Eating Disorders

Question 1

SCOFF Questionnaire

Answer 1

If patients score 2 or more positive answers, then an eating disorder is likely:
Do you make yourself Sick because you feel uncomfortably full?
Do you worry you have lost Control over how much you eat?
Have you recently lost more than One stone (14 pounds or 6.35 kg) in a three month period?
Do you believe yourself to be Fat when others say you are too thin?
Would you say that Food dominates your life?

Question 2

Common features of Eating Disorders

Answer 2

Obsessive fear of fatness with avoidance of food and other sources of calories. A range of compulsive compensatory behaviours when food cannot be avoided.

Question 3

Anorexia Nervosa

Answer 3

Restriction of intake to reduce weight. Relies of compulsive compensatory behaviours when food cannot be avoided, self induced vomiting, laxative abuse, excessive exercise.

Considered anorexic if they are 15% below ideal body weight

Fear of weight gain

Question 4

Bulimia Nervosa

Answer 4

Episodes of binge eating with a sense of loss of control. Bing eating is followed by compensatory behaviour of the purging type. Binges and the resulting compensatory behaviours must occur a minimum of two times per week for three months. There is a dissatisfaction with body shape and weight.

Question 5

Avoidance of Calorie Intake

Answer 5

Diets - becoming vegetarian, vegan etc. Interpreting all symptoms as allergy. Eating very slowly, only eating at certain times. Avoiding parties and social occasions. Medication abuse.

Question 6

Getting Rid of Calories

Answer 6

Self-induced vomiting, chewing and spitting out, overexercising, overactivity, cooling, blood letting, medication abuse (omitting insulin)

Question 7

“Anorexic Police Force”

Answer 7

Body-checking, displaying emaciation to elicit reassuringly shocked attention, cruising “por-ana” websites, competing with self and others to attain lower and lower targets, deliberate self harm if rules are broken

Question 8

Psychological consequences of eating disorders

Answer 8

Cognitively impaired, reduced attention span, difficulty interpreting emotion (this is usually better with nutrition). Malnourished brains experience depression, anxiety, obsessionality and loss of concentration. This rarely responds to medication due to the low weight.

Question 9

Social consequences of eating disorders

Answer 9

Withdrawal from friendships and sexual relationships

Question 10

Physical consequences of eating disorders

Answer 10

Starvation causes physical damage, poor repair and resistance, heart damage, reduced immunity to infections, anaemia, bone loss, fertility problems. Purging behaviours cause neuro-chemical disruption with special damage to the brain and the heart.

Question 11

Causes of anorexia

Answer 11

Genetic predisposition – OCD, anxiety disorders, perfectionism
Perinatal factors - prematurity
Life events – and traumas
Perpetuating consequences of starvation and of avoidance

Question 12

Precipitating Factors of Eating Disorder

Answer 12

Puberty, dieting or even non-deliberate weight loss, increased exercise, stressful life events

Question 13

Perpetuating Factors of Eating Disorder

Answer 13

Delayed gastric emptying giving the sensation of fullness interpreted as fatness. Narrowing focus. Obsessionality - phobia of fat increases as avoidance increases.

Question 14

Recovery time of AN

Answer 14

6-7 years

Question 15

Management of Eating disorders

Answer 15

CBT, SSCM, fluoxetine 60mg daily, olanzapine