Eating Disorders Flashcards
Define anorexia
Eating disorder characterised by a relentless pursuit of thinness resulting in low body weight and a body image disturbance.
What are the causes of anorexia?
Phobia of normal body size & weight Body image disturbance- mirror imaging Perfectionism Low self-esteem Lack of close friends Biological causes Fhx- Genetics Anxiety Culture/society Puberty Stress Family pressure Bereavement
What are the signs & symptoms of anorexia?
Dietary restriction- <85% of expected body weight for age Weight loss & Decreased subcut fat Fear of gaining weight Reduced calorie intake/misuse of laxatives/enemas/diuretics Amenorrhoea Body dysmorphia: Feeling fat/bloated Cold intolerance Hair loss Fatigue Bruising Hypotension
What are the signs of starvation?
Low metabolic rate, cold peripheries, alopecia, bradycardia, osteopenia, skin changes, lanugo hair, amenorrhoea, vit & electrolyte disturbances, ankle oedema, low plasma proteins, falsely low T3
What investigations should be carried out for anorexia?
BLOODS: FBC (Normocytic normochromatic anaemia, thrombocytopenia, mild leukopenia), Serum chemistry/ U&E,Creatinine Kinase, (hypoK-V&lax, met acid/alkalosis, hypoCa, hypoMg, ↑urea, hypoN), TFTs (↓T3, normal TSH & T4), LFTs (↑ALT & AST, ↓ ALP), Glucose, Zinc
BMI
ECG
URINALYSIS & pregnancy test: May show ketonuria
How is anorexia managed?
ONGOING: Structured eating plan w/oral nutrition Psychotherapy: Body awareness therapy, CBT, nutritional rehabilitation, family intervention, psychodynamic Potassium repletion (65mmol orally/day) MEDICALLY UNSTABLE: Oral/enteral/parenteral nutrition, Fluid intake correction, Potassium/magnesium/calcium/sodium repletion, meds may be used to suppress behaviours
What are the complications of anorexia?
Highest mortality rate of all psychiatric disorders
Re-feeding syndrome
Osteopenia/osteoporosis
Infertility
Primary amenorrhoea
Peripheral oedema secondary to re-feeding
What are the types of anorexia?
RESTRICTIVE: No episodes of binge-purging in the preceding 3months, weight loss achieved by exercising/dieting/fasting
BINGE-PURGE: Recurrent episodes of binge/purge in the preceding 3months
What are the mechanisms of anorexia?
Restricting calorie intake Over-exercise Use of laxatives Vomiting Use of diuretics
Define bulimia
An eating disorder characterised by severe preoccupation about weight & body shape. Includes recurrent episodes of binge eating with compensatory mechanism such as self-induced vomiting.
What ages do anorexia & bulimia tend to occur? Which is more common?
Bulimia more common
A: 14-15 peak 18
B: Early 20s
What are the signs & symptoms of bulimia?
x2-3 more common than anorexia Recurrent binge eating episodes w/loss of control- 7000-8000calories in one meal Dental erosion Russell’s sign Arrhythmia Parotid hypertrophy Depression & low self-esteem Concern about weight & body shape Purging Vomiting Appetite suppression Laxative abuse Diuretic abuse Body weight higher than in anorexia
How is bulimia managed?
CBT or IPT
Nutritional & meal support
SSRI: Fluoxetine 60mg daily (try to interrupt binge-purge cycle)
Other psychotherapies (family support, self-help groups)
Glycaemic control
Immediate referral for specialist evaluation/A&E assessment
What are the classifications of severity for bulimia?
Mild: 1-3episodes/week
Moderate: 4-7episodes/week
Severe: 8-13episodes/week
Extreme: >14episodes/week
What differentials should be considered related to an eating disorder?
Depression OCD Somatoform disorders Hypopituitarism Addison's Thyrotoxicosis IBD DM TB Cancer
What electrolyte imbalances can be seen with the different behaviours occurring in an eating disorder?
Starvation = HypoG Vomiting= HypoK Water-loading = HypoN Laxatives = HypoN, HyperK Diuretics = HypoK, HyperN Thyroxine misuse = ↑T3/T4, ↓TSH Refeeding = HypoPhos, HypoK, HypoCa, HypoMg Proximal myopathy = ↑ CK, ↑ LFTs
What questions does the SCOFF screening questionnaire consist of?
S- Do you are yourself SICK because you feel uncomfortably full?
C- Do you worry you have lost CONTROL over how much you eat
O- Have you recently lost >1 STONE in a 3m period?
F- Do you believe yourself to be FAT when others say you are thin?
F- Would you say FOOD dominates your life?
Positive response >2 GP referral
What forms of psychotherapy can be offered in eating disorders?
- Guided Self-help: Brief, low intensity, 1st line CBT, educational, inc awareness & responsibility, structured eating, promotes self-management, clinician acts as source of support
- Motivational enhancement: 4-6sessions, inc motivation to change, benefits in initial phase promotes responsibility & commitment to change
- Motivational interviewing: Guiding > directing, honours a person’s autonomy, open ended questions
- Structured eating: Adequate nutrition, stop purge behaviour, reduce excessive exercise, meds, education, individual/group therapy
How is anorexia diagnosed?
Must have all 4:
1) BMI <18.5 /body weight 15% below expected
2) Endocrine disturbance: Amenorrhoea, lanugo hair, pubertal delay
3) Morbid fear of being fat (overvalued idea rather than delusion)
4) Self induced weight loss (dieting, exercise, vomiting)
How is Bulimia diagnosed?
Must have all 3:
1) Regular binge/purge x1/week
2) Method to prevent weight gain: Vomiting, purging, diuretic/laxative abuse
3) Morbid fear of being fat (overvalued idea not delusion)
Other: BMI >18.5
How is an eating disorder investigated?
Bloods: U&Es, FBC, LFT, Glucose BMI BP Muscle power Pulses
What is the main physical risk associated with Anorexia & Bulimia?
A: Hypotension, Sudden death, Bradycardia
B: Arrhythmia, Cardiac failure, Sudden death
How does binge eating stop?
- Food source finished
- Stomach distension causes physical feeling of sickness which prompts purging
- Feelings of guilt about binge = purge
What are the components of the physical risk assessment in eating disorders?
- Hx & Ex: Rapid ↓weight >1kg/week, CVS exam, irregular pulse, postural hypoT, medical review, assess proximal myopathy
- BMI
- ECG: T wave changes (hypoK)
Bradycardia <40 = strict bed rest & re-feeding
Prolonged QTc = Tx: re-feeding - Bloods
What are the severities of BMI in anorexia?
<18.5 Anorexia
<15 Moderate risk- Can still be treated in the community
<13 High risk- Hospital admission
What are the risk factors for anorexia?
High social class
Caucasian
Academic prowess
Interests: Modelling, ballet
