Eating disorders

Question 1

What is the DSM-5 criteria for diagnosis of Anorexia Nervosa (AN)

Answer 1

• Persistent restriction of energy intake leading to low body weight
• Fear of gaining weight
• Disturbance in perception of one’s own body weight, shape, or size
  (Women usually have amenorrhoea longer than 3 months)

Question 2

What are the two types of presentation of anorexia nervosa?

Answer 2

Restricting

Binging and purging

Question 3

What is the mortality rate for anorexia nervosa over an 11 year period?

Answer 3

2.8% - highest mortality rate of any psychiatric condition

20% of those who died had committed suicide

Question 4

What is the DSM-5 criteria for Bulimia Nervosa (BN)

Answer 4

• Recurrent episodes of binge eating with sense of lack of control when eating
• Recurrent compensatory behaviour to prevent weight gain (vomiting, diuretics, laxatives)
• Needs to occur at least once a week for 3 months
• Self evaluation unduly influenced by own body weight
• BN does not occur during episodes of Anorexia Nervosa

Question 5

What investigations should be done in Anorexia Nervosa (AN) patients?

Answer 5

FBC, U&Es, Glu, LFTs, RFTs
TFTs - rule our hyperthyroidism
DEXA scan - baseline bone density and then annually
ECG - bradycardia or prolonged QT (severe AN)

Question 6

What psychological treatments are recommended for Anorexia Nervosa?

Answer 6

Self Help programme (with or without guidance form a therapist), Cognitive Analytic Therapy, Cognitive Behavioural Therapy, Family Therapy

Question 7

What medical treatments are recommended for Bulimia Nervosa?

Answer 7

SSRI in children over 8 - Fluoxetine, Sertraline, Citalopram - BEWARE RISK OF SUICIDE

Question 8

What medical treatments are recommended for Anorexia Nervosa?

Answer 8

There is very limited evidence for pharmaco-management of Anorexia Nervosa