Eating Disorders

Question 1

All of the following are eating disorders, which is the least common?

1 - anorexia nervosa
2 - binge eating disorder
3 - bulimia nervosa
4 - Avoidant restrictive food intake disorder

Answer 1

1 - anorexia nervosa
- BUT has one of the highest mortality rates of all mental health conditions, caused by physical and physiological difficulties, as well as suicide

Question 2

All of the following are eating disorders, but which is the most common?

1 - anorexia nervosa
2 - binge eating disorder
3 - bulimia nervosa
4 - Avoidant restrictive food intake disorder

Answer 2

2 - binge eating disorder

Most common in men

Question 3

What age group are most commonly affected by anorexia nervosa?

1 - 15-19y/o
2 - 15-30y/o
3 - 30-45y/o
4 - >55y/o

Answer 3

1 - 15-19y/o

Question 4

Anorexia nervosa (AN) is characterised by which of the following?

1 - significantly low body weight for the individual’s height, age, developmental stage or weight history
2 - BMI <18.5 in adults, and BMI-for-age <5th percentile in children
3 - rapid weight loss (>20% of total body weight within 6 months)
4 - all of the above

Answer 4

4 - all of the above

Question 5

Patients with anorexia nervosa (AN) typically have an altered view of themselves. Patients typically have all or some of the following EXCEPT which one?

1 - think they are overweight when underweight
2 - able to gain weight easily
3 - reduce weight through fasting, choosing low calorie options or excessively slow eating
4 - purging behaviours such as self-induced vomiting, use of laxatives or diuretics
5 - increased energy expenditure
6- excessive preoccupation with weight, body shape and food
7 - overvalued ideation with reference to weight and shape
8 - intense desire for thinness which is central to their self-worth, confidence and self-esteem

Answer 5

2 - able to gain weight easily
- they typically have an intense fear of gaining weight.

Question 6

Do all patients with anorexia nervosa have insight into their condition?

Answer 6

• no
• often family and friends notice the weight loss

Question 7

There are 2 subtypes of anorexia nervosa:

• Restricting pattern
• Binge-purge pattern

Which of these matches the following:

• weight loss and maintenance of low weight is accomplished primarily through restriction alone or combined with increasing energy expenditure.

Answer 7

• Restricting pattern

Question 8

There are 2 subtypes of anorexia nervosa:

• Restricting pattern
• Binge-purge pattern

Which of these matches the following:

• engages in binge eating or purging or both (purging is making themselves vomit following binging)

Answer 8

• Binge-purge pattern
• similar to bulimia nervosa, but in AN the patient has a very low weight
• diagnosis can change to bulimia nervosa in cases where the individual continues to engage in binging and/or purging behaviours after regaining a more normal weight, and maintaining this for a year.

Question 9

Which of the following do NICE recommend when treating an adult patient with anorexia nervosa?

1 - individual cognitive behavioural therapy focused on eating disorders (CBT-ED)
2 - maudsley anorexia nervosa treatment for Adults (MANTRA)
3 - specialist supportive clinical management (SSCM)
4 - focal psychodynamic therapy (FPT) focused on eating disorders
5 - all of the above

Answer 9

5 - all of the above

• MANTRA = intensive outpatient treatment. Parents are integrated as an active and positive role to incorporate and encourage participation in their child’s recovery journey
• FPT = long term management on what symptoms means to patient and their affects

Question 10

Which of the following do NICE recommend when treating a child patient with anorexia nervosa?

1 - individual cognitive behavioural therapy focused on eating disorders (CBT-ED)
2 - family therapy focused on anorexia nervosa (FT-AN).
3 - maudsley anorexia nervosa treatment for Adults (MANTRA)
4 - specialist supportive clinical management (SSCM)
5 - focal psychodynamic therapy (FPT) focused on eating disorders
6 - all of the above

Answer 10

2 - family therapy focused on anorexia nervosa (FT-AN).

• if unsuitable then can try CBT-ED

Question 11

Which of the following best describes Bulimia nervosa?

