Eating Disorders Flashcards
What are the two main subdivisions of anorexia?
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
What are the diagnostic criteria for anorexia?
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
What is the BMI cutoff for probable anorexia?
17.5
What are some of the physical manifestations of anorexia?
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
What are some common electrolyte abnormalities in anorexia?
hyponatremia,
hypochloremic hypokalemic metabolic alkalosis (if vomiting)
What cardiac arrhythmia is common in anorexia?
prolonged qTC
What are some hormone changes seen in anorexia?
increased growth hormone increased cortisol reduced gonadotropins reduced sex steroids hypothyroidism
What distinguishes anorexia with purging from bulimia?
People with bulimia tend to have a normal or slightly above normal body weight
What percentage of people with anorexia are male?
5-`10%
Describe the bimodal distribution of age of onset for anorexia?
peak at 13-14 due to hormone influences
peak at 17-18 due to environmental influences
How can you differentiate anorexia from major depression with significant weight loss?
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
THe mortality rate of anorexia is about 10% - from what causes?
starvation, suicide or cardiac failure
Why do you need to be careful when feeding anorexics?
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
When does someone with anorexia need to be hospitalized?
when they are more than 20% below ideal body weight or if there are serious medical or pschiatric complications
What is the typical treatment for anorexia?
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
What are the two subcategories of bulimia?
purging type (involves vomiting, laxatives, enemas or diuretics) nonpurging type (involves excessive exercise or fasting)
What are the diagnostic criteria for bulimia?
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
What are some physical manifestations of bulimia?
salivary gland enlargement, dental erosion/caries, callouses/abrasions on dorsum of hand (Russell’s sign), petechiae, peripheral edema, aspiration
What are some lab/imaging findings in bulimia?
hypochloremia hypokalemic alkalosis if vomiting
metabolic acidosis if laxative abuse
elevated bicarb (to compensate for the acidsosi), hypernatremia, increased BUN and amylase.
What is the definition of a binge?
excessive food intake (more than 1200 calories in one sitting) within a 2-hr period, accompanied by a sense of lack of control
Which has a better prognosis - bulimia or anorexia?
bulimia
What is the treatment for bulimia?
antidepressants plus therapy - antidepressants actually work here!
SSRIs are first line, and fluoxetine is actually the only FDA-approved med for bulimia
What med should you avoid in those with bulimia?
buproprion because it lowers the seizure threshold
How does binge-eating disorder differ from bulimia?
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
