eating disorders (329 E2) Flashcards
amenorrhea
the loss of menstrual periods in girls and women post puberty
anorexia nervosa (AN)
a life threatening eating disorder characterized by:
-intense fear of weight gain
-a severely distorted body image
-restriction of calories relative to requirements w/ significantly low BMI
binge eating disorder
an eating disorder characterized by recurrent episodes of binge eating, w/ accompanying marked distressed and impaired control over such behavior
bulimia nervosa (BN)
an eating disorder in which the individual engages in recurrent episodes of uncontrollable binge eating and compensatory behavior to avoid wt gain through purging methods such as self induced vomiting, use of laxatives, diuretics or excessive exercise
needs to occur 1x/wk for 3 months for dx
eating disorders
-consistently below or above a person’s caloric needs to maintain a healthy weight
-can be accompanied by anxiety and guilt
-occurs w/o hunger or fails to produce satiety
-results in physiologic imbalances or medical complications
lanugo
downy growth of body hair on the face and back
pica
ingestion of substances that have no nutritional value, such as dirt or paint
-usually early childhood
-males & female affected equally
-monitoring eating behavior is essential
-rewarding appropriate eating can be helping
refeeding syndrome
a sudden shift in the electrolytes that help your body metabolize food
rumination disorder
characterized by undigested food being returned to the mouth. it is then rechewed, reswallowed or spit out
-dx after 1m of sx, at any age
-occurs more frequently among people w/ ID
-childhood neglect is predisposing factor to the development of this disorder
Russell’s sign
calluses and/or scars on back of hands and knuckles from self induced vomiting
satiety
comfortable fullness
eating disorder progression
normal eating -> development of risk factors (low self esteem, dieting, body dissat) -> partial syndrome eating disorder (binge eating & serious dieting) -> full syndrome eating disorder -> treatment
etiology of EDs: psychological factors
-low self esteem
-feelings of inadequacy
-lack of control in life
-depression, anxiety, stress, loneliness, trauma
etiology of EDs: interpersonal factors
-troubled relationships
-difficulty expressing emotions
-hx of being teased based on size/wt
-hx of physical or sexual abuse
etiology of EDs: social factors
-cultural pressures that glorify “thinness” or muscularity & place value on obtaining the “perfect body”
-narrow definitions of beauty
-cultural norms that values people on the basis of physical appearance and not inner qualities and strengths
etiology of EDs: biological factors
-irregular hormones functions
-genetics
etiology of EDs: neurobiological
demonstrates that altered brain serotonin function contribute to the dysregulation of appetite, mood and impulse control
etiology of EDs: environmental
-childhood trauma and sexual abuse
-hx of abuse have a poorer prognosis
-culture influences the development of self concept & satisfaction w/ body size
co morbidities / dual dx & eating disorders
-pts w/ anorexia, have hx of anxiety 25-50% of the time
-up to 33% of pt w/ binge purge behavior have co morbid alcohol or substance abuse problem
-bulimia frequently coexists w/ major depressions, substance abuse and personality disorders
AN: restricting type
describes individuals that do not regularly engage in binge eating or purging behavior -> wt loss is accomplished through dieting, fasting and/or excessive exercise
during last 3 months
AN: binge eating & purging type
refers to those who regularly engage in binge eating or purging behavior
during last 3 months
S/s of AN
-low body wt (15% or more below what is expected for age, ht & activity level)
-amenorrhea
-lanugo
-mottled, cool skin
-peripheral edema
-lack of energy & muscle weakness
-constipation
-low BP, pulse & vitals
-abnormal labs
-impaired renal funciton
-decreased bone density
-anemic pancytopenia
w/ eating disorders, when do electrolytes become abnormal
usually only w/ purging
AN epidemiology
-uncommon before puberty or after 40 years old
-regardless of gender, more common in athletes
-higher in the LGTBQ community
-less common than bulimia
-co morbid w/ bipolar, anxiety, OCD, depression, PTSD, trauma related disorders & alcohol/substance use
AN etiology: biological
-genetic & familial
-comorbids
-glucose & lipid metabolism?
