Eating Disorders Flashcards
Risk factors for eating disorders
- Female
- Pear shaped body
- High BMI
- Sexual abuse (esp BN)
- Negative feelings about ones body at puberty
- Family hx of eating disorder
- Anorexia – more likely to be anxious, inhibited, controlled, obsessive-compulsive; families more likely to be overly controlled, organized, or have weight concerned parent
- Bulimia – under-controlled, mood labile; families chaotic, conflicted, critical
Personality disorders common to AN
Avoidant and obsessive compulsive
Personality disorders common to BN
Avoidant and borderline
Nervous system findings in eating disorders (8)
- Cold intolerance
- Low core body temp
- Cognitive disturbance
- Depression/apathy
- Irritability
- Fatigue
- Seizures
- Mild neuropathies
Cardiovascular findings in eating disorders (6)
- Bradycardia
- Hypotension
- Myocardial atrophy
- Arrhythmias
- Ventricular tachycardias
- Death
Dermatologic findings in eating disorders (5)
- Lanugo (fine, baby-like hair)
- Easy bruising
- Dry skin
- Brittle nails/hair
- Dorsal hand calluses/scars on hands (from self-induced vomiting, Russell sign)
Digestive/GI findings in eating disorders (7)
- Salivary gland/pancreatic inflammation
- Increase serum amylase
- Delayed gastric emptying
- Esophageal erosions
- Abdominal pain
- Constipation
- Bloating
Muscles/Joints findings in eating disorders (4)
- Loss of muscle mass/fat
- Weakness
- Fractures
- Osteoporosis
Reproductive/hormonal findings in eating disorders (6)
- Amenorrhea
- Growth delay
- Lack of sexual desire
- Infertility
- High risk pregnancy (if becomes pregnant)
- Low LH, FSH, TSH
Kidney findings in eating disorders (3)
- Renal stones
- Renal failure
- Edema
Dental findings in eating disorders (2)
Erosion of teeth enamel and decay
Metabolic findings in eating disorders (3)
- Hypokalemic, hypochloremic alkalosis
- Hypomagnesemia
- Hyponatremia
AN Criteria
Restriction of energy intake relative to reqs –> significantly low body weight for age/sex/dev trajectory/physical health
Intense fear of weight gain/becoming fat even though underweight
Disturbed view of own weight/shape, undue influence of weight/shape on self-eval, or denial of seriousness of low weight
Subtypes of AN (2)
Restricting – restricts eating (no binging or purging w/in last 3 mos)
Binge/Purge – regularly engages in binging/purging (i.e. self-induced vomiting, misuse laxatives, diuretics, enemas) in last 3 mos
Safety concerns in AN
Suicide rate 55x that of gen pop females
Mortality up to 10%
Good prognostic indicators for AN
- Short duration of illness prior to tx
- Younger age of onset
- Close to ideal body weight at discharge
- Exercising/dieting to lose weight
- Good parent-child relationship
Poor prognostic indicators for AN
- Chronic illness
- Alcohol/drug use
- Lower initial weight
- Vomiting, bulimia, and purgative abuse to lose weight
Initial AN Tx
- Gradual weight restoration and medical stabilization are top priority (rapid refeeding is dangerous –> refeeding syndrome can cause hypophosphatemia and cardiac complications)
- May need hospitalization
- Meds: Cyproheptadine (increase appetite), SSRIs (once weight restored), sometimes antipsychotics
Later AN Tx
- Outpatient
- Psychotherapy: supportive therapy, psychoeducation, CBT, family therapy
- Meds: SSRIs (fluoxetine), atypical antipsychotics, cyproheptadine
BN criteria
- Recurrent binge eating (excessive amount of food in discrete time period, sense of lack of control on eating)
- Recurrent inappropriate compensatory behavior to prevent weight gain (e.g. self-vomiting, misuse laxatives/diuretics/enemas/other meds, fasting, excessive exercise
- Binging/compensatory behavior at least 1x q/wk x 3mos
- Self eval unduly on body shape/weight
BN Subtypes
Purging type: self-induced vomiting or use of laxatives
Nonpurging: other compensatory behaviors (fasting, excessive exercise)
BN Tx
- Usually outpatient
- Psychotherapy: supportive therapy, psychoeducation, CBT, family therapy
- Meds: fluoxetine FDA approved (sometimes atypical antipsychotics)
Eating disorder NOS examples
Binge eating disorder – no compensatory behavior
Purging disorder – no bingeing (small amount of food)
Medication cautions in eating disorders
Bupropion – CI in AN and BN bc increases seizure risk
Stimulants – CI due to abuse potential and weight loss
