Eating Disorders Flashcards
Eating disorders typically affect
Perfectionist, high achieving young women with low self-esteem
What is Anorexia nervosa
Persistent pattern of reduced energy intake, purging behaviours, and/or increased energy expenditure associated with a significantly low bodyweight - usually associated with fear of gaining weight
What is bulimia nervosa
Frequent recurrent episodes of bingeing e.g. 1 weekly/monthly followed by repeated inappropriate purging. Normal bodyweight typically
What is binge eating disorder
Pattern of bingeing seen in BN, accompanied by feelings of guilt and disgust but without the compensatory purging ∴ can lead to obesity.
What is ARFID
Avoidant/restrictive food intake disorder - lack of quantity/variety of food to meet energy requirements, without bodyweight/shape concerns.
AN epidemiology
- Mostly affected westernised societies, white people moreso
- Onset16-22F,12M
BN epidemiology
- More common than AN
- Starts in adolescence
- Typically history of AN
- Comorbid with depression, anxiety and substance misuse.
AN presentation
- BMI<17.5 (or weight 15% less than expected) = weight(kg)/[height(m)]2
- Deliberate weight loss: restrict calorie intake by avoiding ‘fattening’ foods and may use laxatives, vomiting, excessive exercise, appetite suppressants, thyroxine, diuretics, stimulant (coke). Diabetics ‘skip’ insulin doses to prevent fat deposition.
- Distorted body image - preoccupied with body shape, dread weight gain, overvalued ideas that they are fat despite being very thin
- Endocrine dysfunction (HPG axis affected ∴ amenorrhea in women, impotence in men, loss of libido. (May also get developmental delay/arrest in adolescence).
AN physical exam
- Emaciation
- Dry skin/brittle hair
- Lanugo hair
- Delayed secondary sexual characteristics
- Russell’s sign
- Bradycardia
- Low BP
- QT prolongation (hypo K)
- Echo: decreased heart size, decreased LV mass, mitral valve prolapse ∴ cardiac failure/ sudden cardiac death
- Muscle wasting
Metabolic findings in AN
Gs and Cs raised: GH, glucose, salviary glands, cortisol, cholesterol, carotinemia.
AN investigations
- Bedside: Physical exam, obs, height weight and BMI. Squat test to test for proximal myopathy. SCOFF/MARSIPAN screening.
- Bloods: FBC, ESR, TFTs, U&Es, LFTs
- Imaging ECG, DEXA for bone density
AN management domains
- Psychotherapy
- Nutrition
- Medical treatment
- Inpatient admission
AN weight management
Realistic target negotiated (0.5-1kg per week). Eating plan also made.
AN psychotherapy 1st line options
- CBT-ED
- Maudsley Anorexia Nervosa Treatment in Adults (MANTRA)
- Specialist Supportive Clinical Management (SSCM)
- Offer each one individually before moving onto ED focussed focal psychodynamic therapy (FPT) or 2nd line = AFP.
When should inpatient admission be considered in AN
- BMI < 13
- Serious physical health risk
- High suicide risk
Mental health act may be needed to enable compulsory feeding
