Eating Disorders Flashcards
What are the two sub-types of anorexia nervosa?
Restrictive
Binge eating/purging type
According to the ICD10 what are the diagnostic criteria of anorexia nervosa?
Refusal to maintain or achieve healthy body weight
BMI <17.5
Intense fear of gaining weight
Undue influence of weight/shape on self-evaluation
Amenorrhoea
What different strategies are used by patients with anorexia nervosa in order to lose/avoid gaining weight?
Ignore hunger
Eat very little
Develop rules about what they can eat
Compensate for what’s eaten
Diabetics may omit or reduce insulin
What rules may a patient with anorexia nervosa set for themselves?
Calorie limits
Foods/food groups to be avoided
Have to eat less than others, or not eat if others aren’t
Have to eat at exact times or not at all
How might a patient with anorexia nervosa compensate for what they eat?
Use purging behaviours
Use slimming aids and fat blockers
Take amphetamine like drugs
What are some examples of purging behaviours used in anorexia nervosa?
Self-induced vomiting
Taking laxatives
Taking diuretics
When may a person with anorexia nervosa feel the need to induce vomiting?
After binges
After small amounts of food
What fuels anorexia nervosa?
Distorted body image
What is meant by a distorted body image in the context of anorexia nervosa?
Know that they are thin but feel fat
What is meant by ‘feeling fat’ in the context of anorexia nervosa?
Many emotions and psychological states
Often due to comparing to others and body checking
What can anorexia nervosa lead to socially?
Avoidance of others to avoid comparing
What are the two sub-types of bulimia nervosa?
Purging
Non-purging
Define a ‘binge’
A subjective loss of control where large amounts of typically calorie laden or ‘forbidden’ foods are eaten
What typically follows binge eating in a patient with bulimia nervosa?
Guilt
How is binge eating conducted by patients with bulimia nervosa?
In secret with the evidence hidden
What is the diagnostic criteria for bulimia nervosa as described by the ICD 10?
Recurrent episodes of overeating
Persistent preoccupation with eating
Strong desire to eat
Patient attempts to counteract fattening affects of binge eating
Self-perception of being too fat
What types of compensatory measures are used by people with bulimia nervosa?
Purging
Non-purging
What purging behaviours are used by people with bulimia nervosa to compensate for binge eating?
Self-induced vomiting
Laxative abuse
What non-purging behaviours are used by patients with bulimia nervosa to compensate for binge eating?
Exercise
Fasting
Do all patients referred to eating disorder clinics have bulimia nervosa or anorexia nervosa?
No, 1/3 have more atypical eating disorders
What are some examples of atypical eating disorders?
Atypical BN or AN
Binge eating disorders
Other disorders that defy classification
What factors can make people more prone to eating disorders?
Genetics
Biological vulnerability
Biological stress
Psychological vulnerability
Psychological stress
Social factors
Cultural factors
Differences in what can lead to differing psychological vulnerability to eating disorders?
Certain thinking styles
Interpersonal styles
Emotional processing
Personality traits
What thinking styles can lead to increased psychological vulnerability to eating disorders?
Cognitive rigidity
All or nothing thinking
What interpersonal styles can lead to increased psychological vulnerability to eating disorders?
Struggling to recognise cues and emotional states of others
Control issues
Managing/avoiding emotions
How can differences in emotional processing lead to increased psychological vulnerability to eating disorders?
Some will have difficulty recognising their own emotional state and expressing emotions
What personality traits can lead to increased psychological vulnerability to eating disorders?
Perfectionistic
Obsessional
What social factors can lead to increased psychological vulnerability to eating disorders?
How relationships are managed
Separation/individualisation
Where is the prevalence of eating disorders currently increasing?
Asia and Africa
What does the increasing prevalence of eating disorders in developing countries suggest?
A link to media images and globalisation
What biological effects can starvation have on the body?
Increased preoccupation with food
Agitation and restlessness
Tired, distress, and lacking in motivation
Low mood and irritability
Social withdrawal
Focus on body
Worrying about weight gain
Binging
What effects can eating disorders have on the endocrine system?
