Eating Disorders

Question 1

epidemiology of eating disorders

Answer 1

*gender ratio = 3:1 female:male
*age of onset: anorexia 13-18yo; bulimia 16-17yo
*similar prevalence among ethnic groups except higher rates of AN among non-latina whites

Question 2

anorexia nervosa - DSM-5 criteria

Answer 2

*restriction of energy intake that leads to low body weight (BMI < 18.5; < 5th percentile for children) (MUST BE UNDERWEIGHT TO QUALIFY)
*intense fear of gaining weight or becoming fat, despite being underweight
*distorted perception of body weight/shape, undue influence of these on self-worth, denial of medical danger of being underweight

Question 3

anorexia nervosa - subtypes

Answer 3

*restricting type
*binge-purge type

Question 4

anorexia nervosa - risk + precipitating factors

Answer 4

*family hx
*going on a diet
*weight loss
*onset of puberty
*athletics (ballet, cross country, wrestling)
*life/family stressors
*anxious, obsessive personality structure
*low conflict, highly controlling family dynamics

Question 5

anorexia nervosa - health consequences

Answer 5

*orthostasis or hypotension
*bradycardia, arrhythmia, heart failure
*osteoporosis
*constipation
*hypothermia
*delayed sexual maturity
*stunted growth
*hair loss, dry skin
*lanugo growth

10-20% mortality rate (all cause)

Question 6

anorexia nervosa - criteria for MEDICAL hospitalization

Answer 6

*<75% ideal body weight
*hypothermia (<35.5 C)
*bradycardia
*orthostasis
*dehydration
*potassium
*re-feeding syndrome

Question 7

re-feeding syndrome

Answer 7

*metabolic abnormalities resulting from reinstatement of nutrition to MALNOURISHED patients
*potentially fatal
*findings:
-low phosphate
-edema
-tachycardia
-hypoglycemia

Question 8

treatment of anorexia nervosa

Answer 8

*medical stabilization
*nutrition + WEIGHT GAIN
*primary care, mental health provider, dietician
*for adolescents: Family-Based treatment (psychotherapy)

Question 9

bulimia nervosa - DSM-5 criteria

Answer 9

*recurrent episodes of BINGE EATING
*recurrent episodes of COMPENSATORY BEHAVIOR (purge)
*binge and purge occur > 1x/week for at least 3 months
*self-evaluation unduly influenced by body shape/weight
*does not occur exclusively during episodes of anorexia nervosa

Question 10

bulimia nervosa - risk, precipitating, and perpetuating factors

Answer 10

*childhood obesity
*early pubertal maturation
*trauma history (esp sexual abuse)
*impulsivity/high risk taking behavioral style
*self-harm behaviors
*dx of borderline
*severe restrictions/”taboo” foods dieting

Question 11

health consequences of bulimia nervosa

Answer 11

*orthostasis
*hypokalemia
*cardiac arrhythmias
*dental
*parotid hypertrophy
*conjunctival hemorrhages
*sore throat, acid reflux
*esophagitis
*hematemesis
*elevated CK

Question 12

treatment of bulimia nervosa

Answer 12

*CBT + SSRI (high dose fluoxetine [60+mg/day] - reduces binge-purge)

bupropion is contraindicated

Question 13

binge eating disorder - DSM-5 criteria

Answer 13

*recurrent episodes of binge eating
*associated with 3+ of:
-eating more rapidly than normal
-eating until uncomfortably full
-eating large amounts when not physically hungry
*at least 1x/week for 3 months
*NO COMPENSATORY BEHAVIOR

Question 14

risk + precipitating factors for binge eating disorder

Answer 14

*family hx
*obesity
*depression
*poor coping skills

Question 15

treatment for binge eating disorder

Answer 15

*CBT
*self-help groups (overeaters anonymous, food addicts anonymous)
*Lisdexamfetamine = FDA approved med (at high dose)