Eating Disorders

Question 1

Anorexia Nervosa Diagnostic Criteria (+ subtypes and severity levels)

Answer 1

• Must have all 3…
  
  • Restriction of energy intake relative to needs —> low body weight for their age/sex/development (less than minimally expected or normal)
  • Intense fear of gaining weight OR behaviors that interfere w/ weight gain even when weight is low
  • Distorted perception or disturbance in how body is experienced; undue influence on self-evaluation OR lack of recognition of how serious low body weight is
• 2 Subtypes
  
  • Restricting Type - (in last 3 mo) - no purging/compensation; weight loss mainly through diet/fasting/exercise
  • Binge-Eating Purging Type - (in last 3 mo) - engaged in recurrent binge eating or purging
• Severity
  
  • Mild (BMI 17 or lower)
  • Moderate (BMI 16-16.99)
  • Severe (BMI 15-15.99)
  • Extreme (BMI 15 or lower)

Question 2

Relative Epidemiology of Ea

Answer 2

AN

• Peaks 13-18 yo
• Female&raquo_space; male (but males may also be less likely to present)
• .1-.7% female population

BM

• Onset somewhat later than AN (mid-adol to late 20s)
• 1-3% prevalence
• 10:1 female:male

Binge Eating Disorder

• 3% women 2% men
• Often associated w/ obesity, medical problems and psych co-morbidities

Question 3

Anorexia Nervosa Tx

Answer 3

• Usually inpatient (<75% ideal body weight) then partial hospitalization (5 days a week) then intensive outpatient (3 days a week)
  
  • Must gain some weight b/f starting CBT (otherwise not effective)
  • Drugs not first line, but may use SSRIs if also depressed/anxious and only use at higher body weights
  • May use atypical anti-psychotics for distortions during re-feeding

Question 4

Anorexia Nervosa Course and Outcomes

Answer 4

• Highest mortality of any psych condition (suicide and medical); 5-7% mortality rate
• 7-15% will be chronic
• 50-60% improve w/ tx
• Less likely to improve if use laxatives, binge, psych problems in family

Question 5

Anorexia Nervosa Cause

Answer 5

• Unknown but multi-factorial

- High concordance rate (50% MZ twins)

Question 6

Bulimia Nervosa Diagnostic Criteria

Answer 6

• Recurrent episodes of binge eating + recurrent episodes of inappropriate compensatory behavior
  
  • Binging = larger portion than others in same context and feel out of control
  • Fast or less calories than normal b/n episodes of binging
• Must occur 1wk for 3 mo
• Self-evaluation unduly influenced by body shape and weight
• R/O anorexia nervosa

Question 7

Bulimia Tx

Answer 7

• Interpersonal psychotherapy or CBT

- High dose SSRis helpful

Question 8

Bulimia Course/Outcomes

Answer 8

• 30% cont after tx

- Worse prognosis if substance abuse

Question 9

Binge Eating Disorder Diagnostic Criteria

Answer 9

• Recurrent episodes of binge eating
  
  • Eating more in set period of time than normal person would in that time
  • Lack of control
• Episodes associated w/ 3 of following…
  
  • Eat more rapidly than normal, eat until uncomfortably full, eat large amounts when not physically hungry, eat alone/feel embarrassed, disgusted/depressed/guilty
• Marked distress
• Occurs at least 1/ wk for 3 mo
• No purging/other compensation

Question 10

Binge Eating Disorder Tx

Answer 10

• CBT for binge eating and SSRIs

Question 11

Associated Health Complications

Answer 11

• Low K, Na, Mg, Ca, glucose
• Cardio - get EKG b/c low K can cause arrhythmias, orthostatic hypotension (often faint), edema
• GI - (esp fo laxative use) dec gastric motility, bleeds, ulcers, gastric dilation or perforation, GERD, erosion of tooth enamel, nutritional hepatitis
• Heme - leukopenia, anemia, bone marrow hypoplasia
• Neuro - seizures, cognitive changes, depression, insomnia, irritability, hypothermia, hyper-sensitive, weak
• Endocrine - dec metabolic rate, abnormal GH, cortisol, TFTs, osteopenia, amenorrhea/irregular period/ infertile, hypoglycemia, dec libido

Question 12

Refeeding Syndrome

Answer 12

• Refeeding Syndrome - pancreas over-reacts to food —> INSULIN —> uptake of glucose, K+, Mg+, Phos
  
  • Can cause dec ATP, hypokalemia, etc

Question 13

How to screen for eating disorders (5)

Answer 13

(if answer is yes to 2+)

• Do you ever make yourself vomit because you feel uncomfortably full?
• Do you worry about losing control over how much you eat?
• Do you believe yourself to be fat when others say you are thin?
• Have you lost 15 lbs or more in last 3 mo?
• Would you say food dominates your life?