Body adjusts its free T4 levels to reduce metabolic requirement
Amenorrhoea
What term is given to the adjustment of free T4 levels as a result of eating disorders?
Sick euthyroid syndrome
What are the effects of sick euthyroid syndrome?
Reduced metabolic rate
Reduced body temperature
Bradycardia
What effects can eating disorders have on the cardiovascular system?
Myocardial thinning
Bradycardia
Hypotension
Arrhythmias
Cardiomyopathy
Mitral prolapse
Heart failure
What effects can eating disorders have on the skeletal system?
Osteopenia/osteoporosis
Fractures
Eating disorders can lead to deficiencies in what?
Electrolytes and nutrients
What effects can eating disorders have on the blood?
Bone marrow suppression
Abnormal WCC, Hb and platelets
What effects can eating disorders have on the GI system?
Delayed gut motility/delayed gastric emptying
Constipation
Mallory-Weiss tears
Hepatitis
Pancreatitis
Do people with anorexia typically appear unwell immediately?
No, can look well until their body decompensates
What is the most dangerous time for patients with anorexia?
Rapid refeeding
What effects does starvation have on blood glucose?
Decreased blood glucose
What effect does decreased blood glucose have on insulin levels?
Decreased insulin
On refeeding what happens to serum glucose and insulin levels?
Increase
What does increased insulin levels do to tissues?
Causes regeneration
What is required for regeneration of tissues?
Phosphate for cell division
What happens to serum phosphate transport during rapid refeeding?
Increased co-transport into cells
What effect does rapid refeeding have on serum phosphate?
Abrupt decrease
Why is there a rapid increase in co-transport of serum phosphate into cells upon refeeding?
Starvation causes decreased intracellular phosphate levels due to decreased oral intake
When refeeding occurs, serum phosphate levels rise and phosphate is rapidly taken up from the serum
Why do serum phosphate levels not fall during starvation?
They are maintained by homeostatic levels
Which patients are most at risk of refeeding syndrome?
Very low weight, malnourished patients
What kind of rapid refeeding carries the biggest risk?
Refeeding with food with high carbohydrate content
What effect does rapid tissue regeneration occurring as a result of refeeding have on the body?
Deficiency in trace elements
Deficiencies in which trace elements can occur as a result of rapid tissue regeneration?
Phosphate
Potassium
Magnesium
(These are the most dangerous and potentially fatal)
What can low serum phosphate result on?
Heart failure/multi-organ failure
What guidelines can be used to prevent refeeding syndrome?
MARSIPAN guidelines
What does MARSIPAN stand for?
MAnagement of Really SIck Patients with Anorexia Nervosa
What suggestions do the MARSIPAN guidelines make?
Refeeding requires specialist management
Close blood monitoring is required with daily blood tests
Oral supplements and maybe IV
What can make treatment of anorexia difficult?
Patients may not want to get better
What treatment methods does NICE recommend for anorexia nervosa?
CBT
MANTS
SSCM
What are the aims of therapy for anorexia?
Shift motivational position
Restore healthy weight
Help patients cope with life, and express themselves without resorting to dietary restrictions
Get life back on track
How does NICE recommend bulimia should be treated?
Guided self-help for milder cases
CBT
Regular eating
Binge analysis
Mood management
Improving self-esteem and resolving interpersonal issues
When may a patient with bulimia nervosa be admitted to a specialist unit?
Patient wants to change but not progressing with out patient treatment
Patient is in immediate danger
What percentage of anorexia nervosa sufferers recover completely?
30-75%
When is complete recovery most likely in sufferers of anorexia nervosa?
Within the first 3 years
When does outcome of anorexia nervosa treatment become poor?
After 10 years
What is the average yearly mortality rate of anorexia nervosa patients?
0.5%
What percentage of deaths in anorexia nervosa patients are due to suicide?
50%
What percentage of bulimia nervosa sufferers recover completely?
50-70%
What kind of course does bulimia nervosa recovery typically follow?
Relpasing and remitting
What are some predictors of good outcomes of eating disorder treatment?
Motivation to change
Short duration of illness
Low level of severity
Onset during adolescence
Good family function
Lack of co-morbid conditions
