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1 Psych Exam 2 > Eating Disorders > Flashcards

Eating Disorders Flashcards

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1
Q

What is an eating disorder?

A

An undue preoccupation with body image leading to impaired intake.

(Except, not quite…)

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2
Q

The basics

A

Disordered behavior…

Disordered thinking…

Disordered physiology…

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3
Q

What is it not?

A

Depression often involves appetite changes
Paranoia in schizophrenia can involve food avoidance
Medical conditions can lead to weight loss.
– DM type 1, thyroid dysfunction, malabsorbtion

Neglect often involves poor intake

Poverty involves poor intake

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4
Q

The Eating disorders

A

Anorexia Nervosa

  • Restricting type
  • Binge/purge type

Bulimia Nervosa

Binge Eating Disorder

Other specified/unspecified Eating Disorder

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5
Q

Binge?… purge?

A

Binge =
Limited period ( ~2 hrs ) with intake significantly greater than others would consume in similar circumstance
Sense of lack of control over eating in episode
Not as fun as it sounds: Almost always followed by guilt, sadness, disgust

Purge =
Self-induced vomiting or misuse of laxatives, diuretics, or enemas
Vomiting is used by 90% of patients

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6
Q

Anorexia Nervosa criteria

A

Restriction of energy intake relative to requirements, leading to significantly low weight
- Below a BMI of 18.5

Intense fear of gaining weight or getting fat, or persistent weight loss behavior despite medical starvation

Significant disturbance in perception of shape or weight of body

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7
Q

Anorexia subtypes

A

Restricting type

  • In last 3 months, has not engaged in recurrent binge eating or purging.
  • This means, weight loss is achieved through diets, fasts, excessive exercise
  • Usually attempting to consume less than 300 kcal/day with no fat
  • Relentless exercise
  • Often high-achievers

Binge/purge type

  • In last 3 months, has engaged in recurrent binges and/or purges
  • Represents a failure to adhere to pure anorexic goals
  • Less “self-control”, more substance use and impulsivity

Anorexic patients are split roughly 50/50

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8
Q

anorexia Epidemiology

A

Most common onset 14-18
About 1% of adolescent females
F:M ratio >10:1
Higher in modeling, ballet, cross-country

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9
Q

Anorexia: Why?

A

Biologic
Higher concordance in monozygotic twins than dizygotic
Mood disorders are more common in family

Social
Heterosexual women and gay men – equally high
Heterosexual men and lesbian women – lower risk

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10
Q

anorexia - Psychodynamic (or Mommie dearest)

A

Often close family, but domineering and lacking in empathy
Family where “excellence” is demanded
Patients lack a sense of autonomy and selfhood
Self-starvation = discipline, self-mastery
Wrest control of self from (often) mother
Rigid and perfectionistic (ego-syntonic)

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11
Q

Loss of appetite?

A

Anorexia is Greek for “loss of appetite”
Complete misnomer
Anorexics spend vast majority of time thinking about food.
- Collecting food, hiding it, making meals for others, reading recipes, rearranging it on the plate

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12
Q

anorexia - A lot of stuff decreases

A

Social isolation and secrecy
- So much time thinking and engaging in behaviors, yet no one else “gets it”
Marked decrease in sex accompanies onset
Usually loved ones drag patients to treatment

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13
Q

anorexia Psychiatric Comorbidities

A 
65% of patients meet MDD criteria
35% meet Social Anxiety criteria
25% meet OCD criteria
12% meet GAD criteria
80% are single
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14
Q

anorexia complications

A

sad, moody, bab memory, fainting, brain chemistry

hair thins, gets brittle

low BP, slow HR, palpitations

anemia

weak muscles, swollen joints, fractures, osteoporosis

kidney stones, failer

low potassium, magnesium, sodium

constipation, bloating

amenorrhea, bone loss,

easy bruising, dry skin, fine hair all over body, cold intolerance, yellow skin, brittle nails

Lowered cognition, anhedonia / apathy
Cold intolerance
Bradycardia
Reduced thyroid metabolism (low T3)
Low LH and FSH, estrogen/testosterone
Delayed sexual development
Osteoporosis, hypocalcemia - fractures
Lanugo 
Chronic dehydration and constipation
Plus purging complications as below
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15
Q

Anorexia treatment

A

Weight normalization

Treat physical complications

CBT
Distorted body image
Low self-esteem
Destructive coping strategies
SSRIs for comorbid depression and anxiety
SGAs are often used for obsessive thinking and wt gaing

Family therapy

Achieving Long term remission

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16
Q

anorexia- To admit, or not to admit,…

A

Hospitalize if:

Under BMI of 17

Evidence of organ system failure
HR under 40 bpm, orthostatic hypotension, temp under 97°, glucose under 60, BP under 80/50
Hypokalemia, hypophosphatemia, hypomagnesemia

Comorbid psychiatric condition requiring hospitalization (i.e. depression w/ SI)
(
Failing outpatient efforts

17
Q

Prognosis - anorexia

A

Age of onset strongly affects prognosis
Adult onset = age of symptom onset after 18 years old

Adolescent Onset Prognosis
5 years post treatment
> 70% full recovery 
25% other specified E.D. 
5% meet criterion for full syndrome
No deaths reported
Adult Onset Prognosis
4 years post treatment
15%  fully recovered
40% “good” outcomes
Weight within 85% of expected
Regular menstruation 
40% enduring morbid food and weight preoccupation
5% dead

Lifetime mortality 25%
5.6% per decade
Death 2° medical complications of starvation and suicide

18
Q

Bulimia Nervosa

A

Recurrent binge eating with inappropriate compensatory methods to avoid weight gain.

