Eating Disorders

Question 1

What is the DSM 5 criteria for anorexia nervosa?

Answer 1

1. Restriction of energy intake relative to requirements lading to reduced body weight.
2. Intense fear of gaining weight.
3. Disturbence in way in which one’s body shape is experianced.

Question 2

Management of anorexia nervosa?

Answer 2

Adults - CBT-ED (individual eating-disorder -focused CBT), MANTRA, SSCM (specalist supportive clinical management)

Children - Anorexia focused family therapy first line. Second line is CBT

Question 3

Features of anorexia nervosa?

Answer 3

Features - reduced BMI, bradycardia, hypotension, enlarged salivary glands.
Physiological - Hypokalaemia, low LH and FSH with low oestrogen/testosterone, raised cortisol and GH, impaired glucose tolerance, hypercholesterolaemia, hypercarotinaemia, low T3

Question 4

DSM 5 diagnostic criteria for bulimia nervosa?

Answer 4

1. Recurrent episodes of binge eating,
2. Lack of sence of control over eating during episode.
3. Recurrent inappropriate compensatory behaviour to prevent weight gain.
4. Binging/compensatory behaviours occur at least once/week for 3 months.
5. Self-evalusation is unduly influenced by body shape/weight.
6. Disturbance does not exclusively occur during episodes of anorexia.

Question 5

Recurrent vomiting in bulima may lead to what?

Answer 5

Erosion of teeth
Russell’s sign - calusses on knuckles on back of hand due to repeated self-induced vomiting.
Swlling of salivary glands

Question 6

Management of bulimia nervosa?

Answer 6

Referral to specialist.
Bulimia nervosa focused guided self help. If ineffective > 4 weeks, contraindicated or unacceptable then CBT-ED.
Children should be offered FT-BN (bulimia-nervosa-focused family therapy).