Eating Disorders Flashcards
Eating disorders
A persistent disturbance of eating behaviour or behaviour intended to control weight which impairs physical health or psychosocial functioning
Driven by fear of fatness or extreme distress about eating
Disturbance of eating behaviour
Binge eating
Restricted eating on quantity and range
Behaviour intended to control weight
Restricted eating (fasting)
Self induced vomiting
Excessive exercise
Laxative diuretics and other energy burning or appetite suppressing medications eg caffeine or smoking
Physical health impact
Impacts growth and development
Stop periods
Effects on brain
Reuksting in osteoporosis
High mortality
Psychosocial function
Functional impairment
Impacts work relationships daily living
Distress
DSM5 and ICD11 feeding and eating disorders
Anorexia nervosa
Bulimia nervosa
Binge eating disorder
Other specific feeding and eating disorders (OSFED)
Avoidant/restrictive food intake disorder
Rumination disorder
Pica
Anorexia nervosa
Restriction of energy intake relative to requirements leading to low body weight
Intense fear of gaining weight or becoming fat or persistent behavior that interferes with weight gain
Disturbance in weight/shape,lack of recognition of low body weight
(Amenorrhea not in DSM5]
Subtypes:restricting vs binge eating and purge
Bulimia nervosa
Over eating episodes
Large amounts of food in discrete time
Sense of lack of control
Inappropriate compensatory mechanisms
Body image disturbances
Occur at least 1 times a week for more than 4 weeks
Binge eating disorder
Episodes of over eating at least once a weak for 4 weeks
No or minimal compensation
Hence frequently overweight
Purging disorder
Recurrent purging behavior to influence weight or shape (eg self induced vomiting,misuse of laxatives,diuretic or other medications including insulin) in the absence of binge eating
OSFED-atypical AN,purging,atypical BN and night eating syndrome
ARFID
Replaced and extends feeding disorders of infancy and early childhood
Feeding and eating disturbances causes significant weight loss,nutritional deficiency,depends on enteral feeding/nutritional supplements
No weight or shape concerns
Three types of ARFID
Individuals that don’t eat
Individual that accepts a limited diet in relation to sensory information
Individuals whose food refusal is related to aversive experience
Combined subtype
Key messages of meed
Medical teams need to actively treat
Refeeding
Manage fluid and electrolyte
Manage behavior
Arranging discharge to apporopriate settings
Provide onward care,concerns,compulsion,advise on complex comorbidity
Are eating disorders genetic
Yes they run in the family
What kind of disorder are ED
Metabolic psychological disorders
This reduces stigma and blame,can identify important gene environments interactions,might inform treatment decisions,can help develop interventions
Childhood eating behaviour and appetite
Children with AN more likely to have had early feeding and GI problems,picky eating,mealtime conflict
Children with BN were less picky and ate faster tending to overeat
Genetic factors linked to obesity also drive eating behaviour (FTO gene)
Psychological risk factor
Personality/temperament
Neurocognition
Self esteem
Psychopathy
Behaviour
Sociocultural risk factors
Family
School/oeers
Wusses social influences
Psychological
Perfectionism
High self esteem protective for AN
low self esteem is a risk factor for bulimic and compulsive eating
Anxiety and OCD increases risk of AN
Externalising disorders eg ADHDZ depression increase risk of BN
Family influences
No evidence for family interaction
Maternal emotional well-being and protective parenting style problem important
Maternal dieting and paternal comments about weight influence girls but not boys
Sociocultural factors
Increasing in developing countries
Social pressures to be thin
Social media
Psychological interventions
Children:ED focused family therapy,CBT,adolescent focused therapy
Adults:MANTRA(AN on,y),SSCM(AN only),CBT
Psycho education on effects of starvation and adverse effects of self induced vomiting or laxatives for example
Medications
SSRIs for anxiety or depression
Olanzapine/aripiprazole to reduce emotional dysregulation during Refeeding
Long term complications
Death
Growth stunting
Osteoporosis
Pregnancy complications
Dental erosion
Mental health comorbidity including substance misuse
Outcome of ed
Most young people do into remission (80%)
Some relapse in adulthood
Later onset and certain personality treats increase likelihood of persistence
