Eating Disorders

Question 1

What is an eating disorder?

Answer 1

Extreme attitudes and behaviors about weight and food that create serious emotional and physical problems with life-threatening consequences

Question 2

3 eating disorders diagnoses common in childhood

Answer 2

PICA, rumination disorder, avoidant/restrictive disorder

Question 3

pica

Answer 3

Persistent eating non-nutritive substances (+1 month)

Question 4

rumination disorder

Answer 4

Repeated regurgitation and rechewing of food for at least 1 month following a period of normal functioning

Question 5

avoidant/restrictive food intake

Answer 5

Disinterest in eating or food due to sensory characteristics or concern about aversive consequences of eating with persistent failure to meet appropriate nutritional and/or energy needs

Question 6

signs of anorexia nervosa

Answer 6

• restriction of energy intake with significantly low weight
• intense fear of gaining weight
• Disturbance in perception of body size and denial of thinness

Question 7

Onset and duration of anorexia and bulimia nervosa?

Answer 7

33% of cases by 11-15 yo and 86% by 20 yo

usually life long disease

Question 8

2 subtypes of anorexia nervosa

Answer 8

1) Restricting type: No binge/purging in last 3 months (dieting, fasting, exercise)
2) Binge-eating/purging type: one or both in last 3 months (vomiting, laxatives, diuretics, enemas)

Question 9

Who is most likely to have anorexia?

Answer 9

women, white, middle to upper class, adolescence

Question 10

What BMI indicates hospitalization for anorexic patient?

Answer 10

< 15

Question 11

PE findings of anorexia

Answer 11

lanugo (thin layer of hair), atrophy, loss of hair, tooth and bone decay, emotional instability

Question 12

bulimia nervosa diagnostic criteria

Answer 12

• Eating in a discrete time period an excessive amount of food
• Sense of lack of control
• Binge followed by compensatory behavior (purging or non-purging subtypes)
• occurs 1/week for 3 months

Question 13

What differentiates binge eating from bulimia nervosa?

Answer 13

binge eating lacks engagement in compensatory behavior (laxatives, purging, excessive exercise)

Question 14

Labs to monitor in eating disorders

Answer 14

weight, electrolytes, EKG, CBC, teeth

Question 15

signs/sx’s of vomiting or laxative abuse

Answer 15

Weight loss
Electrolyte imbalance
Tooth enamel erosion
Hypovolemia
Dehydration (poor skin turgor)
Knuckle calluses (Russel's Sign)
Sialadenosis (bilateral parotid gland enlargement)

Question 16

signs of vomiting

Answer 16

low K+, high bicarb, arrhythmia, acid-base imbalance

Question 17

signs of laxative abuse

Answer 17

low K+, low bicarb, renal injury, arrhythmia, acid-base imbalance

Question 18

binge eating disorder diagnostic criteria

Answer 18

• Recurrent episodes of binging characterized by: eating in discrete time period an excessive amount of food AND sense of lack of control
• Associated with 3+: eat rapidly, until uncomfortably full, eat when not hungry, eat alone, feel disgusted/guilty afterward
• Marked distress
• Occurs 1x/week for 3 months
• No compensatory behavior

Question 19

Differential and comorbid diagnoses with eating disorders?

Answer 19

• Medical conditions: superior artery syndrome, colitis
• Major depressive disorder
• OCD
• Body Dysmorphic disorder
• Somatoform disorders: food avoidance d/t GI sx’s

Question 20

Eating and feeding disorders seen in men

Answer 20

• muscle dysmorphia or “bigorexia”
• anorexia and bulimia nervosa same as in women
• synthol injections

Question 21

Differences in eating disorders in men

Answer 21

usually want muscle mass, compulsive exercise (typically non-purging), more substance abuse, less likely to seek help

Question 22

Which population of men has significantly high eating disorder prevalence?

Answer 22

almost half of gay men will have some type of eating disorder

Question 23

Important risky behavior to watch for in eating disorders

Answer 23

current BMI
history of suicide attempts
current suicide thoughts
self-injurious behaviors

Question 24

SCOFF Questionnaire

Answer 24

Do you make yourself SICK because you feel uncomfortably full?

Do you worry that you have lost CONTROL over how much you eat?

In any recent 3-month period, have you lost OVER 6.5 kg or 15 lbs?

Do you believe yourself to be FAT when others say you are thin?

Would you say that FOOD dominates your life?

Question 25

Specific cognitions in feeding and eating disorders

Answer 25

Body image, rules around eating and exercising, beliefs about weight

Question 26

Body Dysmorphic Disorder (BDD) diagnostic criteria

Answer 26

Need A-D:
A. preoccupation with perceived defect or flaw (+1 hr daily)
B. repetitive behaviors or mental acts
C. clinically significant distress or impairment
D. not better explained by a primary eating d/o

Question 27

Characteristic mood of patient with BDD

Answer 27

depressed, irritable, anxious

Question 28

BDD treatment

Answer 28

Meds: SSRIs, Trazodone, Lithium

Consistent treatment with same provider; all txs and surgeries well documented

Regularly scheduled supportive office visits

90% feel no relief with surgery