-neurobio: tryptophan & impact on serotonin synthesis
AN etiology: psychological & cognitive
-egosyntonic disorders (knows the action is harmful but believes benefit outweighs the harm)
-struggle significantly w/ emotional ID, regulation & processing
-exhibit low distress tolerance & deficits in behavioral control in response to distress
AN etiology: environmental
-internalization of a thin body ideal
-associated w/ cultures that values thinness
AN risk factors
female, fam hx, hx of obesity, dieting, over exercising, low self esteem, body dissat, lack of assertiveness, other EDs, hx of abuse, comorbid conditions, distorted body image, media, fashion industry, being an athlete
warning signs of AN
-dramatic wt loss
-preoccupation w/ weight, food, calories, far grams & dieting
-refusal to eat certain foods, progressing to restrictions against whole categories of food
-frequent comments about feeling “fat” or overweight despite wt loss
-anxiety about gaining wt or being “fat”
-denial of hunger
-development of food rituals
-consistent excuses to avoid mealtimes or situations involving food
-excessive, rigid exercise regimen
-w/draw from usual friends & activites
-behaviors and attitudes indicating that wt loss, dieting & control of food are becoming primary concerns
clinical course of AN
-chronic condition w/ relapses characterized by significant wt loss & 50% relapse wt
-often continue to be preoccupied w/ food
-10 to 25% develop bulimia
-1 in 5 AN death is by suicide
-poor outcomes r/t initial lower min wt, presence of purging & earlier age of onset
difficult to treat but recovery is possible
goals for AN
-initial goals: start nutritional rehab, health teaching & promotion
-later goals: resolving conflicts around body image, inc effective coping, address underlying conflicts & assisting family w/ health functioning & comm
treatment modalities for AN
-hospitalization
-intensive therapies
-outpatient partial hospitalization
criteria for hospitalization for AN
-extreme lyte imbalance or wt below 75% IBW
-less than 10% body fat
-daytime heart rate <50 bpm
-a systolic bp <90
-temp <96
-arrhythmias
treatment for AN once medically stable
-wt restoration program begins
-goal is set at 90% IBW
-precise mealtimes, adherence to selected menu, observation during meals & weigh ins
-constant monitoring during bathroom trips
-monitor for refeeding syndrome
-milieu therapy focusing on eating behavior & anxiety, dysphoria, low self esteem & lack of control
other treatments for AN
-fluoxetine for has been proven helpful for obsessive compulsive behavior
-CBT
BN overview
-more prevalent then AN
-mean onset 18
-typically, normal wt
-generally not life threatening
-outpatient treatment
-better outcomes & lower mortality rates
-medications are effectives
BN etiology: biological
-neuropatho: changes in the brain may be due to eating dysregulation
-genetic & familial predispositions
-gene connection
-biochem: lower brain serotonin
BN etiology: psychological & cognitive
-anxiety disorders or low self esteem
-impulsivity & compulsivity
-chaotic, non nurturing family relationships
-difficult interpersonal relationships
-triggers: stress, poor body self image, food, restrictive dieting or boredom
BN etiology: environmental
-internalization of a thin body ideal, wt based teasing or bullying
-childhood sexual or physical abuse, traumatic events & environmental stress
clinical course of BN
initially do not appear physically ill -> often at or close to normal wt -> binge & purge in secret -> treatment delayed for years -> treatment initiated when control of eating is lost -> once treatment is complete, typically there is complete recovery expect if depression &/or personality disorders are present
risk factors of BN
-binge eating behaviors
-hx fo AN
-depressive signs & symptoms
-problems w/ interpersonal relationships
-impulsive behaviors
-increased levels of anxiety and compulsivity
-possible substance use disorders
warning signs of BN
-evidence of binge eating (disappearance of large amounts of food in short time, finding wrappers & containers empty)
-evidence of purging behavior (frequent bathroom trips after meals, signs of vomiting, packages of laxatives)
-excessive, rigid exercise regimen
-creation of lifestyle schedules or rituals to make time for binge/purge sessions
-w/draw from friends and famili
-primary concern is wt loss & control of food
-parotid swelling
-Russell’s sign
-dental caries, tooth erosion and discoloration of teeth
treatment of BN
(hospital is life threatening comps/SI)
-outpatient for stabilization and normalizing eating
-restructuring dysfunctional thoughts & attitudes about eating, wt & shape
-teaching healthy boundary setting
-nutrition counseling
-behavior techniques like journaling to record binge/purges & precipitating emotions and environmental cues
medications for BN
-SSRIs
-fluoxetine (only FDA approved med for treatment of BN, most effective w/ CBT)
psychological therapies for BN
-CBT (first line)
-DBT
-group
-family therapy not usually used d/t age of pt
epidemiology & comorbidity of BED
-most common eating disorder
-occurs in normal wt/overwt individual
-inc in women of any race
-50% of risk is d/t genetics
-most prevalent w/ specific phobias, social phobia, PTSD & alcohol abuse
-impulsivity and reward sensitivity, low self esteem, body dissat, difficulty coping w/ feelings
-hx of trauma & adverse childhood events
-hx of food insecurity
treatment of BED
-hospitalization usually not required
-outpatient health teaching & health promo & healthy eating & exercise
-meds: SSRIs, lisdexamfetamine dimesylate
-CBT & DBT
-group
binge eating is not about the food but instead coping w/ emotions
rumination disorder interventions
-repositioning infants & small children during feeds
-improving the interaction between caregiver & child & making mealtimes a pleasant experience often helps reduce
-distracting the child when the behavior starts
-family therapy may be required
avoidant/restrictive food intake disorder
-can result in significant wt loss, nutritional deficiency, dependence on sups or enteral feeding, & marked interference w/ functioning
-food avoidance may be related to strong dislikes r/t sensory qualities of food
-males & females equally affected
-seen infancy & childhood
-personal anxiety and family anxiety are a risk factors
avoidant/restrictive food intake disorder treatment
-primary treatment modality is some form of behavioral modification to increase regular food consumption
-families caring for a child w/ a feeding disorder often need support and education in behavioral techniques but family therapy is not usually needed
-tx of anxiety and depression may be helpful
