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