Eating Disorders Flashcards
What is an eating disorder?
- mental disorder
- persistent disturbance of eating behaviour or behaviour intended to control weight which significantly impairs physical health or psychosocial functioning
- driven by fear of fatness or extreme distress about eating
What are the two disturbances of eating behaviour?
- binge eating
- restricted eating (quantity or range)
What are behaviours intended to control weight?
- fasting
- self-induced vomiting
- excessive exercise
- laxative, diuretic or other energy burning and appetite supressing medication
How do eating disorders impair physical health?
- impacts growth and development
- stops periods
- affects brain
- osteoporosis
- high mortality
How do eating disorders impair psychosocial function?
- work
- relationships
- daily living
- distress
What are the eating disorders in the DSM-5 and ICD11?
- anorexia nervosa
- bullimia nervosa
- binge eating disorder
- other specified feeding and eating disorder (OSFED)
- avoidand/restrictive food intake disorder (ARFID)
- rumination disorder
- pica
Wat are the key symptoms of anorexia?
- restriction of food intake leading to significantly low body weight
- intense fear of gaining weight or persistent behaviour that interferes with weight gain
- disturbance in experience of weight/shape
What are the sub-types of anorexia?
- restricting
- binge-purge
What are the syptoms of bullimia?
- characterised by binging rather than purging
- overeating episodes (large amount of food and lack of self control)
- inappropriate compensatory mechanisms
- body image disturbance
- occurs once a week for at least 3 weeks
What are the symptoms of binge eating disorder?
- episodes of overeating
- no or minimal compensation
- frequently overweight
What is purging disorder?
- purging without binging
- vomiting, laxatives, diuretics or other medications including insulin
- weight is often normal
Which disorders come under OSFED?
- atypical anorexia
- purging disorder
- atypical bullimia
- night eating disorder
What are the symptoms of ARFID?
- eating disturbance
- significant weight loss
- significant nutritional deficiencies
- dependance on enteral feeding or nutritional substances
- interference with psychosocial functioning
- no weight/shape concerns
What are the three main subtypes of ARFID?
- not eating enough/little interest in eating
- diet is limited due to sensory issues
- refusing food because of adverse experiences
What is the epidemiology of eating disorders?
- relativrly common in childhood and adolescence
- around 40% of adolescent girls show ED behaviours by age 16 but only 11% diagnosable
- incidence of anorexia and bullimia are stable
- OSFED and BED are increasing
- anorexia is most common in clinic
What is the peak onset for eating disorders in women?
15-19
What is the most prevelant eating disorder?
Binge eating disorder
What is the guidance used for medical emergencies caused by eating disorders?
MARSIPAN guidance
What does the medical team need to do for ED patients in a medical emergency?
- actively treat patient
- safe refeeding
- managing fluid and electrolyte imbalances
- arranging discharge to an appropriate setting
- managing ED behaviours
What does the mental health team need to do for ED patients in a medical emergency?
- assess and treat patients under compulsion
- address family concerns
- advise on appropriate onward care
- advise on patients with complex comorbidities (e.g personality disorders or autism)
What are key points to consider in treating patients with an eating disorder?
- they are not visible
- normal bloods do not mean things are ok
- cardiovascular parameters are the best pointer to risk
- intake and rate of weight loss > weight
- red for risk means ask someone who knows
What are the family risk factors for eating disorders?
- history of dieting/eating disorders
- history of depression, anxiety or alcohol dependence
- history of obesity
What are some individual risk factors for eating disorders?
- female
- genetics
- premature birth
- low self esteem
- perfectionism
- previous depression or anxiety
- previous obesity
- early puberty
- diabetes
- Crohn’s disease
- temperment
- neurocognition
- life events
- trauma
How do eating disorders become self-perpetuating?
- weight loss from diet leads to starvation-induced changes
- increses anxiety, depression and obsessionality
- leads to chronic illness
What is the most common model for the onset of eating disorders?
- Stice and Argas dual pathway model
- updated Stice and Shaw dual pathway takes into acount that high BMI increases likelihood of developing an eating disorder and that there is a range of eating pathologies
What is the triad of evidence based practise?
- best scientific evidence
- clinical experience
- patient preference
What is the best scientific evidence for eating disorders?
- evidence of effectiveness of existing treatments is weak across the age range
- few large scale randomized controlled treatment trials and many show no difference between treatment arms
What are the main psychological interventions for children and young people with eating disorders?
- ED focused family therapy
- CBT
- adolescent focused therapy for anorexia
What are the main psychological interventions for adults with eating disorders?
- MANTRA and SSCM for anorexia
- CBT
What does psychoeducation for eating disorders focus on?
- effects of starvation on the body and mind
- regulating body weight
- dieting
- adverse effects of inappropriate compensatory behaviours
What is the goal of psychological interventions for eating disorders?
- increasing confidence in making good decision when coping with stress which don’t include food or eating
What are the most common medications used for eating disorders?
- SSRIs for depression and anxiety
- olanzapine or aripiprazole to reduce emotional dysregulation during refeeding
What are the key things to remember about medication for eating disorders?
- should never be used on its own
- tend to manage comorbidities or support symptoms short-term
What are the long term complications of eating disorders?
- death
- growth stunting
- osteoporosis
- pregnancy complications
- dental erosison
- mental health comorbidities
- substance misuse
What are the outcomes for eating disorders?
- 80% of young people go into remission
- later onset and certain personality traits increase likelihood of persistence
What are possible triggers and maintaing factors for eating disorders?
- puberty
- socio-cultural pressures
- family
- pressure to achieve
- peer behaviours
- comments about weight
