Eating Disorders Flashcards by Sydney Perry

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

biopsychosocial

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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

second highest

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

Biological

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_____________
○ Perfectionism, anxiety, body dissatisfaction, cognitive rigidity

Psychological

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

Sociocultural

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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

anorexia nervosa

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

weight

Amenorrhea

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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

Restricting type anorexia nervosa

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

Binge/Purge type anorexia nervosa

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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

0.9%
2.0%

0.1%
0.3%

15-24
10%

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Levels of Severity of AN Based on BMI

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

17
16-16.99
15-15.99
15

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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

anxiety

obsessive-compulsive

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AN Physical Characteristics

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

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___________
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

Bulimia Nervosa

once
3 months

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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

Binge

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Bulimia Nervosa Compensatory Behaviors

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

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

1.1%
4.6%

0.1%
0.5%

3.9%

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

1-3
4-7
8-13
14+

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● 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

Binge Eating Disorder

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BN Physical Characteristics

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

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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

rapidly
uncomfortably full
hungry
alone
disgusted

Other Specified Feeding or Eating Disorders (OSFED)

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

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

weight is within or above the “normal range”

_______- 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

ARFID

body image

abdominal pain
fear of vomiting
generalized anxiety

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

Cardiovascular complications GI complications

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

esophageal

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

rectal bleeding reliance on drugs for contraction

● Diuretic abuse ○ Dehydration, _________

hypokalemia

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

permanent and severe damage

Two types of laxatives? Examples?

● Osmotic laxatives ○ Miralax and Colace ● Stimulant laxatives ○ Senna, Ex-Lax, Dulcolax

osmotic laxatives mechanism vs stimulant?

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

● 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

Refeeding Syndrome electrolytes insulin

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

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

● 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

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

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

Gradually electrolytes 5-7 Thiamine

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

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

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

Hospital

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

residential

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

PHP

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

IOP

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

Outpatient

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

Psychoeducation

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 ● _______________________

Nutrition Rehabilitation Intuitive Eating Body image work and relapse prevention

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

WNL

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 ■ _________

Refeeding edema

____________ ● 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

Nutrition Assessment

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

Positive energy balance to promote weight gain 2-3 0.5-1 3 3 3000-4000 4000-4500

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

REE weight gain 1600 50% 30% 20% 500

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

binge/purge cycle 3 snacks CHO protein & fat low calorie Weight loss

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

Adolescents minimum weight range

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.

bone density only for burning calories