Eating disorders Flashcards
Two subtypes of anorexia nervosa
Restricting type or binge-eating/purging type
Diagnostic criteria for anorexia nervosa
Restriction of energy intake relative to requirements, leading to significant low body weight
Intense fear of gaining weight or becoming fat, or persistent behaviors that prevent weight gain
Disturbed body image, undue influence of weight or shape on self-evaluation, or denial of low body weight
Physical manifestations of anorexia (there are many)
Amenorrhea, cold intolerance, hypotension, bradycardia, arrhythmia, ACS, cardiomyopathy, mitral valve prolapse, constipation, alopecia, seizures, etc.
Lab findings in anorexia
Hyponatremia, hypocholremic hypokalemic metabolic alkalosis 2/2 vomiting, arrhythmia, high cholesterol, high LFTs, leukopenia, anemia, high BUN, ………….many
Medical Ddx for anorexia
Endocrine: hypothalamic disease, DM, hyperthyroid
GI: Malabsorption, IBD
Genetic: Turner syndrome, Gaucher disease
Cancer
AIDS
Psych Ddx for anorexia
MDD, bulimia, other
Management of anorexia
Food, hospitalize if >20-25% below ideal body weight, CBT or other therapy (Maudsley method of family therapy), treat comorbid anxiety and depression
What distinguishes bulimia nervosa from anorexia nervosa?
Patients usually maintain a normal weight or are overweight
Diagnostic criteria for bulimia nervosa
Recurrent episodes of binge eating
Recurrent, inappropriate attempts to compensate for overeating and prevent weight gain (laxatives, vomiting, diuretics, fasting, exercise)
Binging/compensatory behaviors at least 1x/wk for 3 mos
Perception of self-worth excessively influenced by body weight and shape
Physical exam findings in bulimia
Salivary gland enlargement, dental erosions, callouses/erosions on dorsum of hands, petechiae, edema
Lab findings in bulimia
Hypochloremic hypokalemic metabolic alkalosis 2/2 vomiting, hypernatremia, high BUN, high amylase, esophagitis (not a lab…?)
Course and prognosis of anorexia and bulimia
Chronic and relapsing illness
Bulimia = better prognosis
Anorexia =5% mortality per decade of life (starvation, suicide, or cardiac failure)
Management of bulimia
SSRIs + therapy (CBT, interpersonal, family, group)
Fluoxetine is FDA approved
Avoid buproprion due to seizure risk
Features of binge eating disorder
Patients have distress about their binge-eating, but do not try to control their weight with compensatory measures
Diagnostic criteria for binge-eating disorder
Recurrent episodes of bingeing with at least 3 of: eating too fast, too full, too much, when not hungry, feeling disgusted/depressed after eating, eating alone due to embarrassment
Severe distress about binge eating
Occurs at least 1x/wk for 3 months
No compensatory behaviors
Physical exam findings of binge-eating disorder
Usually obese, with related medical problems
Course and prognosis of binge-eating disorder
Usually begins in adolescence or young adulthood
Persistent, but better chance of remission compared to other eating disorders
Management of binge-eating disorder
Individual psychotherapy (CBT, interpersonal) + strict diet and exercise program
Treat comorbid mood or anxiety disorders
MAYBE drugs for weight loss: stimulants, topiramate zonisimide, orlistat (inhibits pancreatic lipase –> decreased fat absorption)
Diagnostic criteria for pica
Consumes nonnutritive substances on a persistent basis for at least 1 month
Inappropriate to the developmental level of the individual
Eating behavior is not culturally supported or socially normal
If it occurs in the context of another mental disorder, it is severe enough to warrant additional clinical attention
Treatment for pica
No specific therapy
Behavior therapy that rewards appropriate eating behavior
What is geophagy?
Eating dirt or clay. A common cultural activity, particulary in central Africa and Southern USA, and Pomo people of Northern California. Takes place during pregnancy, religious ceremonies, as part of a normal diet, or as a remedy for disease
What is rumination disorder?
Repeated regurgitation of food
Diagnostic criteria for rumination disorder
Repeated regurgitation of food for at least 1 month
Not related to an underlying GI problem or other medical condition
Not due to another eating disorder
If it occurs in the context of another mental disorder, it is severe enough to warrant additional clinical attention
Treatment for rumination disorder
No specific therapy
Reward non-rumination
Diagnostic criteria for avoidant/restrictive food intake disorder
-Eating/feeding disturbance manifested by persistent failure to meet appropriate nutritional/energy needs associated with at least one of:
–Significant weight loss
–Significant nutritional deficiency
–Dependence on enteral feeding/oral supplements
–Interference with psychosocial functioning
Not better explained by lack of available of food or by culturally sanctioned practice
Not related to anorexia or bulimia, and no disturbance in body image
Not related to another medical condition
