Eating Disorders

Question 1

What are the main types of psychiatric conditions involving body image and food?

Answer 1

• anorexia nervosa
• bulimia nervosa
• binge eating disorder

These conditions are characterized by unhealthy obsessions with body image and food intake.

Question 2

Define anorexia nervosa.

Answer 2

Individual feels they are overweight despite evidence of normal or low body weight.

Involves restricting calorie intake and often excessive exercise.

Question 3

What are the clinical features of anorexia nervosa?

Answer 3

• weight loss (15% below expected, BMI <17.5)
• amenorrhoea
• lanugo hair
• hypotension
• hypothermia
• mood changes

These features indicate severe malnutrition and its effects.

Question 4

Define bulimia nervosa.

Answer 4

Condition involves binge eating, followed by purging to prevent calories being absorbed.

Individuals may have normal body weight but experience fluctuations.

Question 5

What are the clinical features of bulimia nervosa?

Answer 5

• erosion of teeth
• swollen salivary glands
• mouth ulcers
• GORD
• Russell’s sign (callused knuckles)
• alkalosis (repeated vomiting of hydrochloric acid)

These features result from repeated cycles of binge eating and purging.

Question 6

Define binge eating disorder.

Answer 6

Characterised by episodes of overeating, often as an expression of underlying psychological distress.

Unlike other disorders, it is not restrictive, and patients are likely to be overweight.

Question 7

What blood results may be seen in restrictive eating disorders?

Answer 7

• anaemia
• leucopenia (low neutrophils and lymphocytes)
• thrombocytopenia (low platelets)
• hypokalaemia (due to vomiting/laxatives)

These results indicate various deficiencies and complications from malnutrition.

Question 8

What is a key challenge in managing eating disorders?

Answer 8

Require specialist services and MDT input.

Management often includes self-help resources and psychological therapies.

Question 9

What is refeeding syndrome?

Answer 9

Occurs when someone with extended severe nutritional deficit resumes eating.

The risk increases with lower BMI and longer malnutrition duration.

Question 10

What are the pathological effects of refeeding syndrome?

Answer 10

• hypomagnesaemia
• hypokalaemia
• hypophosphataemia
• fluid overload

These effects can lead to serious complications such as arrhythmia and heart failure.

Question 11

How can refeeding syndrome be prevented?

Answer 11

• slowly reintroducing food with limited calories
• potassium, phosphate, magnesium and glucose monitoring
• fluid balance monitoring
• ECG monitoring
• supplementation with electrolytes and vitamins, especially B vitamins and thiamine

Prevention is crucial for patients with a history of severe malnutrition.