Eating disorders

Question 1

List the biological causes of anorexia / bulimia (3)

Answer 1

Twin concordance
Neuro/endocrine changes:
hypothalamic disturbance / serotonin variations

Question 2

List the psychological causes of anorexia / bulimia (7)

Answer 2

H/o overweight
H/o self-harm
H/o abuse
Sexual development
Perfectionism
Personality traits/disorder (anankastic / impulsive)
Low self-esteem

Question 3

List the social causes of anorexia /bulimia (2)

Answer 3

Avoiding separation from fam (parental overprotection)

Exposure to culture of dieting

Question 4

What is the screening questionnaire for eating disorders?

Answer 4

SCOFF

S - ever made self sick felt so full?
CO - lost control over how much eating?
F - think fat when others say thin?
F - food dominates life?

Question 5

How is the rest of a Eating Disorders Hx taken?

Would Psychiatrists Do Complex Investigations

Answer 5

W: wt/ht, changing rapidly, intentional?

P(perception): weigh/mirror self, consider self overwt?

D(diet): what/how much eat? ever diet/fasted?

C(compensatory behavs): ritualistic behavs, vomiting, laxatives

I(impact - PPPP): Pt (school/relationships), Psych (dep/anx), Physical, Periods

Question 6

What are some of the Physical consequences of eating disorders? (think systems)

Answer 6

CNS - poor concentration / irritability
Skin/hair -dry-brittle, lanugo, Russels’ sign
Cardiac - hypotension, bradycardia, arrhythmias (hypokal), QT prolongation
GI - constipation, pain, M-W tears
MSK - osteopenia, muscle weakness-wasting
Extremities - swollen ankles, cold, broken skin

Question 7

What may be seen on Ix (blood tests) in anorexia and bulimia?

Answer 7

Anorexia: 
Hypokal/nat/gly/phos
Vit defc
Hyperchol
Deranged LFTs
FBC: neutropenia + anaemia

Bulimia:
Electrolyte imbalance (low K vom; high K laxatives)
Dehydration

Question 8

What are the Dx criteria for anorexia? (3)

Answer 8

BMI<17.5
Overvalued idea of being overweight
Persistent behaviours to prevent gaining wt (intense fear)

Question 9

What are the Dx criteria for bulimia? (4)

Answer 9

Recurrent binge eating episodes
Recurrent inappropriate compensatory behaviours to prevent wt gain
At least once/wk for 3m
Self-evaluation unduly influenced by shape/weight

Question 10

What are some DDx for eating disorders (mainly anorexia)? (5)

Answer 10

Medical cause - e.g. hyperthyroidism
Mood disorder - depression
OCD → xs energy expenditure
Body dysmorphic disorder
Psychosis (believe food is poisoned)

Question 11

Managing/reducing binge/purge behaviours in bulimia may → what other harmful behaviours?

Answer 11

Alc/drug abuse

DSH

Question 12

Describe the biological management of anorexia

+ bulimia

Answer 12

Anorexia:
Dietician - monitor intake/re-feeding syndrome
Regular wt monitoring (freq dep on sev)
Regular blood monitoring (freq dep on sev)

Bulimia:
SSRI (fluoxetine)
Regular wt monitoring (freq dep on sev)
Regular blood monitoring (esp U&Es) (freq dep on sev)

Question 13

What blood tests are done in anorexia (+ extra ones done in severe BMI<15)

Answer 13

LFTs / FBC / U&E / Glucose

If BMI<15: Above + Phosphate/Mg/Ca/Zinc/B12+Folate, CK

Question 14

Describe the psychological management of anorexia (3)

Answer 14

Psychotherapy (unhelpful in BMI<13 → admit)
Family therapy (commonly used in <18s)

Individualised care plan, inc:
Motivational interviewing, CBT, IPT, Mindfulness, Arts, Cognitive Analytic/Compassion focused therapy

Question 15

Describe the psychological management of bulimia (3)

Answer 15

Psycho-education re: coping mechanisms + balanced diet
Psychotherapy (20 CBT session - NICE)
Indiv care plan (sim to anorexia):
Motivational Interviewing, CBT/IPT/CAT/CFT, Mindfulness, Arts

Question 16

Describe the social management of anorexia/bulimia (3)

Answer 16

Advise to inform a loved one for support
Carer support
Encourage social participation/ lifestyle goals (hobbies)