Eating disorders Flashcards
Describe aetiology, clinical presentation, diagnosis and management of Eating Disorders
Describe the DSM-V diagnostic criteria for Eating Disorders
Describe the physical signs and medical complications associated with eating disorders
Carry out a clinical assessment of a patient with an eating disorder
Develop a management plan for a person with an eating disorder
o yah!!!
List 6 types of eating disorder
- pica
- rumination disorder
- avoidant/restrictive food intake disorder
- anorexia nervosa
- bulimia nervosa
- binge-eating disorder
DSM criteria for pica
- Persistent eating of non nutritive, non food substances over a period of at least 1 month.
- The eating of nonnutritive, nonfood substances is inappropriate to the developmental level of the individual.
- The eating behavior is not part of a culturally supported or socially normative practice.
- If the eating behavior occurs in the context of another mental disorder(e.g.,intellectual disability [intellectual developmental disorder], autism spectrum disorder, schizophrenia) or medical condition (including pregnancy), it is sufficiently severe to warrant additional clinical attention.
DSM criteria for rumination disorder
- Repeated regurgitation of food over a period of at least 1 month. Regurgitated food may be re-chewed, re-swallowed, or spit out.
- The repeated regurgitation is not attributable to an associated gastrointestinal or other medical condition (e.g., gastroesophageal reflux, pyloric stenosis).
- The eating disturbance does not occur exclusively during the course of anorexia nervosa, bulimia nervosa, binge-eating disorder, or avoidant/restrictive food intake disorder.
- If the symptoms occur in the context of another mental disorder (e.g., intellectual dis- ability [intellectual developmental disorder] or another neurodevelopmental disorder), they are sufficiently severe to warrant additional clinical attention.
DSM criteria for Avoidant/Restrictive Food Intake Disorder
A) An eating or feeding disturbance (e.g., apparent lack of interest in eating or food; avoidance based on the sensory characteristics of food; concern about aversive consequences of eating) as manifested by persistent failure to meet appropriate nutritional and/or energy needs associated with one (or more) of the following:
- Significant weight loss (or failure to achieve expected weight gain or faltering growth in children).
- Significant nutritional deficiency.
- Dependence on enteral feeding or oral nutritional supplements.
- Marked interference with psychosocial functioning.
B) The disturbance is not better explained by lack of available food or by an associated culturally sanctioned practice.
C) The eating disturbance does not occur exclusively during the course of anorexia nervosa or bulimia nervosa, and there is no evidence of a disturbance in the way in which one’s body weight or shape is experienced.
D) The eating disturbance is not attributable to a concurrent medical condition or not bet- ter explained by another mental disorder. When the eating disturbance occurs in the context of another condition or disorder, the severity of the eating disturbance exceeds that routinely associated with the condition or disorder and warrants additional clinical attention.
DSM criteria for anorexia nervosa
A) Restriction of energy intake relative to requirements, leading to a significantly low body weight in the context of age, sex, developmental trajectory, and physical health. Significantly low weight is defined as a weight that is less than minimally normal or, for children and adolescents, less than that minimally expected.
B) Intense fear of gaining weight or of becoming fat, or persistent behavior that interferes with weight gain, even though at a significantly low weight.
C) Disturbance in the way in which one’s body weight or shape is experienced, undue influence of body weight or shape on self-evaluation, or persistent lack of recognition of the seriousness of the current low body weight.
Specify if restrictive type or binge eating/purging type
How do you classify severity of anorexia?
- Mild: BMI ≥ 17
- Moderate: BMI 16–16.99
- Severe: BMI 15–15.99
- Extreme: BMI < 15
Etiology of eating disorders
Multifactorial
- Psychological
- Social/cultural
- Genetic
- Personality: obsessive-compulsive, histrionic, borderlines
Risk factors for eating disorders
Physical: obesity, chronic medical illness (eg. DM), family history (eating
disorders, mood disorders, substance abuse)
Psychological: certain careers (eg. Athletes), hx sexual abuse, depression, anxiety,
OCD, substance abuse
Management of anorexia
- Outpatient and inpatient programs available
- Admit to medical ward if: <65% standard body weight, hypovolaemic, HR
- <40, significant electrolyte abnormality
- Refer for psychotherapy
- Monitor weight and bloods regularly
Prognosis of anorexia
- Early intervention better
- 1 in 10 adolescents continue to have anorexia into adulthood
- 70% assume weight of at least 85% expected level, 50% resume normal
- menstrual function
- Long-term mortality 10-20%
DSM criteria of bulimia
A. Recurrent episodes of binge eating. An episode of binge eating is characterized by both of the following:
- Eating, in a discrete period of time (e.g., within any 2-hour period), an amount of food that is definitely larger than what most individuals would eat in a similar period of time under similar circumstances.
- A sense of lack of control over eating during the episode (e.g., a feeling that one cannot stop eating or control what or how much one is eating).
B) Recurrent inappropriate compensatory behaviors in order to prevent weight gain, such as self induced vomiting; misuse of laxatives, diuretics, or other medications; fasting; or excessive exercise.
C) The binge eating and inappropriate compensatory behaviors both occur, on average, at least once a week for 3 months.
D) Self-evaluation is unduly influenced by body shape and weight.
E) The disturbance does not occur exclusively during episodes of anorexia nervosa.
How to specify severity of bulimia?
- Mild: An average of 1–3 episodes of inappropriate compensatory behaviors per week.
- Moderate: An average of 4–7 episodes of inappropriate compensatory behaviors per week.
- Severe: An average of 8–13 episodes of inappropriate compensatory behaviors per week.
- Extreme: An average of 14 or more episodes of inappropriate compensatory behav- iors per week.
Management of bulimia
- Admit to medical ward if: significant electrolyte abnormality
- Pharmacological: SSRI
- Psychological: CBT, family therapy, recognition of health risks
- Social: challenge social views of women
- Monitor regularly
What is the prognosis for bulimia?
- Relapsing/remitting disease
- Good prognostic factors: onset before 15yo, achieving health weight within 2 years of treatment
- Poor prognostic factors: later age of onset, previous hospitalisation, individual and familial disturbance
- 60% have good treatment outcome, 30% intermediate outcome, 10% poor outcome