1 - binge eating following by purging, whilst being underweight
2 - restricting food and increasing activity to maintain low weight
3 - recurrent binge eating, followed by behaviours to avoid weight gain over >1month but not underweight
4 - all of the above

Answer 11

3 - recurrent binge eating, followed by behaviours to avoid weight gain over >1month but not underweight

• the not being underweight is what distinguishes this from anorexia nervosa

Question 12

Bulimia (greek for hunger) nervosa patients typically binge and then use behaviours to avoid weight gain. When these patients do binge, is this a control or a loss of control?

Answer 12

• typically a loss of control
• BUT then use compensatory behaviours to avoid weight gain

Self-induced vomiting is most reported, however all compensatory behaviours cause distress to the individual have conditions relating to teeth, oesophagus, gastro-intestinal, low potassium
hide their condition due to shame
have body image disturbance

Question 13

Bulimia (greek for hunger) nervosa patients typically binge and then use behaviours to avoid weight gain. Do all patients with Bulimia nervosa use self-induced vomiting?

Answer 13

• common
• BUT not all patients use it
• compensatory behaviours cause significant stress to the patient, such as teeth, oesophagus, gastro-intestinal, low K+, but they ALL hide their condition due to shame
  have body image disturbance

Question 14

Which of the following symptoms do patients with Bulimia nervosa NOT typically present with?

1 - eat in a discrete period of time (<2 hours), a larger than usual amount of food
2 - taking control during the binge
3 - recurrent inappropriate compensatory behaviour to prevent weight gain (exercise, no insulin etc.)
4 - self-evaluation is unduly influenced by body shape and weight
5 - bingeing or purging does not occur exclusively during episodes of behaviour that would be common in those with anorexia nervosa

Answer 14

2 - taking control during the binge
- patients describe losing control during a binge and feeling unable to stop

• typically patients describe it as an uncontrollable impulsive urge

Question 15

In patients with Bulimia nervosa, binging is often triggered by something. Which 2 of the following are commonly reported?

1 - emotional/difficult situation
2 - new medications
3 - period of food restriction
4 - meeting other patients with Bulimia nervosa

Answer 15

1 - emotional/difficult situation
3 - period of food restriction

Question 16

In patients with Bulimia nervosa, when these patients binge, is this on healthy food or foods that they try to avoid?

Answer 16

• foods that they try to avoid
• in extreme cases binge foods may include flour, dried pasta, partially defrosted or discarded foods

Question 17

In patients with Bulimia nervosa, which of the following is NOT true?

1 - eat much more rapidly and with a loss of control
2 - eat until uncomfortably full and eat large quantities when not physically hungry
3 - eat when others can see them eating
4 - patients often experience negative emotions at how much they have eaten such as shame, guilt or disgust

Answer 17

3 - eat when others can see them eating
- this is incorrect, patients typically eat alone or in secret

• binging is typically cyclical

Question 18

In bulimia nervosa, what are the NICE guidelines for treatment in adults and children?

1 - group cognitive behavioural therapy focused on eating disorders (CBT-ED)
2 - family therapy focused on anorexia nervosa (FT-AN).
3 - maudsley anorexia nervosa treatment for Adults (MANTRA)
4 - specialist supportive clinical management (SSCM)
5 - focussed guided self help programme
6 - all of the above

Answer 18

5 - focussed guided self help programme

If this does not work then can use group or individual CBT-ED

• in children FT-AN should be offered

Question 19

In patients with binge eating disorder, patients are characterised by regular episodes of binge eating. However, do these patients engage in compensatory behaviours following the binges in an attempt to reduce any weight gain?

Answer 19

• no
• binge eating disorder = NO compensatory behaviours
• bulimia nervosa = YES to compensatory behaviours

Question 20

In patients with a binge eating disorder, patients are characterised by regular episodes of binge eating without compensatory behaviours following the binges in an attempt to reduce any weight gain. During the binges do patients feel in control or a loss of control?

Answer 20

• experience a loss of control
• typically eat more, or different foods than they normally would
• typically eat, even if not hungry

Question 21

In patients with binge eating disorder, patients are characterised by regular episodes of binge eating, where they feel a loss of control, without compensatory behaviours following the binges in an attempt to reduce any weight gain. Following the binge, how do patients typically feel?

