Eating Disorders Flashcards
Anorexia Nervosa: What is it?
A morbid fear of obesity associated with significant weigh loss. Characterized by a dramatic restriction in caloric intake that results in significantly low body weight for age, sex, developmental trajectory, and physical health.
- Also associated with disturbances in body weight and body shape perception. This is potentially life-threatening disorder.
Anorexia Nervosa: Two Subtypes
- Restricting - severe limitation of food as primary means to achieve weight loss
- Binge eating/purging - periods of food intake compensated by self-induced vomiting, laxative or diuretic abuse, and/or excessive exercise
Anorexia Nervosa: Etiology
- Unknown, but serotonergic dysregulation is thought to play a major role
- Recent studies suggest dysfunction of midbrain regions contribute to illness
- May be a combination of genetics, societal norms, family dynamics, and stressful life events
Anorexia Nervosa: Incidence
- Third most common chronic disease among young people after asthma and Type 1 DM
- Women affected more than men
- 0.3-0.4% of young women and 0.1% of men are affected
- Onset is typically between ages 14-18 years
- Predominantly affects white, middle to upper class populations: increasing incidence in men, minorities, and women of all ages
- May coexist with depression (50-75%) or OCD (10-13%)
Anorexia Nervosa: Risk Factors
- Meticulous, compulsive Type A personality
- Low self-esteem
- High self-expectations
- Multiple responsibilities
- Early puberty
- Family history
- Patients at risk: ballet dancers, cheerleaders, gymnasts, weightlifters, jockeys, runners, wrestlers, and other athletes for whom extreme thinness is considered an asset
Anorexia Nervosa: Assessment Findings
- Initially insidious
- Low energy
- Formal screening tools (SCOFF questionnaire)
- Primary symptom is preoccupation about weight loss and being fat
- Denial of problem
- Disturbance in body image
- Strenuous exercise to lose weight
- Resistance to medical treatment
- Must assess patients’ motivation to change
- Possible depression
- Elaborate food rituals; bizarre, excessive use of condiments
- Amenorrhea
- Russell’s sign - scarring on dorsum of hand
Anorexia Nervosa: Assessment Findings that are Related to Starvation
- Sparse scalp hair, dry skin
- Growth arrest, arrested sexual maturation
- Lanugo on extremities, face, and trunk
- Cognitive decline
- Bradycardia, hypotension, cardiovascular compromise
- Hypothermia
- Weight loss of 30% in 6 months requires hospitalization
Anorexia Nervosa: Non-Pharmacologic Management
- Usually treated on outpatient basis but may require hospitalization when weight loss is severe and requires stabilization of acute medical problems
- For some patients, psychiatric hospitalization needed to help cope with weight gain
- An interprofessional approach is most helpful and should include a dietitian, psychotherapist, and prescriber skilled in treating eating disorders. The team may also include dentists, other medical specialists, and school personnel
- Psychotherapies focused on underlying maladaptive thoughts and attitudes
- Individual and family therapy
- Begin intake at 30-40 kcal/kg as tolerated and increase slowly to 70-100 kcal/kg per day
- Weigh three times in first 1-2 weeks, then weekly. Do not allow patient to see weight
- Goal is 1-2 lb. weight gain per week until target is reached
Anorexia Nervosa: Pharmacologic Management
- Pharmacologic interventions play a limited role
- Psychotropics not well tolerated in patients with low weight; they are prone to dehydration
- May need to consider atypical antipsychotics for patients with severe symptoms and delusional symptoms
- Olanzapine can bring modest weight restoration
- Careful dosing due to impaired renal/hepatic function
- Consider treatment with SSRI if depression is persistent
- Mirtazapine for insomnia and to increase appetite
- Assess need for vitamin supplementation
- Estrogen replacement recommended for treatment of osteopenia
- Avoid medications that can lower seizure threshold (bupropion)
Anorexia Nervosa: Consultation/Referral
- Refer to psychiatric professional skilled in the treatment of eating disorders for initial treatment plan
- Consult support group or eating disorders clinic
- Family therapy
- Refer to psychiatrist for weight less than 75% expected for age and height; compromised physical status (hypothermia, hypotension, bradycardia)
- Registered dietitian for meal planning
Anorexia Nervosa: Follow-Up
- Monitor weight weekly until stable, then monthly
- Monitor for depression, possible suicide
- Monitor abnormal lab values
- Monitor for pellagra: administer niacin if deficient; without treatment, death can occur
- Participation in long-term maintenance program is recommended to help prevent relapse
Binge Eating Disorder (BED): What is it?
Disorder characterized by uncontrolled eating during limited time periods, usually less than 2 hours, in which the person
consumes larger amounts of food than most people would eat in a similar time period under similar circumstances.
- The hallmark feature of BED is regular binge eating that occurs, on average, once a week for 3 consecutive months
- Clinically significant distress, functional impairment and negative affect accompany symptoms of BED
- Binge-eating episodes are associated with at least three of the following: eating more rapidly than normal; eating until
uncomfortably full; eating large amounts of food when not hungry; eating alone; and feeling disgusted with oneself,
depressed, or guilty afterward
- BED occurs in normal-weight, overweight, and obese people
- Regular use of inappropriate compensatory weight control methods does NOT occur in BED
- BED is the most prevalent eating disorder. People whose BED is untreated are at significantly higher risk for
comorbidities such as depression, anxiety, obesity, diabetes mellitus, and cardiovascular disease.
Binge Eating Disorder (BED): Etiology
- The underlying neurobiological features of BED are poorly understood
- People with BED have greater cognitive attentional biases toward food, decreased reward sensitivities, and altered brain activation in regions associated
with impulsivity and compulsivity - Stress and emotional regulation may play a role in BED
- Altered dopamine function is an important contributor in binge eating
- Dysfunction in the prefrontal, insular, and orbitofrontal cortices and striatum
- An interchange between genetic influences and environmental stressors is likely
- Patients with BED exhibit increased impulsivity, compulsivity, and altered reward sensitivity.
Binge Eating Disorder (BED): Incidence
- Lifetime prevalence is 0.85% in the U.S.
- More than twice as likely to occur in women as in men
- More common in people desiring weight loss than in the general population
- The average age of onset for BED is 23.3 years; higher incidence during adolescence
- Affects all racial, gender, and sexual orientation groups
Binge Eating Disorder (BED): Assessment Findings
- Recurrent, distressing binge eating episodes
- HLD
- HTN
- Cardiovascular disease
- DM
- GERD
- Sleep-related breathing disorders
- Musculoskeletal disorders
- Anemia
- Bowel problems
- Arthritis
- Osteoporosis
- Psychiatric comorbidities
