Eating Disorders

Question 1

What is the definition of anorexia nervosa?

Answer 1

Maintenance of low body weight as a result of preoccupation with weight, construed as either a fear of fatness or a pursuit of thinness.

Question 2

What age range and gender has the highest incidence of anorexia nervosa?

Answer 2

Females aged 15-19 years

Question 3

What kind of personality traits do people with anorexia nervosa tend to have?

Answer 3

Often isolated
Usually conflict-avoidant

Question 4

What are some features on examination of someone with anorexia nervosa?

Answer 4

BMI <17.5kg/m2
Hypotension
Bradycardia
Hypothermia (red flag)
Enlarged salivary glands
Lanugo hair
Amenorrhoea (hypogonadotrophic hypogonadism)
Low score on sit-up-squat-stand test (red flag)

Question 5

What are some investigations for anorexia nervosa?

Answer 5

FBC
ESR + TFTs (normal in anorexia, raised indicates other cause of weight loss)
U+Es
LFTs
Blood glucose
ECG

Question 6

What are some typical blood results in anorexia nervosa?

Answer 6

Deranged electrolytes (low calcium, magnesium, phosphate and potassium)
Low sex hormone levels (FSH, LH, oestrogen and testosterone)
Leukopenia
Raised growth hormone and cortisol levels (stress hormones)
Hypercholesterolaemia
Metabolic alkalosis

Question 7

What scoring system is used to assess physical risk in anorexia nervosa?

Answer 7

MARSIPAN

Question 8

What is the treatment of anorexia nervosa in under 18s?

Answer 8

Anorexia-nervosa-focused family therapy (1st line)

If severely ill then inpatient treatment may be required

Question 9

What is the treatment for anorexia nervosa in adults?

Answer 9

Psychological treatment:
Individual eating-disorder-focused cognitive behavioural therapy (CBT-ED)
Maudsley Anorexia Nervosa Treatment for Adults (MANTRA)
Specialist supportive clinical management (SSCM)

If severely ill, inpatient treatment may be required

Question 10

What are some complications of anorexia nervosa?

Answer 10

Refeeding syndrome
Cardiac arrhythmias
Osteoporosis

Question 11

Who is most at risk of refeeding syndrome?

Answer 11

Severely underweight
Rapid weight loss
Minimal intake in preceding 7-14 days

Question 12

What is the pathophysiology behind refeeding syndrome?

Answer 12

Re-feeding stimulates insulin production which causes potassium/magnesium/phosphate to be taken into cells whilst serum levels fall
Rapid change in BMR + serum electrolyte depletion causes the physical syndrome

Question 13

What is the management of refeeding syndrome?

Answer 13

Low energy replacement with high phosphate content building up every 2-3 days
Vitamin supplementation for at least 10 days
Daily monitoring of bloods
Correct electrolyte and fluid imbalances

Question 14

What ECG changes are often seen in anorexia nervosa?

Answer 14

Bradycardia
Prolonged QTc

Question 15

What is the definition of bulimia nervosa?

Answer 15

Repeated episodes of uncontrolled overeating followed by compensatory weight loss behaviours.

Question 16

What is the peak age incidence of bulimia nervosa?

Answer 16

15-25 years

Question 17

What kind of personality traits do people with bulimia nervosa tend to have?

Answer 17

Isolated or popular
Often conflict-attracted but can be avoidant
Often impulsive
Can be obsessional
Often independent high achievers

Question 18

What are some physical symptoms of bulimia nervosa?

Answer 18

Dental erosion
Parotid gland swelling
Russell’s sign

Question 19

What are same investigations of bulimia nervosa?

Answer 19

Bloods (often normal apart from serum potassium which is often low)

Question 20

What is the management of bulimia nervosa in under 18s?

Answer 20

Bulimia-nervosa-focused family therapy (1st line)

Inpatient treatment not recommended unless serious complications (eg very low weight or cardiac defects associated with hypokalaemia)

Question 21

What is the management of bulimia nervosa in adults?

Answer 21

Guided self help
Individual eating-disorder-focused CBT (CBT-ED) where self help is ineffective or not an option
Fluoxetine (up to 60mg daily)

Inpatient treatment not recommended unless serious complications (eg very low weight or cardiac defects associated with hypokalaemia)

Question 22

What is the definition of ARFID?

Answer 22

Avoidance and/or restriction of certain foods or types of foods

Question 23

What conditions are associated with ARFID?

Answer 23

ASD
Anorexia
Bulimia
Anxiety disorder

Question 24

What is the pathophysiology behind ARFID?

Answer 24

Sensory based (eg texture, smell, etc)
Concern regarding consequences of eating particular foods (eg fear of vomiting leading to restriction to safe foods)
Little interest in eating (little recognition or generally poor appetite)

Question 25

What is the management of ARFID?

Answer 25

Tailored to individual needs:
Anxiety driven - CBT or SSRI
ASD - help with sensory problems
Nutritional input

Question 26

What is the definition of binge eating disorder?

Answer 26

Person feels compelled to overeat on a regular basis.

Question 27

What is the aetiology behind binge eating disorder?

Answer 27

Identified in males more often than any other eating disorder
Often associated with obesity
More common in adults, onset age 20+

Question 28

What are some personality traits of binge eating disorder?

Answer 28

Often isolated and/or conflict-avoidant
Often depressed and anxious
Often exercise avoidant

Question 29

What is the management of binge eating disorder?

Answer 29

Self-help CBT with support sessions
Individual or group CBT