alcohol misuse or drugs

32
Q

Refeeding Syndrome

● _________ increase kcal intake

● Monitor _________ daily for the 1st ______ days of refeeding and every other days for several weeks afterwards; replete as needed

● ________ supplementation may be needed

A

Gradually

electrolytes
5-7

Thiamine

33
Q

Micronutrient Deficiencies
● Patients with ED likely have some degree of chronic __________ that won’t show up in lab work
● Most common deficiencies: ___________
● ____ deficiency (often related to avoidance of red meat)
● Thiamin deficiency
● Iron deficiency anemia—uncommon

A

malnutrition

calcium, vitamin D, iron, B12, omega-3

Zn

34
Q

Inpatient, short-term (~7-10 days), crisis and medical stabilization

A

Hospital

35
Q

Long-term (weeks to months), 24-hours per day, therapy (individual, group, nutrition), meal support, nutrition rehabilitation

A

residential

36
Q

Partial hospitalization, 5 days per week, 8 hours per day, therapy (individual, group, nutrition), meal support, nutrition rehabilitation

A

PHP

37
Q

Intensive outpatient, 2-3 days per week, therapy (individual, group, nutrition), meal support, nutrition rehabilitation

A

IOP

38
Q

Long-term (months to years), multidisciplinary team, nutrition rehabilitation, Intuitive Eating, a majority of the healing work happens in this

A

Outpatient

39
Q

The Role of the RD in Eating Disorder Treatment
● Support nutritional adequacy
● ______________ to establish balanced and flexible thinking about food, exercise, and bodies

● Early phase work:
○ Assess, establish rapport, define and discuss food, nutrition, weight principles, present healthy patterns of eating, educate family
● Longer term work:
○ Separate food and weight related behaviors from feelings and psychological issues
● Food exposures and challenges
● Slow and steady behavior change

A

Psychoeducation

40
Q

Stages of ED Treatment

● ________________
○ Where most MNT is utilized
○ Weight gain/restoration and stabilization
○ Decrease in ED behavior usage

● ____________
○ Rejecting diet mentality
○ Food exposures/challenges
○ Strengthening hunger and fullness cues
○ Gentle nutrition

● _______________________

A

Nutrition Rehabilitation
Intuitive Eating
Body image work and relapse prevention

41
Q

Biochemical Assessment
● Just because labs are WNL does not mean the patient is nutritionally stable
● Low serum glucose
● Hypokalemia
● Elevated Na, BUN, osmolality
● Serum albumin often______ due to adaptive mechanisms

A

WNL

42
Q

Depending on duration of illness and type of eating and purging behaviors, nutrition-focused physical findings may or may not show visible signs of malnutrition

Depleted somatic muscle & adipose stores

Weight and recent weight changes
○ Requires an accurate measure
○ Hydration status
■ Dehydration
■ _________

A

Refeeding edema

43
Q

____________
● Daily intake
○ 24-hour recalls, food journals
○ Calorie intake, macronutrients that are favored or restricted
○ “Diet” or low kcal foods
○ Bulk or volume eating
● Personal and family history
● Assess for food insecurity/contributing environmental factors
● Weight history
● Food rules and rituals
● Compensatory behaviors

A

Nutrition Assessment

44
Q

MNT for AN
● Goal: ______________
○ _____ lb gain per week for inpatients
○ _____ lb gain per week for outpatients

● Typical meal pattern consists of ___ meals and ___ snacks
○ Some patients may require oral supplementation to reach kcal prescription

● Minimize energy expenditure
● May require up to 70-100 kcal/kg (~_______ kcal/day for females & ~_________ kcal/day for males) for continued weight gain

A

Positive energy balance to promote weight gain
2-3
0.5-1

3
3

3000-4000
4000-4500

45
Q

MNT for AN and Hypermetabolism
● Restriction of kcal slows the RMR
● Hypermetabolic state requires a prescriptive, rather than intuitive, eating plan to heal
○ Refeeding increases _____ which can cause metabolic resistance to _______
● In the outpatient setting, patients should start calories at a minimum of ______ kcal/day
○ ___ CHO, ___ protein, ____ fat
○ Kcals in the outpatient setting can be increased by_____ every week

A

REE
weight gain
1600
50%
30%
20%
500

46
Q

MNT for BN
● Stop the ___________ by normalizing the eating pattern
● ______meals per day with prescribed _____ to strengthen biologic cues of hunger and satiety

● Balanced diet: sufficient _____ to prevent cravings and adequate _______ to promote satiety

● Avoid _______ diets as they may exacerbate binge & purge behaviors
● ________ is not an appropriate goal
○ Prioritize weight stabilization or gain when appropriate

A

binge/purge cycle
3
snacks

CHO
protein & fat

low calorie
Weight loss

47
Q

Establishing Target Weight Ranges
● Ideally not discussed until well into the refeeding process
● Initial goal weight range should be based on:
○ Height, childhood growth curve, pre-eating disorder weight range, familial body type
● ___________- are served best getting right to their target weight, restoring steadily the whole time and nourishing their brain and bones without delay
● Others with many rounds of treatment and variable success can be restored to a _____________ agreed upon by the team and held there for a few months

A

Adolescents
minimum weight range

48
Q

Exercise Recommendations in Recovery
● Exercise while underweight worsens ________, but movement during weight restoration makes recovery sustainable
● Once patient is medically stable and exercise is deemed safe, team can begin to introduce gentle movement
● Ultimate goal is gentle and intuitive relationship with exercise
● Asking patients not to do physical activity during ED recovery may reinforce the idea that movement is __________
● Should put aside step-tracking devices, phones, watches, etc.

A

bone density
only for burning calories

49
Q
A