Eating Disorders

Question 1

Anorexia Nervosa

Answer 1

The inability to maintain body weight at or above a minimally normal weight for age and height. There is an intense fear of gaining weight or becoming fat even though the individual is underweight. There is a disturbance in the way ones body weight/shape is experienced or undue influence of body weight or shape on self-evaluation or a denial of seriousness of the current low body weight.

Question 2

Bulimia Nervosa

Answer 2

Recurrent episodes of binge eating (associated with loss of control) with recurrent inappropriate compensatory behaviour in order to prevent weight gain.

This occurs at least 1x a week for 3 months and the self evaluation is unduly influenced by body shape and weight.

Two subtypes are the purging type which is using vomiting, laxatives, enemas, and the non-purging type which counters with excessive exercise and fasting.

Question 3

Epidemiology of Anorexia Nervosa

Answer 3

0.5% - 2% of adolescent girls

Incidence is increasing

Onset is usually between 13-18 years old

F > M

Question 4

Epidemiology of Bulimia Nervosa

Answer 4

1-3% of adolescent girls

F > M

Question 5

Risk Factors for AN and BN

Answer 5

Female

Adolescence

Western society

FHx of eating disorder

Low self-esteem

Depression

Substance abuse

Aversive parenting

Dieting

Perfectionism

Anxiety

Aversive parenting

Question 6

Prognosis of AN

Answer 6

Good recovery if treated early or young patients (>70%)

Chronic if it lasts for longer than 6 years

10-20% mortality (due to cardiac arrest or suicide)

Question 7

Prognosis of BN

Answer 7

Lower mortality than AN and less hospitalization than AN

High short term success but high relapse rates

50% recovery at 10 years

Death is usually due to suicide, seizures, or upper GI problems such as pancreatitis, gastric perforations, esophageal tears.

Question 8

Starved Brain

Answer 8

Can mimic many psychiatric conditions.

Obsessional thinking, rigid/inflexibile activities, trouble focusing, etc.

Question 9

When to Admit to Hospital for BN

Answer 9

HR <40-50

Orthostatic hypotension

Orthostatic HR changes >35

Temp <35.5

Decreased K

Decreased Na

Increased Na (dehydration)

Decreased PO4

Question 10

Refeeding Syndrome

Answer 10

During refeeding, insulin secretion resumes in response to increased blood sugar. Metabolic processes require phosphates, magnesium and potassium which are already depleted and the stores rapidly become used up. Formation of phosphorylated carbohydrate compounds depletes intracellular ATP and 2,3 diphosphoglycerate in red blood cells, leading to cellular dysfunction and inadequate oxygen delivery to the body’s organs.

Common cause of death is cardiac arrythmias and arrest.

Question 11

SCOFF History

Answer 11

Do you make yourself sick because you feel uncomfortably full?

Do you worry you have lost control over how much you eat?

Have you lost over 6.5kg or 15 pounds?

Do you think you are fat when others say you are thin?

Does food dominate your life?

Question 12

Treatment for AN

Answer 12

Food

Therapeutic relationship is important

Must treat cognitive and psychosocial misconceptions

Family therapy

Question 13

Treatment for BN

Answer 13

Antidepressants –> 1st line is SSRIs

CBT / IPT +/- DBT

Question 14

Starvation and WBC Response

Answer 14

WBC response may become blunted