Eating Disorders Flashcards by Aoife Madden

How is BMI calculated?

BMI = (weight in kg)/(height in m^2) = kg/m^2

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What the range for a normal BMI?

18.5-25kg/m^2

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What does the ICD-11 classify as an eating disorder?

Anorexia nervosa (AN)
AN in recovery
Bulimia nervosa (BN)
Binge eating disorder (BED)
Avoidant restrictive food intake disorder (ARFID)
Rumination-regurgitation disorder
Feeding or eating disorders, unspecified (EDNOS)

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What is required for an ICD-11 classification of an eating disorder?

BMI <18.5
Persistent pattern of behaviours to prevent restoration of normal weight
Typically associated with a fear of weight gain and inaccurate perception of body weight/ shape
No requirement for physiological disturbance/ amenorrhoea

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What are the differentials for a low BMI?

Medical causes (Addisons, thyroid causes, IBD, cancer)
Lack of access to food
Confusion/ delirium
Depression
Personality disorder
Other mental health conditions eg. OCD, autism, psychosis

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What is the ICD-11 diagnostic criteria for bulimia nervosa?

Repeated bouts of overeating (binges)
Excessive preoccupation with control of body weight
Compensation for binges (eg. vomiting/ laxatives)
Binges associated with loss of control/ guilt

Don’t have to have a low BMI to diagnose bulimia, if SUs have a BMI <17.5, they’re diagnosed with AN rather than BN

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What is the classification of atypical bulimia nervosa?

One of the key ICD-11 diagnostic features is missing

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What is the most commonly diagnosed eating disorder?

Eating disorder not otherwise specified (EDNOS)

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What is binge eating disorder?

Bingeing without any compensatory behaviours

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What is avoidant restrictive food intake disorder?

Restricted intake with no body weight/ shape concerns, resulting in either:

Significant weight loss as a result of insufficient intake
Significant impairment in functioning

Not due to another physical/ mental illness, substance/ medication or unavailability of food

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What is rumination regurgitation syndrome?

When someone repeatedly regurgitates undigested or partially digested food from the stomach

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What is type one diabetes with disordered eating?

Patients deliberately omit insulin in order to try and control their weight:

1) minimises weight gain from bingeing
2) ketotic state promotes fat and weight loss

High risk of DKA

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How are eating disorders screened in primary care?

The SCOFF questionnarie:
- Do you make yourself Sick because you feel uncomfortably full?
- Do you worry you have lost Control over how much you eat?
- Have you recently lost more than One stone in a 3 month period?
- Do you believe yourself to be Fat when others say you are too thin?
- Would you say that Food dominates your life?

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How is the SCOFF questionnaire scored?

One point for every yes
- Score of >=2 indicates a likely case of anorexia nervosa or bulimia

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What is the Prochaska & DiClemente’s Stages of Change Model?

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What is the treatment algorithm for anorexia nervosa?

What is the first line psychological treatment for children/ adolescents with anorexia nervosa?

1st line: family therapy
CBT

What is the psychological management for adults with anorexia nervosa?

CBT
Maudsley anorexia nervosa treatment for adults (MANTRA)
Specialist supportive clinical management

What is the treatment algorithm for bulimia nervosa?

What is the psychological treatment for children/ adolescents with bulimia nervosa?

1st line: family therapy
CBT

What is the psychological management for adults with bulimia nervosa?

Guided self-help
CBT

What is the managment for severe cases of bulimia nervosa?

Day programmes/ intensive community programmes
Specialist eating disorder unit admissions
Acute medical hospital admissions
NG feeding

What could indicate an admission for a SU with an eating disorder?

Very low BMI (>=0.5kg weight loss for at least 2 weeks)
High risk of refeeding syndrome
Severe muscle weakness
Hypoglycaemia
Dehydration (fainting/ dizziness)
Electrolyte disturbance (urea and creatinine usually low in underweight people)
Arrhythmias (or bradycardia or long QTc >450ms, HR<40)

When do SUs with eating disorders lack capacity?

If they would rather die than eat, they lack capacity

This is on the grounds that cognitions that are part of AN are preventing them from appropriate weighing up of pros and cons and without AN they would likely make a different decision

What are the symptoms of anorexia nervosa?

- Low BMI - Intentional weight loss - Restriction of food - Excessive exercise - Induced vomiting/ laxative use/ appetite suppressants - Muscle wasting - Body dysmorphia - Fear of fatness

What are the physical effects of starvation?

What are the commonly associated eating disorder behaviours?

- Weight falsification (eg. water loading, concealing weights to appear heavier) - Exercise (excessive and micro exercise - fidgeting, holding stress positions) - Food avoidance - Capillary blood glucose falsification - Absconding

What is the Sit Up Squat Stand (SUSS) test?

What is refeeding syndrome?

Occurs with the sudden reversal of prolonged starvation which leads to large shifts in electrolytes from the intravascular space into cells Decrease in serum phosphate, potassium and magnesium

When is the onset of refeeding syndrome?

Within the first 72 hours of refeeding Can range from 1-5 days, can be further delayed in severly malnourished patients

What are the NICE guidelines for identiying the risk of refeeding syndrome in SUs?

What are the guidelines for preventing and managing refeeding syndrome?

- Immediate prescription of vitamins & minerals (pabrinex or oral vitamin B/ thiamine, A-Z multivitamin) - Baseline and daily refeeding bloods for 7 days - Replace electrolytes promptly if below normal - Start slow rate of reefeeding and titrate up

What are the baseline and daily refeeding bloods?

- Urea and creatinine - **Magnesium, phosphate, potassium**, sodium, corrected calcium - Glucose Repeat bloods following substantial meal increase

What constitutes hypoglycaemia?

- <3 low - <2.5 very low

Why are urea and creatinine low in SUs with eating disorders?

**Urea:** - Breakdown product of protein - Diets are usually low in protein **Creatinine:** - Waste product from muscles - Muscular wasting in SUs with eating disorders

What are the risk factors for developing anorexia nervosa?

- Genetic: first degree relatives, twins - Personality: perfectionism, OCD traits - Family factors: insecure attachment - Sociocultural: western culture, social class - Maternal risk factors: obstetric/ perinatal complications

What are the risk factors for developing bulimia nervosa?

- Similar to anorexia nervosa but **dieting** is a major risk factor - Adverse life experiences/ trauma (BN>AN) - Possible association with impulse control

What is the key difference between bulimia and anorexia nervosa?

In BN, there is an impulse to eat when starving which leads to bingeing In AN, the impulse to eat when starving is overcome and doesn't lead to bingeing