1 - relief from emotional distress
2 - delayed feeling of guilt and self loathe
3 - patients may have binge eating disorder with anorexia or bulimia nervosa
4 - patients often make self promises to be different following binges
5 - all of the above

Answer 21

5 - all of the above

Question 22

In order to be diagnosed with a binge eating disorder, do patients typically have to be overweight?

Answer 22

• no

Question 23

In binge eating disorders, what are the NICE guidelines for treatment in adults and children?

1 - group cognitive behavioural therapy focused on eating disorders (CBT-ED)
2 - family therapy focused on anorexia nervosa (FT-AN).
3 - maudsley anorexia nervosa treatment for Adults (MANTRA)
4 - specialist supportive clinical management (SSCM)
5 - focussed guided self help programme
6 - all of the above

Answer 23

5 - focussed guided self help programme

If this does not work then can use group or individual cognitive behavioural therapy focused on eating disorders (CBT-ED)

Question 24

Other specified feeding and eating disorders (OSFED) is when a person experiences abnormal eating behaviours that do not meet the full criteria for any of the other disorders. Which of the following are signs of a patient with OSFED?

1 - Difficulties eating in front of others.
2 - Preoccupation with food.
3 - Low confidence and self-esteem.
4 - Negative body image.
5 - Irritability and mood swings.
6 - Tiredness and difficulty concentrating.
7 - Social withdrawal.
8 - Feelings of shame, guilt and anxiety.
9 - Secretive behaviour around food.
10 - all of the above

Answer 24

10 - all of the above

Question 25

Atypical anorexia is an example of Other specified feeding and eating disorders (OSFED). Which of the following matches the description of Atypical anorexia?

1 - purging (sick or using laxatives) to affect their weight or shape, but this is not as part of binge/purge cycles.
2 - all signs/symptom of anorexia nervosa, but ‘normal weight’
3 - cyclical binge eating of low frequency/intensity, not following by compensatory behaviour
4 - repeatably eating at night, either following their evening meal, or if they wake up in the night
5 - cyclical binge eating of low frequency/intensity, following by compensatory behaviour

Answer 25

2 - all signs/symptom of anorexia nervosa, but ‘normal weight’

Question 26

Bulimia nervosa is an example of other specified feeding and eating disorders (OSFED). Which of the following matches the description of Bulimia nervosa?

1 - purging (sick or using laxatives) to affect their weight or shape, but this is not as part of binge/purge cycles.
2 - all signs/symptom of anorexia nervosa, but ‘normal weight’
3 - cyclical binge eating of low frequency/intensity, not followed by compensatory behaviour
4 - repeatably eating at night, either following their evening meal, or if they wake up in the night
5 - cyclical binge eating of low frequency/intensity, followed by compensatory behaviour

Answer 26

5 - cyclical binge eating of low frequency/intensity, followed by compensatory behaviour

Question 27

Binge eating disorder is an example of other specified feeding and eating disorders (OSFED). Which of the following matches the description of Binge eating disorder?

1 - purging (sick or using laxatives) to affect their weight or shape, but this is not as part of binge/purge cycles.
2 - all signs/symptom of anorexia nervosa, but ‘normal weight’
3 - cyclical binge eating of low frequency/intensity, not following by compensatory behaviour
4 - repeatably eating at night, either following their evening meal, or if they wake up in the night
5 - cyclical binge eating of low frequency/intensity, following by compensatory behaviour

Answer 27

3 - cyclical binge eating of low frequency/intensity, not followed by compensatory behaviour

Question 28

Purging disorder is an example of other specified feeding and eating disorders (OSFED). Which of the following matches the description of Purging disorder?

1 - purging (sick or using laxatives) to affect their weight or shape, but this is not as part of binge/purge cycles.
2 - all signs/symptom of anorexia nervosa, but ‘normal weight’
3 - cyclical binge eating of low frequency/intensity, not following by compensatory behaviour
4 - repeatably eating at night, either following their evening meal, or if they wake up in the night
5 - cyclical binge eating of low frequency/intensity, following by compensatory behaviour

Answer 28

1 - purging (sick or using laxatives) to affect their weight or shape, but this is not as part of binge/purge cycles.

