Eating Disorders

Question 1

describe diagnostic criteria for anorexia nervosa

Answer 1

1. restriction of food that leads to being significantly underweight
   
   • 18.5 BMI is the lower limit of normal
   • Adults:
     
     • BMI < 17 (clearly below normal)
       BMI ≥ 17 but around 18.5 (grey zone)
   • children (2-18 yrs):
     
     • BMI < 5th percentile
2. intense fear of weight gain
   
   • evidenced by extreme preoccupation and frequent assessment behaviors that interefere with weight gain)
3. body image disturbance
   
   • ​​belief of being overweight or denies the seriousness of low weight, etc.

Question 2

describe anorexia subtypes

Answer 2

• binge-eating/purging type: the person recurrently binges AND/OR purges*
• restricting type: the person does not recurrently binge of purge* (weight loss is primarily through dieting, fasting, and/or exercise)
• purge = use of vomiting, laxatives, diuretics, or enemas to eliminate calories

Question 3

Clicker #1

Answer 3

• does she meet criteria? YES
  
  • BMI for child is below 5th percentile
  • has fear of gaining weight
  • has disturbance of body image
• does she binge/purge?
  
  • yes, she purges, so she is the binge eating/purging type

Question 4

what are indicators of excessive thinness?

Answer 4

• low BMI
• amenorrhea & loss of sex drive
• constipation
• hypothermia
• bradycardia & hypotension
• hypercholesterolemia
• anemia
• leukopenia
• low bone mineral desnity

Question 5

describe indicators of excessive vomiting

Answer 5

• calloused knuckles (Russell’s sign)
• dental enamel erosion
• salivary gland inflammation
  
  • “chipmunk cheeks”
• subconjunctival hemorrhage
• hypokalemia (loss of electrolytes)

Question 6

describe the psychological and social factors of anorexia

Answer 6

• excessive weight loss may result from:
  
  • dieting due to cultural pressures to be thin
  • using dieting as a means to “control” one’s life (especially when establishing autonomy from parents in adolescence)
  • a perfectionist personality trait leading to obsessive dieting
• weight loss is reinforced (internally and externally)

Question 7

describe biological factors explaining anorexia

Answer 7

• there is a genetic susceptibility to anorexia
• a person may inherit biochemical alterations leading to obesessiveness
• cultural pressures may direct the obsessiveness to body image

Question 8

describe the treatment of anorexia

Answer 8

• a patient is typically not self-referred, since anorexia tends not to be distressful
• in-patient hospitalization:
  
  • behavioral technique (reinforcement/punishment) are utilized to achieve the immediate goal of weight gain
  • an attendant often supervises the patient to thwart attempts to lose weight

Question 9

describe psychotherapy/pharmacological treatments of anorexia

Answer 9

• psychotherapy
  
  • CBT: the goal is to change patient’s attitude about food/weight and stop their destructive eating habits
• pharmacological
  
  • no drug is consistently effective for anorexia
  • ADs and appetite stimulants are tried but often lack effectiveness

Question 10

explain the outcome of anorexia treatment

Answer 10

• short-term: good repsonse to treatment (weight-gain) in a controlled, in-patient setting
• long-term: prognosis tends to be poor
  
  • patients tend to relapse once released into their home environment

Question 11

describe the diagnostic criteria for bulimia nervosa

Answer 11

1. recurrent binge eating
   
   • eating a large amount in a discrete period
   • eating is out of control during the episode
2. recurrent inappropriate compensatory behavior for binge
   
   • purging (vomiting, laxative, diuretics, enemas)
   • non-purging (fasting and/or excessive exercise)
3. the binge/inappropriate compensatory behaviors must occur ≥ 1 time/week for 3 months
4. self-evaluation is unduly influenced by body shape and weight

Question 12

Answer 12

• BMI is < 17 (14) so that makes it anorexia nervosa, binge eating/purging type

Question 13

name features of bulimia

Answer 13

• bulimics typically have normal body weight or slightly overweight

Question 14

describe the course of bulimia

Answer 14

• symptoms tend to being in adolescence and be chronic
• binging & purging (BMI = < 17): anorexia
• binging and purging (BMI = 25): bulimia

Question 15

describe biological factors of bulimia

Answer 15

• a person may be inheriting biochemical changes that leads to impulse dyscontrol
• low (unstable) serotonin is associated with this disorder
  
  • SSRIs can help

Question 16

describe the treatment of bulimia

Answer 16

• a patient typically initiates treatment, since the disorder distresses the patient
  
  • treatment is usually out-patient based
  • CBT is essential
  • AD medications may be a useful adjunct to help with impulse dyscontrol
• with greater motivation to change, the prognosis is better for bulimia than anorexia

Question 17

describe diagnostic criteria for binge-eating disorder (BED)

Answer 17

1. binge eating at least 1 time/week for 3 months
2. binging is associated with behaviors such as:
   
   • rapid eating
   • eating until uncomofortably full
   • eating when not physically hungry
   • eating alone due to shame about quantitiy
   • feeling disgusted/guilt/depressed after binge
3. NO inappropriate compensatory behavior

Question 18

describe the features of BED

Answer 18

• BED is usually associated (not necessarily) with obesity (BMI > 30) but considered a distinct problem:
  
  • there is greater distress and functional impairment in BED than in obesity
• health consequences of BED are similar to those of obesity

Question 19

describe the course, etiology and treatment for BED

Answer 19

• course:
  
  • adolescence with chronic course
• etiology:
  
  • unknown but different from bulimia (in BED, dysfunctional dieting doesn’t precede binging)
• treatment: CBT and ADs

Question 20

clicker #3

Answer 20

• BMI is not <17, so not anorexia
• she binges regulary AND inappropriately compensates (purges), so therefore bulimia

Question 21

Answer 21

• BMI is < 17, so anorexia possible
• phobia of gaining weight
• distorted judgement
• therefore anorexia
• does she regularly binge or purge? YES, so anorexia, binge-eating/purging type

Question 22

Answer 22

• BMI not low, so not anorexia
• does she inappropriately compensate? no, so not bulimia
• therefore, binge-eating disorder

Question 23

describe screening for eating disorders (SCOFF questions)

Answer 23

• S: Sick (induce vomiting?)
• C: Control (lose control?)
• O: One (1 “stone” weight loss in 3 months?)
  
  • 1 stone = 14 pounds/6.5 kgs
• F: Fat (believe fat?)
• F: Food (food dominates)

yes to ≥ 2 suggests an eating problem