Eating Disorders Flashcards
What are eating disorders?
Psychiatric conditions involving unhealthy and distorted obsession with body image and food
What are the different types of eating disorders?
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Other specific feeding or eating disorder
Avoidant restrictive food intake disorder
What happens in anorexia nervosa?
Person feels they are overweight despite being low body weight
Obsessive calorie restriction to lose weight
Highest mortality of psychiatric conditions
What may a patient with anorexia nervosa use to lose weight?
Diet pills
Laxatives
What are the features of anorexia nervosa?
Weight loss (BMI less than 17.5)
Amenorrhoea
Lanugo hair
Hypotension
Hypothermia
Mood changes
What causes amenorrhoea in anorexia nervosa?
Less adipose tissue, oestrogen production also takes places in adipose tissue, less oestrogen
Disruption of the hypothalamic-pituitary-gonadal axis
Lack of gonadotrophins causing reduced activity of the ovaries
What can happen to the heart in anorexia?
Loss of cardiac muscle
Patients can present with new murmurs due to loss of myocardium
What test can be used to assess muscle wasting in patients with anorexia?
Sit-up-squat-stand test
Patient lies flat on the floor and attempts to situp without their hands and then in squat position
Red flag if patient unable to do this
What are the ICD-11 essential features for anorexia nervosa diagnosis?
Significantly low body weight
- Adults BMI less than 18.5
- Children BMI < 5th percentile or failure to gain weight as expected
- Rapid weight loss, 20% in 6 months
Low body weight not explained by other medical condition or food availability
Persistent pattern of restrictive eating or behaviours to maintain low body weight
- Fasting
- Low calorie food
- Excessively slow eating of small amounts of food
- Hiding food
- Chewing and spitting
- Purging behaviours
Increased energy expenditure
Excessive preoccupation with body, weight and shape
- Repeatedly checking body weight
- Repeatedly looking n the mirror
- Extreme avoidant behaviours
What is bulimia nervosa?
Binge eating followed by purging by induced vomiting or taking laxatives
What are some differences between bulimia nervosa and anorexia nervosa?
People with bulimia tend to have normal body weight
Weight can fluctuate
What are the features of bulimia nervosa?
Teeth erosion
Swollen salivary glands
Mouth ulcers
Gastro-oesophageal reflux
Calluses on knuckles where they have been scraped across teeth (Russell’s sign)
Why does alkalosis occur in bulimia?
Repetitive loss of hydrochloric acid from the stomach
What are the essential features of the ICD-11 for bulimia nervosa diagnosis?
Frequent, recurrent episode of binge eating
- Once a week or more for at least a month
Repeated inappropriate behaviours to prevent weight gain
Once a week or more over a period of at least a month
- Self induced vomiting
- Fasting, diuretics, laxatives
- Insulin omission
Excessive preoccupation with body weight
Marked distress about pattern of binge eating and inappropriate compensatory behaviours
Binges can be objective or subjective
- Loss of control over eating
What is the binge-purge cycle?
Strict dieting
Diet slips or difficult situation arises
Binge eating triggered
Purging to avoid weight gain
Feelings of shame and self-hatred
What is binge eating disorder?
Episode where person excessively overeats
Expression of underlying psychological distress
Person typically feels a loss of control
What do binges involve?
Planned binge
Eating very quickly
Unrelated to hunger
Becoming uncomfortably full
Eating in a dazed state
What can trigger a binge eating episode?
- Not eating regularly
- Not eating enough
- Upset or angry
- Broke rule “blown it, may as well carry on