Question 29

Night eating syndrome can be an example of Other specified feeding and eating disorders (OSFED). Which of the following matches the description of Night eating syndrome?

1 - purging (sick or using laxatives) to affect their weight or shape, but this is not as part of binge/purge cycles.
2 - all signs/symptom of anorexia nervosa, but ‘normal weight’
3 - cyclical binge eating of low frequency/intensity, not following by compensatory behaviour
4 - repeatably eating at night, either following their evening meal, or if they wake up in the night
5 - cyclical binge eating of low frequency/intensity, following by compensatory behaviour

Answer 29

4 - repeatably eating at night, either following their evening meal, or if they wake up in the night

Question 30

Avoidant restrictive food intake disorder (ARFID) behaviours is another classification of eating disorders. Which of the following is NOT a characteristic of ARFID?

1 - concerned with weight
2 - concerned with perceptions about the appearance/shape
3 - avoid specific foods or food groups
4 - can cause weight loss and nutrient deficiency
5 - may require enteral feeding

Answer 30

1 - concerned with weight
- these patients are NOT concerned with their weight

-ARFID has a significant impact upon daily life, including impairment in personal, educational, occupational, social and other areas of functioning

Question 31

Avoidant restrictive food intake disorder (ARFID) behaviours characterised by the avoidance of specific foods/food groups that can cause weight loss and nutrient deficiencies. Which of the following is NOT a sign that a patient may have ARFID?

1 - lack of interest in eating
2 - emotional arousal can lead to increased food intake
3 - sensitive to specific characteristics of some foods (small, texture, etc)
4 - concerns about eating foods they avoid (vomiting, illness, etc.). This may be from a previous experience as well
5 - avoiding social events to avoid specific foods
6 - supplements taken to maintain nutritional needs

Answer 31

2 - emotional arousal can lead to increased food intake

• emotional stress typically leads to distraction and LESS eating

Question 32

Avoidant restrictive food intake disorder (ARFID) behaviours characterised by the avoidance of specific foods/food groups that can cause weight loss and nutrient deficiencies. Do patients with ARFID typically meet all their normal development targets when they are children?

Answer 32

• no
• often delays in typical development (for example, growth) can occur, especially where malnutrition is present.

Question 33

Avoidant restrictive food intake disorder (ARFID) behaviours characterised by the avoidance of specific foods/food groups that can cause weight loss and nutrient deficiencies. Typically does ARFID affect only children?

Answer 33

• no
• can affect any age, but more common in children
• Autistic people, people with a diagnosis of attention deficit hyperactivity disorder (ADHD) and people with anxiety disorders may be more likely to develop ARFID

Question 34

Avoidant restrictive food intake disorder (ARFID) behaviours characterised by the avoidance of specific foods/food groups that can cause weight loss and nutrient deficiencies. ARFID can be diagnosed in any age group, but affects children more. Which of the following mental health disorders has ARFID NOT been shown to occur more often in?

1 - autistic patients
2 - depressed patients
3 - attention deficit hyperactivity disorder (ADHD)
4 - anxiety disorders

Answer 34

2 - depressed patients

Question 35

Which 2 of the following best describes Pica, an eating disorder?

1 - consumption of liquid only diets
2 - consumption of 1 type of food
3 - consumption of non-nutrient substances (soil, clay, etc.)
4 - consumption of raw foods (salt, corn flour, etc.)

Answer 35

3 - consumption of non-nutrient substances (soil, clay, etc.)
4 - consumption of raw foods (salt, corn flour, etc.)

• PICA will continue until it has an impact upon the patients health and they require clinical attention

Question 36

Which of the following are characteristics of rumination-regurgitation disorder?

1 - intentionally bringing previously chewed food back up into mouth
2 - eating food brought back up, or spitting it out (NOT vomiting)
3 - regurgitation is regular (>2-3/week for several weeks), but can also be chronic or continuous
4 - regurgitation is NOT another medical condition, it is voluntary
5 - patients feel embarrassment and shame and become very secretive
6 - all of the above

Answer 36

6 - all of the above

Question 37

Young women and girls aged 12 to 20 years are most at risk of an eating disorder. Is this true or false?

