Eating Disorders

Question 1

What are the two main subdivisions of anorexia?

Answer 1

restrictive type - has not regularly engaged in binge-eating or purging behavior

binge-eating/purging type - binges followed by self-induced vomiting, laxatives, excessive exercising, or diuretics

Question 2

What are the diagnostic criteria for anorexia?

Answer 2

refusal to maintain a normal body weight for one’s age and height

intense fear of gaining weight or becoming fat

disturbed body image, undue influence of weight or shape on self evaluation or denial of the seriousness of current low body weight.

amenorrhea in the DSM IV, but not V

Question 3

What is the BMI cutoff for probable anorexia?

Answer 3

17.5

Question 4

What are some of the physical manifestations of anorexia?

Answer 4

amenorrhea, cold intolerance/hypothermia, hypotension (esp orthostatic), bradycardia, arrhythmia, acute coronary syndrome, cardiomyopathy, mitral valve prolapse, constipation, lanugo, alopecia, edema, dehydration, peripheral neuropathy, seizures, hypothyroidism, osteopenia/porosis

Question 5

What are some common electrolyte abnormalities in anorexia?

Answer 5

hyponatremia,

hypochloremic hypokalemic metabolic alkalosis (if vomiting)

Question 6

What cardiac arrhythmia is common in anorexia?

Answer 6

prolonged qTC

Question 7

What are some hormone changes seen in anorexia?

Answer 7

increased growth hormone
increased cortisol
reduced gonadotropins
reduced sex steroids
hypothyroidism

Question 8

What distinguishes anorexia with purging from bulimia?

Answer 8

People with bulimia tend to have a normal or slightly above normal body weight

Question 9

What percentage of people with anorexia are male?

Answer 9

5-`10%

Question 10

Describe the bimodal distribution of age of onset for anorexia?

Answer 10

peak at 13-14 due to hormone influences

peak at 17-18 due to environmental influences

Question 11

How can you differentiate anorexia from major depression with significant weight loss?

Answer 11

people with anorexia are often preoccupied with food and think about it constantly/prepare it for others

whereas people with MDD just don’t have any appetite and have no interest in food

Question 12

THe mortality rate of anorexia is about 10% - from what causes?

Answer 12

starvation, suicide or cardiac failure

Question 13

Why do you need to be careful when feeding anorexics?

Answer 13

refeeding syndrome - happens when they’re fed too quickly

look for fluid retention and decreased levels of phosphorus, magnesium and calcium

complications include arrhythmias, respiratory failure, delirium and seizures

replace electrolytes and slow the feedings

Question 14

When does someone with anorexia need to be hospitalized?

Answer 14

when they are more than 20% below ideal body weight or if there are serious medical or pschiatric complications

Question 15

What is the typical treatment for anorexia?

Answer 15

behavioral therapy, family therapy and supervised weight gain programs

SSRIs have not been found to be effective (probably because they don’t take in enough tryptophan and therefore can’t make it in the first place)

low dose 2nd gen antipsychotics may treat excessive preoccupation with weight and food

benzos prior to meals may reduce preprandial anxiety

Question 16

What are the two subcategories of bulimia?

Answer 16

purging type (involves vomiting, laxatives, enemas or diuretics)
nonpurging type (involves excessive exercise or fasting)

Question 17

What are the diagnostic criteria for bulimia?

Answer 17

recurrent episodes of binge eating

recurrent attempts to compensate for overeating and prevent weight gain (laxatives, vomiting, etc.)

bind eating and compensatory behaviors occur at least 2x a week for 3 months

perception of self-worth is excessively influenced by body weight and shape

Question 18

What are some physical manifestations of bulimia?

Answer 18

salivary gland enlargement, dental erosion/caries, callouses/abrasions on dorsum of hand (Russell’s sign), petechiae, peripheral edema, aspiration

Question 19

What are some lab/imaging findings in bulimia?

Answer 19

hypochloremia hypokalemic alkalosis if vomiting

metabolic acidosis if laxative abuse

elevated bicarb (to compensate for the acidsosi), hypernatremia, increased BUN and amylase.

Question 20

What is the definition of a binge?

Answer 20

excessive food intake (more than 1200 calories in one sitting) within a 2-hr period, accompanied by a sense of lack of control

Question 21

Which has a better prognosis - bulimia or anorexia?

Answer 21

bulimia

Question 22

What is the treatment for bulimia?

Answer 22

antidepressants plus therapy - antidepressants actually work here!

SSRIs are first line, and fluoxetine is actually the only FDA-approved med for bulimia

Question 23

What med should you avoid in those with bulimia?

Answer 23

buproprion because it lowers the seizure threshold

Question 24

How does binge-eating disorder differ from bulimia?

Answer 24

they have binge eating and emotional distress over this, but they don’t try to control their weight by purging or restricting calories

also are not fixated on their body shape and weight - just eat a ton