Eating Disorders

Question 1

What are the DSM criteria for anorexia nervosa?

Answer 1

• A - restriction of intake relative to requirements leading to a significantly low weight by age, gender, development and physical health
• B - intense fear of gaining weight or being fat or persistent behaviour interfering with weight gain, even at a significantly low weight
• C - disturbance in the way body shape or weight is experienced, undue influence of this on self-evaluation or persistent lack of seriousness of current low body weight

Question 2

What are the specifying subtypes of anorexia nervosa?

Answer 2

• Restricting type: during last 3 months, no recurrent binging/purging (i.e. weight loss through diet, fasting, exercise)
• Binge-eating/purging type: during last 3 months, individual has engaged in recurrent binging/purging behaviour
• In partial remission: A not met for a substantial period, but B or C have been
• In full remission: no criteria met for a substantial period
• Severity
  
  • Mild: BMI 17+
  • Moderate: BMI 16+
  • Severe: BMI 15+
  • Extreme: BMI

Question 3

What are the main treatment principls for anorexia nervosa?

Answer 3

• Individual and family therapy
• Outpatient programs with hospital backup > inpatient stays with supervised refeeding
• Pharmacotherapy: not appropriate for underlying anorexia but may be relevant for associated medical conditions/comorbid depression

Question 4

What are the DSM criteria for bulimia nervosa?

Answer 4

• A - recurrent episodes of binge eating characterised by:
  
  • Eating in a discrete period more than what most individuals would eat in a similar period under similar circumstances
  • A sense of a lack of control over eating during the episode (i.e. cannot stop eating or control what)
• B - recurrent inappropriate compensatory measures to prevent weight gain (vomiting, laxatives, diuretics, fasting, exercise)
• C - A and B occur at least once a week for 3 months
• D - self-evaluation unduly influenced by body weight
• E - disturbance does not occur during periods of anorexia nervosa

Question 5

What are the treatment mainstays for bulimia nervosa?

Answer 5

• Psychotherapy: CBT
• Pharmacotherapy: in short term or as adjunct to psychotherapySSRIs (especially fluoxetine)
  
  • Topiramate (not widely used)