Eating Disorders

Question 1

List some aetiological factors contributing to anorexia nervosa

Answer 1

• Genetics
• FHx
• Female
• Early puberty
• Early dieting
• Preoccupation with weight
• Anankastic personality/high achiever
• Peer pressure
• Childhood bullying due to weight

Question 2

What are the key clinical features of anorexia nervosa which are necessary for diagnosis?

Answer 2

"FEED":
Fear of weight gain/fatness
Endocrine disturbance - amenorrhoea
Emaciated - BMI <17.5
Deliberate weight loss/Distorted body image

Question 3

Give some other clinical features of anorexia, apart from those vital for diagnosis

Answer 3

• Fatigue
• Hypothermia
• Bradycardia
• Headaches
• Lanugo hair
• Constipation
• Hair loss
• Vigorous exercising
• Preoccupation with food

Question 4

List some investigations you would do in anorexia nervosa

Answer 4

Bloods - FBC, U+E, LFTs, pituitary hormones, TFTs, cholesterol, glucose
ECG

Question 5

List some DDx for anorexia

Answer 5

• Bulimia
• ED not otherwise specified
• Organic cause of emaciation
• Depression
• OCD/anankastic PD
• Alcohol/drug misuse

Question 6

Outline the management of anorexia nervosa

Answer 6

• Bio - treat medical complications, SSRIs if depression/anxiety
• Psych - psychoeducation, CBT, IPT, family therapy
• Social - self-help groups
• In-patient if BMI < 13.5/significant risks

Question 7

List 4 complications of Anorexia Nervosa

Answer 7

Metabolic and endocrine disurbances
Pancreatitis
Hepatitis
HF
Arrythmias
Renal failure
Seizures
Anaemia
Osteoporosis

Question 8

Outline the vicious cycle underpinning Bulimia

Answer 8

Sense of compulsion to eat –> bing eating –> Fear of fatness –> Compensatory weight loss behaviours

Question 9

What are the key clinical features of bulimia necessary for diagnosis?

Answer 9

• Fear of fatness
• Overeating, e.g. >2000kcal in one sitting, 2x per week for 3 months
• Methods to counter weight-gain, e.g. vomiting, fasting, drugs, exercise
• Preoccupation with shape/weight/eating

Question 10

List some other features of bulimia apart from the ones key to diagnosis

Answer 10

• Normal or overweight
• Depression
• Low self-esteem
• Irregular periods
• Consequences of repeated vomiting, e.g. erosion of teeth, calluses on hands, hypokalaemia, metabolic alkalosis

Question 11

Outline the management of bulimia

Answer 11

Bio - SSRI, usually Fluoxetine. Treat medical complications

Psych - CBT/IPT

Social - food diary, techniques to avoid bingeing