Answer 37

• false
• only 1 to 2% of young women and girls are diagnosed with an eating disorder
• binge eating disorder is identified more in men than bulimia nervosa or anorexia nervosa.

Question 38

Eating disorders are a form of teenage attention seeking or rebellion. Is this true or false?

Answer 38

• false
• eating disorders are a sign of emotional distress

Question 39

Early detection saves lives. Is this true or false?

Answer 39

• true
• full recovery is possible.
• the sooner someone gets the treatment they need, the more likely they are to make a fast and sustained recovery.

Question 40

Patients with eating disorders have something wrong with their family and they are responsible. Is this true or false?

Answer 40

• false
• there may be underlying issues within a family, but this is not the cause of an eating disorder; families are the best allies in treatment.
• eating disorders begin from complex interactions of biological, genetic, social, cultural and environmental influences. It is estimated that 5 million people are impacted by disorders when family, friends and colleagues are considered.

Question 41

Eating disorders are just difficulties with eating. Is this true or false?

Answer 41

• false
• eating disorders are serious mental illnesses. They are a sign of emotional distress and are about more than just food.

Question 42

People with eating disorders want to starve themselves to death. Is this true or false?

Answer 42

• false
• many people with eating disorders do not starve themselves at all and eating disorders can present in many ways. People of any weight can experience an eating disorder.

Question 43

During a consultation, which of the following are often red flags that a patient may have an eating disorder?

1 - low or high BMI
2 - rapid weight loss.
3 - dieting or restrictive eating that causes concern to them or others.
4 - family/friends/carers reporting changes in their eating behaviour.
5 - social withdrawal, particularly from situations involving food
6 - all of the above

Answer 43

6 - all of the above

Question 44

During a consultation, which of the following is NOT a red flag that a patient may have an eating disorder?

1 - unconcerned with weight and body shape
2 - problem managing chronic illness (diabetes or coeliac disease)
3 - menstrual or other endocrine disturbances, or GIT symptoms​
4 - unexplained electrolyte imbalance or hypoglycaemia.​
5 - atypical dental wear
6 - activities associated with eating disorders (modelling, dance, etc.)

Answer 44

1 - unconcerned with weight and body shape
- patients typically have an disproportionate concern with weight and body image

Question 45

Do patients with eating disorders have increased stress by not eating?

Answer 45

• no
• patients use not eating as a coping strategy
• patients feeling not eating reduces stress

Question 46

In patients with eating disorders, which of the following behaviours does NOT occur?

1 - nutritional decrease
2 - hyperactivity
3 - anxiety, intense negative emotions increases.
4 - numbing of negative and positive emotions.

Answer 46

2 - hyperactivity

• patients also lose the ability to cope and attention to threat, rigid rule by habits and routines increases.

Question 47

CVD is the most common cause of death attributed to patients with eating disorders, with 4 out of 5 being related to physical illness. Which of the following is NOT a common finding in patients with eating disorders that can increase mortality risk?

1 - severely underweight
2 - chronic illness
3 - chronic hyponatraemia
4 - chronic hypokalaemia
5 - ECG
6 - chronically low serum albumin

Answer 47

3 - chronic hyponatraemia
- can occur but not commonly and is not associated with an increased risk of mortality

Question 48

Which part of the brain is responsible for self-regulation, rational thinking and regulating thoughts and behaviours?

1 - midbrain
2 - forebrain
3 - temporal lobe
4 - hippocampus

Answer 48

2 - forebrain
- this is often the most sensitive to starvation and most affected

Question 49

In people without eating disorders, a chemical reaction in the brain tells them they are hungry and to eat. If they don’t eat they can become irritable and try to seek food. Following eating, people get a sensation of reward and pleasure. Does the same occur in patients who have an eating disorder respond in the same way?

Answer 49

• no
• patients with eating disorders become calmer when they dont eat

Question 50

Which of the following is NOT a risk factor for eating disorders?

1 - genetics
2 - age/biology/puberty etc..
3 - gender
4 - psychological traits (perfectionism, low self-esteem and shyness)
5 - stressful life events (need for control)
6 - family environment

Answer 50

3 - gender

Question 51

Do patients with an eating disorder present to A&E?

