eating disorders

Question 1

anorexia kills more ppl

Answer 1

than any other DSM5 diagnosis (w/ the exception of opioids)

Question 2

anorexia - High comorbidity with

Answer 2

personality d/o (esp. OCD), depression, anxiety d/o

Question 3

anorexia - age of onset

Answer 3

Age of onset: 10-20 yo, but this is changing

Question 4

anorexia and hunger

Answer 4

decreased interoceptive awareness - ability to notice and respond to bodily cues like hunger

Question 5

anorexia - characteristics

Answer 5

difficulty expressing anger, non-assertiveness
low self-esteem
perfectionism
fear of sexuality, emotional maturation - afraid to date
enmeshed families (overprotective, rigid, difficulty w/ individuation)
“people-pleasers”
dichotomous thinking

Question 6

anorexia - physical - just body weight %

Answer 6

emaciation (<75% IBW = hospitalization)

Question 7

anorexia - prognosis

Answer 7

Prognosis: < 50% recover fully

Question 8

anorexia - nursing process- should you argue w/ them?

Answer 8

Avoid power struggles
Don’t underestimate their impairment

Question 9

bulimia - biologic - what neurotransmitter

Answer 9

biologic (low serotonin/tryptophan),

Question 10

bulimia - High comorbidity with

Answer 10

BPD, depression, PSA, anxiety d/os

Question 11

bulimia - Age of onset

Answer 11

Age of onset: 14-24 (but growing in women age 25-45)

Question 12

bulimia - characteristics - how does it differ from anorexia?

Answer 12

similar to those for anorexia, but (unlike anorexia) they recognize that their eating behaviors are abnormal and often seek help
binging and purging (sense of lack of control)
impulsive

Question 13

bulimia - physical

Answer 13

Often normal weight
Salivary (parotid) gland inflammation, esophageal varices, dental erosion
electrolyte imbalances, seizures, ipecac cardiac arrhythymias
metabolic alkalosis (from vomiting) or metabolic acidosis (from diarrhea)
scars or reddened areas on knuckles

Question 14

bulimia - what therapy?

Answer 14

Cognitive behavioral therapy

Question 15

binge eating - treatment (binge eating is el diablo)

Answer 15

DBT, meds (SSRIs are often used which also help tx the common comorbid depression; appetite suppressants), Overeater’s Anonymous

Question 16

Rumination

Answer 16

regurgitating food

Question 17

bulimia - meds- just 1

Answer 17

Meds: SSRIs (esp Prozac) in high doses (60 mg/day)

Question 18

bulimia - teach pt what coping skills

Answer 18

Teach assertiveness, healthy boundaries
Teach recognition of triggers, alternative coping mechanisms

Question 19

what is important with anorexia?

Answer 19

Interdisciplinary approach: consistency is important
Family (Maudsley) and individual therapy

Question 20

what to avoid during acute phase of anorexia?

Answer 20

No meds during acute phase

Question 21

what to assess for with anorexia?

Answer 21

Teach assertiveness
Suicide assessment (comorbid depression is common!)

Question 22

what meds for anorexia

Answer 22

SSRIs and Olanzapine may be helpful once normal weight has been restored