Binge, and compensation, average once a week for at least 3 months

Self-evaluation unduly influenced by weight or shape

19
Q

bulimia epidemiology

A

1-4% lifetime prevalence in females

Onset is usually late teens to early twenties

20
Q

Bulimia: why?

A

Biologic
Serotonin: linked to satiety
- SSRIs decrease binging and purging, and depression
Increased rate of Bulimia in first degree relatives

Psychodynamic
Less superego control
More outgoing, impulsive, emotional lability
Engage in substance use and destructive sexual relations
Significant BPD-associated traits
Often view family as conflictual, neglectful, and rejecting
More often, dislike the disordered eating
- “Ego-dystonic”

21
Q

“Anxious” + “Ox hunger”

A

Disorder is less “controlled”

  • Failed attempt at anorexia
  • Binges as “breakthrough eating”
  • Eating as self soothing in times of stress

Binge is soothing

  • High calorie, sweet, soft/smooth
  • Secret, fast, and not always chewed

Binges provoke panic state
- Pt proves to self “lack of control”

22
Q

Bulimia complications

A

Dehydration and electrolyte disturbances

  • Laxatives can lead to metabolic acidosis
  • Vomiting can lead to a metabolic alkalosis
  • – Also chipped teeth and enlarged parotids
  • – Leads to renal excretion of K+

Low magnesium and elevated amylase

Often have irregular menses

23
Q

Treatment - bulimia

A

Psychotherapy: 50% symptom reduction

Cognitive Behavioral Therapy
* most effective form of short-term intervention
Psychodynamic
Psychotherapy
- Useful once binge/purge symptoms improve
- Targets both E/D and broader personality issues

Family Therapy
- Very important for adolescents

Meds: SSRIs

  • Fluoxetine is FDA approved
  • Decreases behaviors substantially

For best results: Combine CBT and SSRI

24
Q

Prognosis - bulimia

A

Most have episodic course

At 3 months post-treatment
- ~ 70% achieved remission

10 yrs. post-treatment

  • 60% Fully Recovered
  • 10% E.D. NOS
  • 30% Still meet diagnostic criteria
25
Q

Binge eating disorder

A

Recurrent binge eating (weekly in 3 mos)

No compensation in any way

Binges are associated with:

  • Eating much faster than normal
  • Get uncomfortably full
  • Very large amounts when not hungry
  • Eating alone due to embarrassment
  • Post-binge disgust, depressed, guilty

Marked distress regarding binge eating

26
Q

binge eating epidemiology

A

Most common Eating Disorder
- Females: 4% Males: 2%

50% of pts are obese

Present in 25% of pts seeking care for obesity
Present in >50% of pts with severe obesity (BMI >40)

27
Q

binge eating Treatment

A

CBT

SSRIs

Self-help groups (OA)

28
Q

When trying to diagnose binge eating…

A

Why is person showing disordered eating?
- Undergoing chemo, stroke, paranoia, depression?

Look at BMI
- BMI is will take you a long way

Look for complications from behavior

29
Q

Social

A

Western societies emphasize thinness and exercise

Visual media exposes 300M people to pictures of a few thousand very thin women, creating a false norm

Is the desire to be found attractive by men “pathologic”?

  • Heterosexual women and gay men – higher risk
  • Heterosexual men and lesbian women – lower risk
30
Q

Go west, young woman

A

As the incidence of overweight and obesity rise, so does the incidence of eating disorders.

As countries become more “Westernized”, eating disorders rates increase

When women from countries with a low prevalence move to countries with higher prevalence, their rates of eating disorders increase

Prevalence in adolescent girls from Fiji increased significantly after exposure to television

Four out of five U.S. women are dissatisfied with their appearance

31
Q

Start them young…

A

42% of girls age 6 to 9 “want to be thinner”

In 1970 the average age a girl started dieting was 14;
by 1990 the average age dropped to 8 years old

One half of 4th grade girls are on a diet
- And stated they felt better about themselves when adhering to a diet

90% of female high school juniors & seniors diet, yet only one out of ten high school girls are overweight

Overall - 62% of girls & 29% of boys are dieting,
yet only 6.9% of these girls and 14.2% of the boys actually overweight

32
Q

Psychiatric comorbidities

A

Substance Abuse

  • 23-40% with Bulimia
  • 12-18% with Anorexia

Sexual Abuse
- 20-50% both Bulimia and Anorexia

Avoidant Personality D/O
- Both Anorexia and Bulimia

Obsessive/Compulsive Personality D/O
- Anorexia Nervosa

Borderline Personality D/O
Bulimia Nervosa

33
Q

The Shame game

A

All of these groups struggle with body-centered shame.

1 Psych Exam 2 (12 decks)

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