Answer 51

• yes
• 16% of all A&E patients have an eating disorder
• 1.6 x more likely to attend A&E

Question 52

What % of the worldwide population is estimated to have an eating disorder?

1 - 0.9%
2 - 9%
3 - 29%
4 - 59%

Answer 52

2 - 9%

Question 53

Which scoring tool can be used in patients with anorexia nervosa or bulimia nervosa?

1 - SCOFF
2 - BEDS-7
3 - ACE-III
4 - all of the above

Answer 53

1 - SCOFF
- Sick, Control, One, Fat, Food

• BEDS-7 is used for binge eating disorder

Question 54

SCOFF (Sick, Control, One, Fat, Food) can be used as a scoring tool to assess the risk of anorexia nervosa or bulimia nervosa. Which of the following is NOT one of the questions in SCOFF?

1 - Do yo often bring food back up intentionally that is not vomiting?
2 - Do you ever make yourself sick because you feel uncomfortably full?
3 - Do you worry you have lost control over how much you eat?
4 - Have you recently lost more than 1 stone in a 3-month period?
5 - Do you believe yourself to be fat when others say you are too thin?
6 - Would you say that food dominates your life?

Answer 54

1 - Do yo often bring food back up intentionally that is not vomiting?
- this occurs in rumination-regurgitation disorder

• 1 point per yes
• score >2 suggests anorexia nervosa or bulimia nervosa

Question 55

In patients with type 1 diabetes, diabetic ketoacidosis can occur in patients with eating disorders due to restricting insulin to lose weight. What % of type 1 diabetics do this?

1 - 5.4%
2 - 15.4%
3 - 35.4%
4 - 54.5%

Answer 55

4 - 54.5%

Question 56

Which risk management guideline should be used in patients who are suspected of having an eating disorder?

1 - MARSIPAN
2 - MEED
3 - Junior MARSIPAN
4 - all of the above

Answer 56

2 - MEED
- Medical Emergencies in Eating Disorders

Question 57

In patients with eating disorders, which of the following is NOT a red alert when using MEED?

1 - BMI <13.
2 - %BMI <70%.
3 - rapid weight loss (1kg per week for 2 consecutive weeks)
4 - <56cm waist circumference

Answer 57

4 - <56cm waist circumference

Question 58

Bradycardia (<40bpm), standing SBP <90mmHg and postural hypotension (>20mmHg) are all red alert signs in patients with eating disorders according to MEED. Which of the following are clinical signs to look for?

1 - reduced urine output
2 - dry mouth
3 - decreased skin turgor
4 - sunken eyes
5 - tachypnoea (rapid breathing)
6 - tachycardia
7 - all of the above

Answer 58

7 - all of the above
- all are associated with dehydration

Question 59

There are lots of signs that a patient has an eating disorder. One of these is Russells sign, what is this?

1 - reduced skin turgor and broken skin
2 - anuria
3 - bite marks on knuckles
4 - triad of all 3

Answer 59

3 - bite marks on knuckles

Question 60

When assessing patients bloods in suspected eating disorders, would we expect their bloods to be high, low or normal?

Answer 60

• most will be normal
• HbA1c will be high
• transaminase will be high (involved in amino acid metabolism)

Question 61

According to the Medical Emergencies in Eating Disorders (MEED) risk assessment, which 2 of the following are classed as a red risk?

1 - Acute food refusal or intake <500kcal/day for >2 days, and physical struggles with staff, parents or carers over nutrition or reduction of exercise.
2 - resistance to weight gain. Staff, parents or carers unable to implement meal plan prescribed.​
3 - uncontrolled exercise in the context of malnutrition (more than 1 hour per day). Regular (more than 3x per week) vomiting and laxative abuse.
4 - high levels of physical activity/ exercise (>2h) on a regular basis with multiple episodes of vomiting or laxative use
5 - some insight and motivation to tackle eating problems. May be ambivalent but not actively resisting

Answer 61

1 - Acute food refusal or intake <500kcal/day for >2 days, and physical struggles with staff, parents or carers over nutrition or reduction of exercise.

4 - high levels of physical activity/ exercise (>2h) on a regular basis with multiple episodes of vomiting or laxative use