eating disorders Flashcards
anorexia nervosa
-Restriction of energy intake below requirements -> low body wt for pts age, sex, developmental trajectory, and physical health
-Significantly low wt = wt < minimal normal wt or, in children and adolescents, < minimal expected wt
-Intense fear of gaining wt or becoming fat, or persistent behavior that interferes with wt gain, even though pt has significantly low wt
-Disturbance in way in which body wt or shape is experienced
-influence of body wt on self-evaluation
-lack of recognition of seriousness of current low body wt
anorexia nervosa: DSM-5 criteria
-restriction of energy intake leading to significantly low body wt (compared to minimally expected for age, sex, developmental trajectory, and physical health)
-Typically BMI < 17.5 or <85% of expected body weight (EBW)
-intense fear of gaining wt or becoming fat, OR persistent behavior that interferes with wt gain (even though significantly low wt)
-Disturbance in way body wt or shape is experienced, influence of body shape and wt on self-evaluation, or lack of recognition of seriousness of current low body wt
-Behaviors present at least 3 months
labs: anorexia
-Leukopenia
-Hypoglycemia
-Hypokalemic, hypochloremic metabolic alkalosis (if purging)
-EKG Changes-ST depression, T wave flattening/inversion, prolonged QTC
clinical features of anorexia
-Intense desire for thinness often despite starvation
-Starvation related medical symptoms:
-Amenorrhea
-Hypothermia
-Fatigue/weakness
-Dependent edema, cold/swollen extremities
-Cardiac arrhythmias: tachy, bradycardia
-Gastric bloating, abdominal pain, constipation
-Seizure
-Lanugo- fine baby hair
-Tooth decay
anorexia behaviors
-Preoccupied with food
-Loss of appetite- RARE, LATE
-Peculiar food related behaviors
-Abuse of laxatives/diuretics
-Excessive ritualistic exercise
-Rigid, perfectionistic
-Somatic complaints
-Lack of sexual drive
bulimia nervosa: DSM-5 criteria
-Recurrent episodes of binge eating
-binge eating:
-Eating, in a discrete period of time (within any 2hr period!!!), amount of food that is larger than most people would eat
-lack of control of eating during episode (feeling you cant stop eating or control what or how much your eating)
bulimia
-Recurrent compensatory behavior to prevent weight gain -> self-induced vomiting, misuse of laxatives, diuretics, or other meds, fasting, or excessive exercise
-binge eating and compensatory behaviors both occur at least 1x week for 3 months
-Self-evaluation is influenced by body shape and wt
-Binging or purging does not occur exclusively during episodes of behavior that would be common in those with anorexia nervosa
clinical features of bulimia nervosa
-Consider premorbid hx of anorexia
-Binges usually secretly: food eaten rapidly, sometimes w/o chewing
-Usually high calorie foods, sweet with smooth soft texture
-Vomiting usually with fingers but some can vomit at will
-About 50% of anorexics will eventually meet criteria for bulimia nervosa.
-It’s HARD to be anorexic and often rigid “control” and restricting breaks down and pt begin the binge-purge cycle.
-russels sign
pathology and lab examine in bulimia
-Malnutrition may not be as obvious in bulimics as it is in anorexia
-Dehydration is common purgers
-Electrolyte abnormalities: decreased Mg, hypokalemia, decreased chloride (metabolic alkalosis) in pts who vomit, use laxatives repeatedly
-Gastric ulcers
-Gastric, esophageal tears
-Esophageal cancer
-Hypotension, bradycardia
psychological factors associated with bulimia
-Difficulties with impulse control: substance abuse, shoplifting, self-injurious behaviors/suicide attempts, destructive emotional relationships
-More outgoing, angry, emotionally labile
-Many meet criteria for Borderline Personality Disorder, Bipolar Disorder II
-Bulimics have a better prognosis compared w/ anorexics
binge eating disorder: DSM-5 criteria
-Recurrent episodes of binge eating
-associated with 3+ of following:
-eating much more rapidly than normal
-eating until feeling uncomfortably full
-eating large amounts of food when not feeling physically hungry
-eating alone because of feeling embarrassed by how much one is eating
-feeling disgusted with oneself, depressed or very guilty afterward
binge eating disorder
-Marked distress regarding binge eating is present
-Binge eating occurs at least 1x week for 3 months
-Binge eating does not include use of compensatory behaviors as in Bulimia Nervosa and does not occur exclusively during the course of Bulimia Nervosa, or Anorexia Nervosa methods to compensate for overeating, such as self-induced vomiting.
-Note: Binge Eating Disorder is less common but much more severe than overeating. Binge Eating Disorder is associated with more subjective distress regarding the eating behavior, and commonly other co-occurring psychological problems
treatment of eating disorders
-Hospitalization: When do we admit/commit a patient?
-When the risk of death is likely:
- malnutrition
- dehydration
- electrolyte imbalance
- BW 20% less than expected norm
- BW 30% less than expected norm usually requires long term care
- SI
-Expect resistance from anorexics!
-Bulimics rarely require admission
inpatient tx of AN and BN
-Daily weight
-Monitoring Is and Os (input and output)
-Monitoring electrolyte levels
-Small meals to prevent circulatory overload, total 500 calories over what is needed to maintain present weight
-Bathroom observation
-Stool softeners for constipation-never laxatives!
-+/- Reinforcement
-Education
-Medication
-CBT, group therapy
pharmacotherapy of eating disorders
-Antidepressants (especially SSRI’s) have shown effectiveness
-Higher doses typically required compared to mood disorders
-Rate of compliance better with bulimics compared to pts with anorexia
eating disorder chart
